女性哺乳期患者血浆和乳汁中游离三碘甲酰原氨酸、游离甲状腺素、促甲状腺素的相关性

Correlation of free triiodothyronine, free thyroxine, and thyroid stimulating hormone in plasma and breast milk of lactating patients with thyroid diseases

目的：探讨甲状腺疾病患者血浆和乳汁中游离三碘甲酰原氨酸（ FT3）,游离甲状腺素（FT4）,促甲状腺激素（TSH）相互之间的关系。方法收集女性甲亢（Graves 病）患者,女性正常人（NC）和女性桥本甲状腺功能减退（HT 或甲减）患者共102例,每例患者和正常人均留取血浆和乳汁,测定 FT3、FT4、TSH 含量,并选取了甲亢和甲减患者之婴儿各11例,分别进行了哺乳和停止哺乳2个月后血液甲状腺功能 FT3、FT4、TSH 含量测定。结果（1）3组乳汁中 FT3和 FT4含量有差异[（1.48±0.81）、（7.79±3.56）和（0.77±0.42）pg/ ml；（2.94±1.43）、（14.78±7.40）和（1.51±0.40）pg/ ml,均 P＜0.05],乳汁中 TSH含量在甲亢组和正常人组间差异无统计学意义（P＞0.05）。（2）甲亢组乳汁和血浆中 FT3比值与正常人组和甲减组间有差异（0.42±0.04对0.35±0.03、0.36±0.03,P＜0.05）,FT4和 TSH 在乳汁和血浆中比值无差异（均 P＞0.05）。（3）甲亢和甲减患者之婴儿,在哺乳时期和停止哺乳2个月后,血液甲状腺功能 FT3、FT4和 TSH 含量有差异[（5.06±1.76）对（6.51±2.23）pg/ ml,（17.39±2.78）对（19.87± 3.26）pg/ ml,（1.34±1.33）对（0.74±0.78）mIU/ L；（1.43±0.74）对（1.83±0.91）pg/ ml,（4.28±1.55）对（5.00±1.75）pg/ ml,（6.48±2.70）对（5.49±2.39）mIU/ L；均 P＜0.05]。（4）各组别 FT3、FT4血浆中浓度含量与乳汁中浓度含量呈正相关（均 P＜0.05）,TSH 在甲减组呈正相关（P＜0.05）。结论血浆和乳汁中 FT3、FT4、TSH 含量存在相关性。

Objective To investigate the relationships among free triiodothyronine（ FT3 ）, free thyroxine （FT4 ）, and thyroid-stimulating hormone（ TSH） in both plasma and breast milk of patients with thyroid diseases. Methods A total of 102 female subjects with hyperthyroidism（GD）, normal thyroid function（NC）, and Hashimoto′s hypothyroidism（HT or hypothyroidism）were enrolled. Their plasma and breast milk were collected for measurement of FT3 and FT4 , and TSH. Meanwhile, 11 infants of patients with hyperthyroidism and another 11 infants of patients with hypothyroidism were selected, blood FT3 , FT4 , and TSH content were determined during lactating period and 2 months after lactation. Results （1） FT3 and FT4 contents in breast milk among 3 groups were different[（1. 48 ± 0. 81）, （7. 79 ± 3. 56）, and （0. 77 ± 0. 42）pg/ ml; （2. 94 ± 1. 43）, （14. 78 ± 7. 40）, and （1. 51 ± 0. 40）pg/ ml, P〈0. 05], TSH in breast milk was similar between hyperthyroidism and normal groups（P〉0. 05）. （2） FT3 ratio of breast milk to plasma of the hyperthyroidism group was different to other 2 groups（0. 42 ± 0. 04 vs 0. 35 ± 0. 03, 0. 36 ± 0. 03, P〈0. 05）, but no difference existed in FT4 and TSH among 3 groups（both P〉0. 05）. （3）Blood FT3 , FT4 , and TSH contents from infants of patients with hyperthyroidism and hypothyroidism were different, both during lactating period and 2 months after lactation[（5. 06 ± 1. 76）vs （6. 51 ± 2. 23）pg/ ml, （17. 39 ± 2. 78）vs （19. 87 ± 3. 26）pg/ ml, （1. 34 ± 1. 33）vs （0. 74 ± 0. 78）mIU/ L; （1. 43 ± 0. 74）vs （1. 83 ± 0. 91）pg/ ml, （4. 28 ± 1. 55）vs （5. 00 ± 1. 75）pg/ ml, （6. 48 ± 2. 70） vs （5. 49 ± 2. 39） mIU/ L; all P〈0. 05]. （4） FT3 and FT4 contents were positively correlated in plasma and breast milk（all P〈0. 05）, while TSH contents were positively correlated only in hypothyroidism group（P〈0. 05）. Conclusion FT3 , FT4 , and TSH in blood and breast milk are correlated.