正常孕妇妊娠各期甲状腺激素参考范围的建立及其临床意义

Establishment and clinical significance of the reference range of thyroid hormone during different normal pregnancy

目的建立本地区正常孕妇早、中、晚孕期甲状腺激素的参考值范围，探讨其变化规律及临床意义。方法采用罗氏E601电化学发光仪测定本地区单胎妊娠健康妇女早、中、晚孕期及年龄匹配非妊娠妇女的甲状腺激素水平并建立各自的参考范围。其中孕早期448例，孕中期451例，孕晚期428例，非妊娠妇女150例。结果早、中、晚孕妇女及非妊娠妇女的甲状腺激素水平均呈偏态分布，以中位数（M）及双侧限值（P2．5～P97．5）表示其参考范围。TSH在早[1．10（0．23～3．58）]、中[2．07（0．13～3．96）]、晚孕期[2．62（1．08～3．62）]逐渐上升，各期两两比较差异有统计学意义（P〈0．017），晚孕期略低于非妊娠妇女[2．63（1．00～5．14）】但差异无统计学意义（P〉0．05）。FT3和FT4在早[4．80（4．25～6．23）；17．56（11．65－22．16）]、中[4．45（3．84～5．18）；14．16（9．49～20．14）]、晚孕期[4．14（3．98～4．45）；12．38（10．13～15．88）]逐渐降低，各期两两比饺差异有统计学意义（P〈0．017），早孕期低于非妊娠妇女[5．01（4．02~6．12）；18．71（14．35－21．69）]且差异有统计学意义（P〈0．05）。结论正常孕妇的甲状腺激素水平明显不同非妊娠妇女，早、中、晚孕期之间也存在显著差异，建立正常孕妇妊娠各期甲状腺激素参考范围将有助于妊娠期甲状腺功能紊乱的临床诊疗。

Objective To establish and estimate the clinical significance of the reference ranges of thyroid hormone during different normal pregnancy. Methods The thyroid hormone levels were determined by automatic Roche Elecsys E601 from 448 cases of the early pregnancy, 451 cases of the second trimester, 428 cases of the third trimester, and 150 non-pregnant women. The reference ranges of thyroid hormone during different normal pregnancy were established by statistical methods. Results The thyroid hormone levels of different normal pregnancy and non-pregnant women all showed obvious skew distribution, so the reference ranges of thyroid hormone were calculated as median （M value） and two-sided limits （the 2.5th and 97.5th percentile values）. TSH level was increasing gradually during the normal pregnancy. There were statistically significant differences in TSH level among all trimesters （P〈0.017）. TSH level of the third trimester was slightly lower than that of non-pregnant women without statistical difference （P〉0.05）. FT3 and FT4 levels were decreasing gradually during the normal pregnancy. There were statistically significant differences in FT3 and FT4 levels among all trimesters （P〈0.017）. FT3 and FT4 levels of the early pregnancy were sharply lower than that of non-pregnant women with statistical difference （P〈0.05）. Conclusion The thyroid hormone levels of normal pregnant women were different from those of non-pregnant women, and the levels showed significant deviation during different normal pregnancy. Therefore, to establish trimester-specific reference ranges of thyroid hormones during normal pregnancy may be important for clinical practice.