摘要
目的初步探讨正常孕妇妊娠早、中、晚期血清促甲状腺激素（TSH）、游离甲状腺素（FT4）水平的参考值范围。方法前瞻性、纵向序贯收集2015年1月至12月于四川大学华西第二医院进行规律产前检查并分娩的155例正常、单胎孕妇（研究组），检测其妊娠早期（妊娠9~13周＋6）、妊娠中期（妊娠24~27周＋6）、妊娠晚期（妊娠32~36周）3个时期的血清TSH、FT4水平，以同期155例育龄期非孕正常妇女为对照组，建立妊娠不同时期甲状腺功能指标的血清学参考值范围[以第2.5百分位数~第97.5百分位数（P2.5~P97.5）表示]；并收集纳入孕妇的155例新生儿的足底血标本，检测新生儿的TSH水平。结果（1）研究组参考值范围：研究组孕妇的妊娠早、中、晚期TSH水平的参考值范围分别为0.08~3.29、0.59~4.22、0.81~4.33 mU/L；FT4的参考值范围分别为11.88~20.06、9.89~15.80、9.22~15.77 pmol/L。（2）TSH水平比较：研究组孕妇妊娠早期的血清TSH水平[以第50百分位数（P50）表示]为1.35 mIU/L，低于妊娠中期（2.15 mU/L）、妊娠晚期（2.19 mU/L）及对照组（2.19 mU/L），分别比较，差异均有统计学意义（P均〈0.05）；妊娠中期与妊娠晚期、妊娠中期与对照组、妊娠晚期与对照组的TSH水平分别比较，差异均无统计学意义（P均〉0.05）。（3）FT4水平比较：研究组孕妇妊娠早期的血清FT4水平（P50）为15.16 pmol/L，高于妊娠中期（12.39 pmol/L）和妊娠晚期（12.26 pmol/L），两两比较，差异均有统计学意义（P均〈0.05），妊娠早期与对照组比较无明显差异（P〈0.05）；妊娠中期、妊娠晚期的FT4水平比较，差异无统计学意义（P〉0.05），但均低于对照组（15.64 pmol/L），分别比较，差异均有统计学意义（P均〈0.05）。（4）总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）水平比较：研究组孕妇妊娠早期血清TT3水平（2.32 nmol/L）高于对照组（1.56 nmol/L），TT4水平（154.60 nmol/L）也高于对照组（98.25 nmol/L），而FT3水平（4.70 pmol/L）低于对照组（4.84 pmol/L），分别比较，差异均有统计学意义（P均〈0.05）。（5）新生儿TSH水平：155例新生儿的TSH水平为（2.1±1.3）mU/L，均在正常值范围内。结论孕妇的血清甲状腺功能指标与非孕正常妇女存在明显差异，且妊娠不同时期的参考值不同，建立本院妊娠早、中、晚期血清甲状腺功能指标的参考值具有重要意义，可减少甲状腺疾病的漏诊及误诊。
ObjectiveTo explore the reference intervals of thyrotropin （TSH） and free thyroxine （FT4） in normal pregnant women.MethodsProspective and longitudinal sequential collection of the cases were performed. A total of 155 singleton pregnant women who had regular prenatal examination and delivery in West China Second Hospital of Sichuan University from January 2015 to December 2015 were included as the research group. Blood samples were sequentially collected from the pregnant women at the first （9-13＋6 weeks） , the second （24-27＋6 weeks） , the third （32-36 weeks） trimesters, respectively. Another 155 non-pregnant women were selected as the control group simultaneously, in an effort to establish a range of reference intervals of thyroid index in each period of pregnancy. Meanwhile, neonatal plantar blood were also collected on special filter paper and TSH levels were measured.Results（1） TSH reference intervals [percentile 2.5-percentile 97.5 （P2.5-P97.5） ] were 0.08-3.29 mU/L, 0.59-4.22 mU/L and 0.81-4.33 mU/L in three trimesters respectively. FT4 reference intervals were 11.88-20.06 pmol/L, 9.89-15.80 pmol/L and 9.22-15.77 pmol/L in three trimesters respectively. （2） The median serum TSH in the first trimester （1.35 mU/L） was lower than that in the second trimester （2.15 mU/L） , the third trimester （2.19 mU/L） , and the control group （2.19 mU/L） . The differences were all statistically significant （P〈0.05） . There was no significant difference in median serum TSH between the second trimester and the third trimester, the second trimester and the control group, and the third trimester versus the control group. （3） The median serum FT4 in the first trimester （15.16 pmol/L） was higher than that in the second trimester （12.39 pmol/L） and the third trimester （12.26 pmol/L） . The differences were both statistically significant （P〈0.05） . The median FT4 in the second trimester and the third trimester was lower than that in the control group （15.64 pmol/L） , and the differences were both statistically significant （P〈0.05） . （4） In the first trimester, the median serum total triiodothyronine （TT3） level （2.32 nmol/L） was higher than that in the control group （1.56 nmol/L） , total thyroxine （TT4） level （154.60 nmol/L） was also higher than that in the control group （98.25 nmol/L） , and free triiodothyronine （FT3） level （4.70 pmol/L） was lower than that in the control group （4.84 pmol/L） , the differences were all statistically significant （P〈0.05） . （5） The TSH levels of all neonatus were normal [ （2.1±1.3） mU/L].ConclusionsThe thyroid hormone levels between pregnant women and non-pregnant women are significantly different. Moreover, the reference intervals are vary with pregnancy period. It is important to establish the specific reference intervals of thyroid hormones in the first, second and third trimester of pregnancy specific to local region or unit.
作者
卫蔷
张力
刘兴会
普筱敏
徐怡
Wei Qiang;Zhang Li;Liu Xinghui;Pu Xiaomin;Xu Yi(Key Laboratory of Birth Defects and Women Children＇s Diseases, Ministry of Education, Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu 610041, China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2018年第5期299-303,共5页
Chinese Journal of Obstetrics and Gynecology
基金
成都市科技局科技惠民项目（2015-HM01-00397-SF）
关键词
妊娠
促甲状腺素
甲状腺素
参考值
Pregnancy
Thyrotropin
Thyroxine
Reference values
