摘要
目的 建立乌鲁木齐地区妊娠期甲状腺激素参考值范围,规范本地区妊娠期甲状腺疾病的诊断标准.评价本地区汉族妊娠妇女碘营养与甲状腺功能变化规律,为妊娠妇女科学补碘提供依据.方法 2015年5月至2016年6月在乌鲁木齐市随机抽取3 731例妊娠妇女,其中孕早期1 206例,孕中期1 125例、孕晚期1 400例,正常非妊娠妇女500例,分析各期血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）,应用尿碘砷铈催化分光光度法检测各期部分孕妇尿碘水平.结果 妊娠各期和正常非妊娠妇女血清中的FT3、FT4及TSH含量差异有统计学意义（P均＜0.05）,各组血清甲状腺浓度分别为：FT3：（4.64±1.15）、（4.36±0.89）、（3.89±0.92）、（5.24±0.65） pmol/L;FT4：（16.49±2.78）、（15.06±3.76）、（12.38±1.65）、（17.56±1.12） pmol/L;TSH：（1.98±0.65）、（2.43±0.83）、（3.15±1.25）、（2.13±0.75） mU/L.随着孕周天数的增加,血清FT3和FT4水平逐渐降低,血清TSH值逐渐升高.血清甲状腺激素在妊娠早期、中期和晚期P2.5和P97.5参考值分别为：FT3：3.24～7.58、3.16～5.47、3.05～4.28 pmol/L;FT4：13.36～22.58、12.04～ 19.77、12.78～20.03 pmol/L;TSH：0.24～3.78、0.51 ～3.91、0.55～4.55 mU/L.TGAb、TPOAb中位数在妊娠早期相对较低,中期和晚期持续增高,妊娠各期抗体水平不同,差异有统计学意义（P分别为0.07、0.04）.对照组、妊娠早期、中期及晚期的尿碘中位数分别为235.78、198.25、175.36、141.24μg/L,随着妊娠天数的增加,妊娠妇女的尿碘水平逐渐下降,差异有统计学意义（P=0.036）.血清中的TSH、FT3、FT4、TGAb和TPOAb随尿碘水平变化明显改变,但差异无统计学意义（P＞0.05）.结论 妊娠期碘营养状况与孕期密切相关,血清中的TSH异常主要分布在妊娠中晚期、FT3和FT4及甲状腺抗体异常主要分布在妊娠早期,碘缺乏则主要在妊娠晚期,建议妊娠各期实施甲状腺功能和尿碘检测.
Objective To establish reference interval of thyroid hormones in pregnant women in Urumqi,standardize the diagnostic criteria of thyroid diseases in pregnancy,assess the iodine nutrition and thyroid function at different stages of pregnancy,and provide evidence to guide iodine supplementation.Methods A cross-sectional survey was performed in 3 731 pregnant women in Urumqi from May 2015 to June 2016.1 206 of them were in the first trimester,1 125 in the second and 1 400 in the third.500 non-pregnant women were recruited as controls.Levels of serum thyrotrophin （TSH）,free triiodothyrunine （FT3）,free thyroxine （FT4）,anti-thyroid peroxidase （anti-TPO） and antithyroglobulin （anti-TG） were measured,and urinary iodine levels were detected by arsenic-cerium catalytic spectrophotometry.Results There were statistically significant differences between the pregnant groups and the control group in FT3,FT4,and TSH levels （P＜0.05）.The serum thyroid concentrations in each group were FT3 values：（4.64±1.15）,（4.36±0.89）,（3.89±0.92）,（5.24±0.65） pmol/L;FT4：（16.49±2.78）,（15.06±3.76）,（12.38± 1.65）,（17.56± 1.12） pmol/L;TSH：（1.98±0.65）,（2.43 ±0.83）,（3.15± 1.25）,（2.13 ± 0.75） mU/L.The reference intervals of thyroid hormones in early,middle and late pregnancy （P2.5 to P97.5） were：FT3：3.24-7.58,3.16-5.47,3.05-4.28 pmol/L;FT4：13.36-22.58,12.04-19.77,12.78-20.03 pmoL/L;TSH：0.24-3.78,0.51-3.91,0.55-4.55 mU/L.The medians of anti-TG and anti-TPO at different stages of pregnancy were significantly different,with the first trimester being the lowest and the third trimester being the highest （P=0.07,0.04）.The medians of urinary iodine in all four groups were 235.78 μg/L （controls）,198.25 μg/L （first trimester）,175.36 pg,/L （second trimester） and 141.24 μg/L （third trimester）,showing a significant gestational age-dependent decrease （P =0.036）.Changes in serum levels of TSH,FT3,FT4,anti-TG and anti-TPO seemed to be in accordance with changes of urinary iodine levels;yet the correlations were not statistically significant （P＞0.05）.Conclusions Iodine nutritional status was closely related to gestational age.Abnormal TSH levels were mainly observed in the second and third trimesters,abnormal serum levels of FT3,FT4,anti-TG and anti-TPO in the first trimester,and iodine deficiency in the third trimester.Thyroid function and urinary iodine should be monitored at each trimester during pregnancy.
作者
卢雪玲
阿丽娅·吉力力
王宁
Lu Xueling, A Liya Jilili, Wang Ning(Department of Endocrinology, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, Chin)
出处
《中华临床营养杂志》
CAS
CSCD
2018年第2期83-89,共7页
Chinese Journal of Clinical Nutrition
关键词
孕妇
甲状腺功能试验
参考区间
尿碘
Pregnant women
Thyroid function tests
Reference interval
Urinary iodine
