湖北省荆州地区妊娠中期孕妇甲状腺功能调查及相关因素分析

Analysis of thyroid function and its related factors of pregnant women during the second trimester in Jingzhou district of Hubei Province

目的 调查湖北省荆州地区妊娠中期孕妇甲状腺功能水平并分析相关影响因素.方法 采用美国临床生化研究院推荐的方法,选取120例孕妇确定荆州地区妊娠中期血清促甲状腺激素(TSH)、游离甲状腺素(FT4)及游离三碘甲状腺原氨酸(FT3)的参考范围.采用2011年美国甲状腺学会(ATA)及本研究建立的参考范围诊断385例妊娠中期妇女,分别计算其甲状腺功能减退症(简称甲减)及亚临床甲减的发生率,并分析妊娠中期甲状腺功能的相关影响因素.结果 荆州地区妊娠中期特异性甲状腺功能参考范围为:TSH 0.44~4.56 mIU/L,FT33.94~6.07 pmol/L,FT47.60~13.32 pmol/L.以此为标准,荆州地区妊娠中期孕妇的甲减发生率为0.26%,亚临床甲减为1.82%,低T4血症为5.46%,TSH<0.44 mIU/L者比例为3.64%.与采用2011年ATA指南推荐妊娠中期参考范围TSH(0.2~3.0 mIU/L)为标准相比较,参照本地区妊娠中期甲状腺功能参考范围获得的甲减及亚临床甲减总发生率明显降低(2.08%比11.17%,P<0.01).Pearson相关性分析结果显示,妊娠中期孕妇FT3与孕周、妊娠年龄、胎次均呈负相关(P<0.05);FT4与孕周、妊娠年龄、TSH均呈负相关(P<0.05);TSH与妊娠年龄、FT4均呈负相关(P<0.05).多元线性回归分析结果显示,妊娠年龄及FT4是妊娠中期孕妇TSH水平的影响因素(P<0.05).结论 为准确地判断妊娠中期甲状腺功能,应建立适合本地区的妊娠中期甲状腺功能参考范围.

Objective To explore the thyroid function of pregnant women and analyze its related factors during the second trimester in Jingzhou district of Hubei Province.Methods A total of 120 pregnant women were selected according to the recommended method by American Institute of Clinical Biochemistry to determine the reference ranges of serum thyroid stimulating hormone (TSH),free thyroxine (FT4 )and free triiodothyronine (PT3 )in the second trimester of Jingzhou district.The incidences of hypothyroidism and subclinical hypothyroidism of 385 pregnant women in the second trimester were separately calculated according to the reference range from 2011 American Thyroid Association (ATA)and our study.The related factors of thyroid function during the second trimester were analyzed.Results The reference ranges of TSH,FT3 and FF4 were 0.44-4.56 mIU/L,3.94-6.07 pmol/L and 7.60-13.32 pmol/L respectively during the second trimester in Jingzhou district.According to the criteria,the incidence rates of hypothyroidism,subclinical hypothyroidism,low FT4 concentration and TSH <0.44 mIU/L were 0.26%,1.82%,5.46%and 3.64%,respectively.Compared with the reference range of the second trimester recommended by 2011 ATA guideline,the total incidence of hypothyroidism and subclinical hypothyroidism diagnosed by the local reference range was significantly decreased(2.08%vs 11.17%, P <0.01 ).Pearson correlation analysis showed that FF3 was negatively correlated with pregnancy period, gestational age and parity (P <0.05 ).FT4 was negatively correlated with pregnancy period,gestational age and TSH (P <0.05 ).TSH was negatively correlated with gestational age and FF4 (P <0.05 ). Multiple linear regression analysis showed that gestational age and PT4 were the influence factors of the TSH level during the second trimester (P <0.05 ).Conclusion It is necessary to establish the local reference range of thyroid function to correctly estimate the thyroid function during the second trimester.