妊娠期特异性甲状腺功能正常参考值范围

Trimester-specific Reference Ranges for Thyroid Tests in Pregnant Women

[目的]建立中山大学孙逸仙纪念医院妊娠期特异性甲状腺功能正常参考值范围.[方法]对2010年3月至2012年12月在中山大学孙逸仙纪念医院产检的2 120例孕妇进行甲状腺功能的检查,包括TT4、FT4、TSH、TPOAb,并随访其妊娠结局.根据美国国家生化研究院推荐的标准,并结合妊娠结局,筛选出“正常孕妇”751例：早孕133例,中孕388例,晚孕230例.对其进行统计分析得到TT4、FT4、TSH的正常参考值范围. [结果]TT4、FT4服从或经对数转换后服从正态分布,TSH不服从正态分布.“正常孕妇”早、中、晚孕期TT4均数分别为：132.56、137.38、128.70 nmol/L,双侧95％参考值范围分别为74.53 ～ 190.59、87.03～187.73、78.46～179.04 nmol/L.早、中、晚孕期FT4均数分别为16.14、13.60、12.03 pmol/L,双侧95％参考值范围分别为11.22 ～ 21.06、9.92～17.28、9.03 ～ 15.03 pmol/L.早、中、晚孕期TSH中位数分别为1.030、1.415、1.550 mU/L;P2.5～P97.5分别为0.037 ～ 3.181、0.146 ～ 3.830、0.355 ～ 3.623 mU/L.[结论]妊娠期甲状腺功能与非孕期有较大差异,结合妊娠结局选择正常孕妇来建立妊娠期正常参考值范围,在理论上来说可能更合理.

[Objective] To establish the reference ranges of thyroid tests during pregnancy of Sun Yat-sen Memorial Hospital,Sun Yat-sen University.[Methods] A total of 2 120 pregnancy women who have took prenatal care in our hospital were recruited from Mar.2010 ～ Dec.2012.All women were individually screened and excluded according to the NACB recommendations and other including or excluding criteria regarding thyroidal and pregnancy outcomes.Finally,seven hundred and fifty-one women at different stages of gestation were selected for setting reference intervals.There are 133 women for the first trimester,388 for the second and 230 for the third.The thyroid tests include TT4,FT4,TSH,and TPOAb.[Results] （1） Based on normal distribution,the mean for TT4 was 132.56 nmol/L for the first trimester,137.38 nmol/L for the second and 128.70 nmol/L for the third,two-sided 95% reference ranges of TT4 were estimated as 74.53 ～ 190.59,87.03 ～ 187.73,and 78.46 ～ 179.04 nmol/L separately.（2） After log-transformation,the distribution of FT4 was conformed to normal distribution.The mean of FT4 for the first,second and the third trimester were 16.14,13.60,and 12.03 pmol/L separately,two-sided 95% reference values of FT4 were 11.22 ～ 21.06,9.92 ～ 17.28,and 9.03 ～ 15.03 pmol/L separately.（3） After log-transformation,the distribution of TSH was conformed to non-normal distribution.The median for TSH is 1.030 mU/L for the first trimester,1.415 for the second and 1.550 for the third trimester.Based on non-normal distribution,the percentile of the 2.5 to the 97.5 reference ranges of TSH was on behalf of two-sided 95% reference values of TSH.There were 0.037～3.181,0.146 ～ 3.830,0.355 ～ 3.623 mU/L,separately.[Conclusion] Combined with the pregnancy outcomes and using a more rigorous screening criteria for establishing the reference rages is more credible in theory.And there are significant differences between pregnant women and the non-pregnant women.