宁波正常孕妇妊娠期甲状腺功能参考值范围探讨与应用(1)
[摘要] 目的 探討宁波地区女性妊娠后各期甲状腺功能特异性血清检测指标的正常参考值范围，比较本文建立的参考值范围与ATA推荐2017指南参考值范围对孕期甲状腺功能异常检出的差异。 方法 选取2017年1～10月本院产科门诊例行产检的单胎健康妊娠妇女 841 例作为研究组，同期孕前检查的172 例非妊娠期妇女作为对照组，根据美国国家临床生化研究院(NACB)指南的推荐，电化学发光法测定受试者血清中TSH、FT4、FT3、TT3、TT4、抗甲状腺球蛋白抗体(Tg Ab)和抗甲状腺过氧化物酶抗体(TPOAb)水平。 结果 妊娠早期(T1)血清中甲状腺各指标中位数及95%参考范围FT3为3.03(2.30～3.91)pg/mL，FT4为0.75(0.51～1.12)ng/dL，TT3为1.25(0.82～1.89)ng/mL，TT4为8.62(5.41～12.36)μg/dL，TSH为1.68(0.17～4.09)mIU/L，妊娠中期(T2)血清中甲状腺各指标中位数及95%参考范围FT3 为2.94(2.30～3.52)pg/mL，FT4为0.69(0.49～1.02)ng/dL，TT3为1.30(0.89～1.87)ng/mL，TT4为8.79(5.22～12.54)μg/dL，TSH为1.99(0.14～4.80)mIU/L，妊娠晚期(T3)血清中甲状腺各指标中位数及95%参考范围 FT3为 2.68(2.10～3.34)pg/mL，FT4：为0.44(0.24～0.87)ng/dL，TT3为1.14(0.75～1.55)ng/mL，TT4为7.94(4.56～11.54)μg/dL，TSH为2.58(0.46～4.46)mIU/L。血清结合球蛋白抗体(TgAb)及血清抗甲状腺过氧化物酶抗体(TPOAb)整个孕期变化比较，差异无统计学意义，ATA推荐标准与本研究新建立的标准，对1330例产检的孕妇进行筛查，甲状腺功能异常检出例数与(检出率)分别为：亚临床甲状腺功能减退68(5.1%)&74(5.6%)，甲状腺功能减退13(0.9%)&23(1.7%)，亚临床甲状腺功能亢进症11(0.8%)&14(1.0%)，甲状腺功能亢进症5(0.4%)& 5(0.4%)，低甲状腺素血症79(5.9%)&72(5.4%)。 结论 ①正常妊娠女性甲状腺功能指标随孕周增加变化，TSH值表现为早孕期降低，中孕期回升，到孕晚期升到最高的变化趋势，FT4、FT3则表现为孕早期升高，中孕期降低至孕晚期最低；②本研究得出的参考值范围对于甲状腺功能异常的检出率与ATA指南的参考值范围有出入；③宁波地区妊娠妇女的血清甲状腺激素水平具备地域上的特异性，制定本地区的妊娠期特异参考值范围很有必要。
[关键词] 妊娠；参考范围；促甲状腺激素；甲状腺素
[中图分类号] R714.2 [文献标识码] B [文章编号] 1673-9701(2018)09-0056-06
Discussion and application of reference value range of thyroid function during pregnancy in normal pregnant women in Ningbo
CAI Hairui SHU Libo LI Dongmei CHEN An'er
Department of Obstetrics， Ningbo Women and Children's Hospital， Ningbo 315010， China
[Abstract] Objective To investigate the normal reference value range of thyroid function-specific serum testing indices in each stage of pregnancy in Ningbo women， and to compare the difference between the reference range established in this article and the reference range recommended by ATA in 2017 guidelines for detecting thyroid dysfunction during pregnancy. Methods A total of 841 healthy pregnant women with single birth who were given antenatal care in the outpatient clinic of obstetrics in our hospital were selected as the research group from January 2017 to October 2017. The 172 non-pregnant women who were given antenatal care during the same period were selected as the control group. According to the recommendations from the guidelines of the National Association of Clinical Biochemistry(NACB)， the levels of TSH， FT4， FT3， TT3， TT4， anti-thyroglobulin antibody (Tg Ab) and anti-thyroid peroxidase antibody (TPOAb) were measured by electrochemiluminescence in the serum of the subjects. Results The median thyroid indices in the serum in the first stage of pregnancy (T1) and the 95% reference range of FT3 were 3.03(2.30-3.91)pg/mL， FT4 was 0.75 (0.51-1.12)ng/dL， TT3 was 1.25(0.82-1.89)ng/mL， TT4 was 8.62 (5.41-12.36) μg/dL， TSH was 1.68 (0.17-4.09)mIU/L. The median thyroid indices in the serum in the second stage of pregnancy (T2) and the 95% reference range of FT3 were 2.94(2.30-3.52) pg/mL， FT4 was 0.69(0.49-1.02) ng/dL， TT3 was 1.30 (0.89-1.87)ng/mL， TT4 was 8.79(5.22-12.54)μg/dL， and TSH was 1.99(0.14-4.80)mIU/L. The median thyroid indices in the serum in the third stage of pregnancy(T3) and the 95% reference range of FT3 were 2.68(2.10-3.34) pg/mL， FT4 was 0.44 (0.24-0.87)ng/dL， TT3 was 1.14(0.75-1.55)ng/mL， TT4 was 7.94(4.56-11.54)μg/dL， and TSH was 2.58 (0.46-4.46)mIU/L. There was no statistical significance in the changes of serum-binding globulin antibody (TgAb) and serum anti-thyroid peroxidase antibody (TPOAb) during the entire pregnancy. According to the ATA recommended standards and the newly established standards of this study，1330 pregnant women were given screening. The number of cases of detected thyroid dysfunction(detection rate) were： subclinical hypothyroidism in 68 cases (5.1%) & 74 (5.6%)， hypothyroidism in 13 cases (0.9%) & 23(1.7%)，subclinical hyperthyroidism in 11 cases(0.8%) & 14(1.0%)， hyperthyroidism in 5 cases (0.4%) & 5(0.4%)， and hypothyroxinemia in 79 cases(5.9%) & 72(5.4%). Conclusion ①The index of thyroid function in normal pregnant women changes with gestational age. The TSH value shows the trend of decreasing in early pregnancy， rising in middLe pregnancy and then rising to the highest in late pregnancy. FT4 and FT3 showed an increase in early pregnancy， lower in middLe pregnancy and lowest in late pregnancy.②The reference value range of this study is different from the reference value range in ATA guidelines for the detection rate of thyroid dysfunction. ③The level of serum thyroid hormone in pregnant women in Ningbo is geographically specific. It is necessary to develop a range of specific reference values for pregnancy in this region., http://www.100md.com(蔡海瑞 舒立波 李冬梅)
