深圳地区孕期妇女甲状腺功能指标参考区间的初步调查

Reference interval in preliminary investigation of maternal thyroid function during pregnancy in Shenzhen China

目的：探讨深圳地区孕早、中、晚期妇女甲状腺功能指标分布特征，建立深圳地区孕期妇女甲状腺功能指标的参考范围。方法选择2012年12月至2013年6月就诊于深圳市人民医院的334名健康孕早期妇女、272名健康孕中期妇女、271名健康孕晚期妇女以及77名非孕期妇女。检测4组人群甲状腺功能指标水平，包括游离三碘甲状腺原氨酸（ FT3）、游离甲状腺素（ FT4）、促甲状腺素（ TSH）、三碘甲状腺原氨酸（ TT3）、甲状腺素（ TT4），建立孕早、中、晚期甲状腺功能指标的参考区间。结果 TSH在孕早期开始下降，孕中期开始逐渐回升，孕早、中、晚期的TSH参考值范围分别为0．08～4．39、0．41～4．16、0．30～5．46 mIU/L；FT4在孕中期开始逐渐下降，孕早、中、晚期的FT4参考值范围分别为7．74～14．58、6．81～12．00、6．36～10．99 pmol/L； FT3在孕早期稍有上升，后逐渐下降，孕早、中、晚期的FT3参考值范围分别为3．59～5．59、3．34～4．91、3．09～4．58 pmol/L。结论深圳地区孕期妇女甲状腺功能指标与健康对照组妇女相比差异有统计学意义，建立深圳地区孕早、中、晚期妇女甲状腺功能指标的参考区间有重要临床意义。

Objective To explore the thyroid function distribution of different trimesters among normal pregnant women and establish the reference interval for maternal thyroid function during pregnancy in Shenzhen, China.Methods A prospective study was conducted for healthy pregnant women in first trimester （n=334）, second trimester （n=272）, third trimester （n=271） and non-pregnant controls （n=77） from December 2012 to June 2013 at our hospital.Free triiodothyronine （FT3）, free thyroxine （FT4）, thyroid stimulating hormone （ TSH ） , triiodothyronine （ TT3 ） and thyroxine （ T4 ） of four groups were measured and analyzed.And the reference intervals for different trimesters were established.Results TSH declined in the first trimester and then rose in the second trimester.The reference ranges of TSH for early, middle and late pregnancy were 0.08-4.39, 0.41-4.16 and 0.30-5.46 mIU/L respectively.FT4 and healthy control groups showed no significant difference in the first trimester.But it declined in the second trimester.The reference ranges of FT4 for early, middle and late pregnancy were 7.74 -14.58, 6.81 -12.00 and 6.36 -10.99 pmol/L respectively.FT3 rose slightly in the first trimester and then gradually decreased.The reference ranges of FT3 for early, middle and late pregnancy were 3.59-5.59, 3.34 -4.91 and 3.09 -4.58 pmol/L respectively.Conclusions As compared with healthy control women in Shenzhen, thyroid function indicators of pregnant women show statistically significant differences.And the establishment of indicators of women′s thyroid function reference intervals for different trimesters has important clinical significance in Shenzhen.