碘充足地区血清TSH正常值范围及其影响因素的流行病学研究

The reference range of serum thyrotropin in iodine-sufficient areas ： An epidemiological study

目的分析血清TSH测定的影响因素，参考美国国家临床生化协会（NACB）指南，建立中国辽宁碘充足地区血清TSH的正常参考范围。方法2007年，来自辽宁省3个碘充足地区的5348人参加了甲状腺疾病的社区调查，进行了TSH、甲状腺自身抗体[甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）]的测定，并作了甲状腺超声检查和问卷调查。结果正常人群的TSH分布向右偏斜，接近于对数正态分布。年龄在12-19岁血清TSH水平明显高于其他年龄段（P〈0．01），而其他年龄段之间尤统计学差异。血清TSH水平女性[（1．68±1．90）mIU／L]明显高于男性[（1．45±1．92）mIU／L，P〈0．01]。因此，年龄大于20岁的健康男性TSH的分布范围是0．43～4．74mlU／L，健康女性TSH的分布范围是0．48～5．39mlU／L。甲状腺疾病家族史、甲状腺超声异常、甲状腺抗体阳性均影响TSH的测定水平，非甲状腺疾病对TSH参考范围没有显著影响。结论建立了碘充足地区血清TSH参考范围。

Objective To verify the criteria proposed by National Academy of Clinical Biochemistry （NACB） guidelines in investigating the factors that affect serum TSH determination, and to determine the reference range of serum TSH in iodine-sufficient areas of China. Methods In 2007, 5 348 inhabitants were enrolled from 3 iodine-sufficient areas of Liaoning Province, and were asked to fulfill the questionnaire. Serum TSH, thyroid peroxidase antibody（ TPOAb）, and thyroglobulin antibody（TgAb） were determined, and thyroid uhrasonography was carried out. Results The distribution of TSH levels was skewed in healthy people and closely fit the curve of Gaussian distribution after logarithmic transformation. The levels of TSH in subjects of 12-19 years of age were significantly higher than those of other age groups（ P〈0. 01 ） , and no significant difference was found among the latter groups. TSH level in females [ （ 1.68±1.90 ）mIU/L] was higher than in males[ （ 1.45± 1.92 ） mIU/L, P〈0. 011] The reference range of TSH was 0.43-4. 74 mlU/L in males, and 0. 48-5.39 mIU/L in females. Family history of thyroid disease, abnormal thyroid uhrasonography, and positive thyroid antibodies were the factors that influenced TSH level. Conclusion The reference range of serum TSH in iodine-sufficient areas of China is established.