[关键词] 妊娠；参考范围；促甲状腺激素；甲状腺素
[中图分类号] R714.2 [文献标识码] B [文章编号] 1673-9701(2018)09-0056-06
Discussion and application of reference value range of thyroid function during pregnancy in normal pregnant women in Ningbo
CAI Hairui SHU Libo LI Dongmei CHEN An'er
Department of Obstetrics， Ningbo Women and Children's Hospital， Ningbo 315010， China
[Abstract] Objective To investigate the normal reference value range of thyroid function-specific serum testing indices in each stage of pregnancy in Ningbo women， and to compare the difference between the reference range established in this article and the reference range recommended by ATA in 2017 guidelines for detecting thyroid dysfunction during pregnancy. Methods A total of 841 healthy pregnant women with single birth who were given antenatal care in the outpatient clinic of obstetrics in our hospital were selected as the research group from January 2017 to October 2017. The 172 non-pregnant women who were given antenatal care during the same period were selected as the control group. According to the recommendations from the guidelines of the National Association of Clinical Biochemistry(NACB)， the levels of TSH， FT4， FT3， TT3， TT4， anti-thyroglobulin antibody (Tg Ab) and anti-thyroid peroxidase antibody (TPOAb) were measured by electrochemiluminescence in the serum of the subjects. Results The median thyroid indices in the serum in the first stage of pregnancy (T1) and the 95% reference range of FT3 were 3.03(2.30-3.91)pg/mL， FT4 was 0.75 (0.51-1.12)ng/dL， TT3 was 1.25(0.82-1.89)ng/mL， TT4 was 8.62 (5.41-12.36) μg/dL， TSH was 1.68 (0.17-4.09)mIU/L. The median thyroid indices in the serum in the second stage of pregnancy (T2) and the 95% reference range of FT3 were 2.94(2.30-3.52) pg/mL， FT4 was 0.69(0.49-1.02) ng/dL， TT3 was 1.30 (0.89-1.87)ng/mL， TT4 was 8.79(5.22-12.54)μg/dL， and TSH was 1.99(0.14-4.80)mIU/L. The median thyroid indices in the serum in the third stage of pregnancy(T3) and the 95% reference range of FT3 were 2.68(2.10-3.34) pg/mL， FT4 was 0.44 (0.24-0.87)ng/dL， TT3 was 1.14(0.75-1.55)ng/mL， TT4 was 7.94(4.56-11.54)μg/dL， and TSH was 2.58 (0.46-4.46)mIU/L. There was no statistical significance in the changes of serum-binding globulin antibody (TgAb) and serum anti-thyroid peroxidase antibody (TPOAb) during the entire pregnancy. According to the ATA recommended standards and the newly established standards of this study，1330 pregnant women were given screening. The number of cases of detected thyroid dysfunction(detection rate) were： subclinical hypothyroidism in 68 cases (5.1%) & 74 (5.6%)， hypothyroidism in 13 cases (0.9%) & 23(1.7%)，subclinical hyperthyroidism in 11 cases(0.8%) & 14(1.0%)， hyperthyroidism in 5 cases (0.4%) & 5(0.4%)， and hypothyroxinemia in 79 cases(5.9%) & 72(5.4%). Conclusion ①The index of thyroid function in normal pregnant women changes with gestational age. The TSH value shows the trend of decreasing in early pregnancy， rising in middLe pregnancy and then rising to the highest in late pregnancy. FT4 and FT3 showed an increase in early pregnancy， lower in middLe pregnancy and lowest in late pregnancy.②The reference value range of this study is different from the reference value range in ATA guidelines for the detection rate of thyroid dysfunction. ③The level of serum thyroid hormone in pregnant women in Ningbo is geographically specific. It is necessary to develop a range of specific reference values for pregnancy in this region., http://www.100md.com(蔡海瑞 舒立波 李冬梅)