贵阳地区妊娠期妇女甲状腺激素参考区间的建立

Establishment of Reference Interval for Thyroid Hormones in Pregnant Women in Guiyang

目的建立贵阳地区妊娠期妇女各孕期甲状腺激素的参考区间,为早期诊断和治疗妊娠期甲状腺疾病提供参考依据。方法选取2019年1月到2019年12月在贵州省人民医院产科门诊进行常规孕检的妊娠妇女,按照妊娠时间分为孕早期组(T1)、孕中期组(T2)、孕晚期组(T3),同时选取进行体检的健康育龄期妇女286例作为对照组,使用化学发光法检测血清:FT3、FT4、TSH、TT3、TT4,依据美国临床生化研究院(NACB)推荐的方法,以P2.5th作为下限、P97.5th作为上限建立甲状腺激素的参考区间。结果本研究建立的参考区间分别为:(1)对照组:FT3(4.15~5.55pmol/L),FT4(11.39~15.66pmol/L),TSH(0.87~3.72m IU/L),TT3(1.36~1.83nmol L),TT4(85.69~127.44nmol/L);(2)孕早期组:FT3(3.67~5.47pmol/L),FT4(10.94~17.67pmol/L),TSH(0.20~4.07m IU/L),TT3(1.30~2.51nmol/L),TT4(72.42~148.56nmol/L);(3)孕中期组:FT3(3.34~5.27pmol/L),FT4(9.16~15.63pmol/L),TSH(0.49~4.72m IU/L),TT3(1.68~2.62nmol/L),TT4(91.83~165.63nmol/L);(4)孕晚期组:FT3(2.92~4.97pmol/L),FT4(7.57~13.16pmol/L),TSH(0.94~4.99m IU/L),TT3(1.30~2.50nmol/L),TT4(63.33~159.85nmol/L)。并绘制FT3、FT4、TSH、TT3、TT4随着孕周变化的趋势图。由趋势图可以清晰看出,不仅妊娠期妇女甲状腺激素水平与非妊娠妇女存在明显差异,而且妊娠各期之间也存在差异,妊娠期妇女甲状腺激素随孕期进展呈动态变化,具有妊娠期特异性。结论本研究建立了贵阳地区妊娠期妇女甲状腺激素的参考范围,不仅真实体现各孕期甲状腺激素水平变化,还能减少因采用成人标准而造成的漏诊,为妊娠期甲状腺疾病的正确诊断和治疗提供参考依据。

Objective Establish a reference interval for thyroid hormones of pregnant women in Guiyang area during pregnancy to provide reference for early diagnosis and treatment of thyroid diseases during pregnancy.Methods Selected pregnant women who have undergone routine pregnancy check-ups in the Obstetrics Clinic of Guizhou People’s Hospital from January 2019 to December 2019.According to the pregnancy time,they are divided into the first trimester group(T1),the second trimester group(T2),and the third trimester group(T3).At the same time,286 healthy women of childbearing age who underwent physical examination were selected as the control group,and the chemiluminescence method was used to detect serum:FT3,FT4,TSH,TT3,TT4,according to the method recommended by the American Institute of Clinical Biochemistry(NACB),with P2.5th as the lower limit,P97.5th as the upper limit to establish the reference interval of thyroid hormone.Results The reference intervals established in this study are:①Control group:FT3(4.15~5.55pmol/L),FT4(11.39~15.66pmol/L),TSH(0.87~3.72m IU/L),TT3(1.36~1.83nmol)/L),TT4(85.69~127.44nmol/L).②Early pregnancy group:FT3(3.67~5.47pmol/L),FT4(10.94~17.67pmol/L),TSH(0.20~4.07m IU/L),TT3(1.30~2.51nmol/L),TT4(72.42~148.56nmol/L).③Second trimester group:FT3(3.34~5.27pmol/L),FT4(9.16~15.63pmol/L),TSH(0.49~4.72)m IU/L),TT3(1.68~2.62nmol/L),TT4(91.83~165.63nmol/L).④The third trimester group:FT3(2.92~4.97pmol/L),FT4(7.57~13.16pmol/L),TSH(0.94~4.99m IU/L),TT3(1.30~2.50nmol/L),TT4(63.33~159.85nmol/L).And we drew the trend chart of FT3,FT4,TSH,TT3,TT4 with gestational week.From the trend chart,it can be clearly seen that there are significant differences in the thyroid hormone levels between pregnant women and nonpregnant women.There are also differences between the various stages of pregnancy.The thyroid hormones of pregnant women change dynamically with the progress of pregnancy and are specific to pregnancy.Conclusion This study has established the reference range of thyroid hormones for pregnant women in Guiyang,which not only truly reflects the changes in thyroid hormone levels during each pregnancy,but also reduces missed diagnosis due to the adoption of adult standards,which is beneficial to the correct diagnosis and treatment of thyroid diseases during pregnancy.