摘要
目的 建立妊娠后半期（20~40孕周）特异性甲状腺功能参考值，并比较这一参考值与非孕期参考值对诊断妊娠期甲状腺疾病的影响，同时分析孕妇年龄和甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）水平与妊娠后半期甲状腺疾病发病率的关系。方法2011年7月至2013年8月在南京医科大学第一附属医院产科门诊常规检查的20~40孕周的孕妇，共4 729例。测定这些孕妇的促甲状腺激素（thyroid stimulating hormone，TSH）、游离甲状腺素（free thyroxine，FT4）、TPOAb以及尿碘水平。根据美国国家临床生化研究院（National Academy of Clinical Biochemistry，NACB）推荐的方法，选择2 568例妊娠后半期孕妇，根据孕周分为≥20~〈24孕周组（682例）、≥24~〈28孕周组（1 322例）、≥28~〈32孕周组（178例）、≥32~〈36孕周组（185例）和≥36~≤40孕周组（201例）。比较妊娠后半期不同孕周甲状腺功能参考值，建立本实验室妊娠后半期特异性甲状腺功能参考值范围。在此基础上，比较非孕期及妊娠后半期特异性甲状腺功能参考值对妊娠后半期孕妇甲状腺疾病的诊断结果，分析年龄和TPOAb阳性对妊娠期甲状腺疾病发病率的影响。采用非参数检验、方差分析或χ^2检验，对数据进行统计学分析。结果（1）本研究建立了本单位妊娠后半期特异性甲状腺功能参考值范围，即TSH为0.65~5.27 mU/L，FT4为8.74~14.84 pmol/L。（2）分别采用本研究建立的妊娠后半期参考值与非孕期参考值（TSH：0.27~4.20 mU/L，FT4：12.00~22.00 pmol/L）对4 729例孕妇的甲状腺功能进行诊断发现，如采用非孕期参考值范围，诊断为甲状腺疾病的比例将明显高于本研究建立的妊娠后半期参考值[64.0%（3 025/4 729）与16.1%（763/4 729），χ^2=47.465，P〈0.01]，表现为临床甲状腺功能减退和单纯性低甲状腺素血症的发病率升高[5.4%（255/4 729）与0.4%（20/4 729），χ^2=14.321；54.1%（2 560/4 729）与9.1%（429/4 729），χ^2=47.108；P值均〈0.01]，亚临床和临床甲状腺功能亢进的发病率降低[1.2%（58/4 729）与3.3%（155/4 729），χ^2=6.650；0.3%（13/4 729）与0.6%（27/4 729），χ^2=2.062；P值均〈0.05]。（3）年龄〉30岁孕妇的临床甲状腺功能减退和单纯性低甲状腺素血症的发病率均高于年龄≤30岁者[0.7%（10/1 377）与0.3%（10/3 352），χ^2=4.257；11.7%（161/1 377）与8.0%（268/3 352），χ^2=16.102；P值均〈0.05]。血清TPOAb阳性孕妇临床甲状腺功能减退和临床甲状腺功能亢进的发病率均高于TPOAb阴性者[2.7%（9/335）与0.3%（11/4 394），χ^2=44.009；3.9%（13/335）与1.2%（52/4 394），χ^2=16.784；P值均〈0.01]。结论采用妊娠特异性甲状腺功能指标的参考值，可减少妊娠期甲状腺疾病的误诊和漏诊。孕妇年龄〉30岁和血清TPOAb阳性，均可增加妊娠期甲状腺疾病的发病风险。
Objective To determine the reference intervals for thyroid function tests during the second half of pregnancy （20-40 gestational weeks）, and to assess the relationship between thyroid peroxidase antibody （TPOAb） levels and the incidence of gestational thyroid diseases. Methods Levels of thyroid stimulating hormone （TSH）, free thyroxine （FT4）, TPOAb and urinary iodine excretion were determined in 4 729 pregnant women, who received prenatal health care at First Affiliated Hospital of Nanjing Medical University from July 2011 to August 2013. Among these women, 2 568 were selected using the recommendations of the American National Academy of Clinical Biochemistry, and were divided into five groups according to their gestational age： ≥20 to 〈24 weeks （682 cases）, ≥24 to 〈28 weeks （1 322 cases）, ≥28 to 〈32 weeks （178 cases）, ≥32 to 〈36 weeks （185 cases） and ≥36 to≤40 weeks （201 cases）. Reference intervals of thyroid function tests in the second half of pregnancy were calculated. The reference values of thyroid functions in different gestational weeks were compared, and the reference intervals of thyroid functions in the second half of pregnancy were determined. The effects of maternal age and positive TPOAb on gestational thyroid diseases were analyzed. A non-parametric test, analysis of variance or Chi-square test was used for statistical analysis.Results （1） Reference intervals for maternal thyroid function in the second half of pregnancy in our hospital were established [TSH： 0.65-5.27 mU/L and FT4： 8.74-14.84 pmol/L]. （2） The percentage of thyroid diseases was higher using the non-pregnancy reference intervals （TSH： 0.27-4.20 mU/L and FT4： 12.00-22.00 pmol/L） than using the pregnancy reference intervals [64.0% （3 025/4 729） vs 16.1% （763/4 729）, χ^2=47.465, P〈0.01], which manifested as a higher rate of clinical hypothyroidism and simple hypothyroxinemia [5.4% （255/4 729） vs 0.4% （20/4 729）, χ^2=14.321; 54.1% （2 560/4 729） vs 9.1% （429/4 729）, χ^2=47.108; both P〈0.01] and a lower rate of subclinical and clinical hyperthyroidism [1.2% （58/4 729） vs 3.3% （155/4 729）, χ^2=6.650; 0.3% （13/4 729）vs 0.6% （27/4 729）, χ^2=2.062; both P〈0.05]. （3） The incidence of clinical hypothyroidism and simple hypothyroxinemia in pregnant women aged 〉30 years was higher than in those aged ≤30 years [0.7% （10/1 377） vs 0.3% （10/3 352）, χ^2=4.257; 11.7% （161/1 377） vs 8.0% （268/3 352）, χ^2=16.102; both P〈0.05]. The incidence of clinical hypothyroidism and clinical hyperthyroidism in TPOAb positive women was higher than that in TPOAb negative women [2.7% （9/335） vs 0.3% （11/4 394）, χ^2=44.009; 3.9% （13/335） vs 1.2% （52/4 394）, χ^2=16.784; both P〈0.01].Conclusions The established pregnancy-specific reference ranges of thyroid function tests can reduce the missed diagnosis and misdiagnosis of gestational thyroid diseases. Maternal age 〉30 years and positive TPOAb may increase the risk of gestational thyroid diseases.
出处
《中华围产医学杂志》
CAS
CSCD
2016年第12期914-919,共6页
Chinese Journal of Perinatal Medicine
