妊娠前半期甲状腺激素参考值范围的研究

Reference ranges for thyroid hormones during the first half of pregnancy

目的 建立妊娠前半期甲状腺激素参考值范围,为诊断、治疗孕妇甲状腺疾病提供参考。方法 调查541例产科门诊就诊、进行甲状腺激素检查的健康孕妇,记录其甲状腺激素和甲状腺相关抗体检测结果;收集429例妊娠前半期正常孕妇甲状腺激素、尿碘,建立甲状腺激素参考值范围。参考值范围采用中位数（P50）及双侧限值（P2.5和P97.5）表示。结果 妊娠前半期FT3、FT4和TSH中位数分别为4.72 pmol/L、15.61 pmol/L和1.63uIU/ml,参考值范围分别为3.53-6.68 pmol/L、11.15-22.81 pmol/L和0.09-5.06 uIU/ml。13-20周与0-12周比较FT3和FT4差异均有统计学意义（P〈0.01）,TSH和尿碘差异均差异无统计学意义（P〉0.05）。结论 建立妊娠前半期甲状腺激素参考值范围具有重要的临床意义。

[ Objective ] To set up the specific reference ranges of thyroid hormones for normal pregnant women in the first half of pregnancy and provide reference criteria for diagnosis, treatment of thyroid disease. [Methods] A total of 541 normal pregnant women were investigated, and thyroid hormones and urine iodine levels were recorded; 429 normal pregnant women in the first half of pregnancy were selected for establishing specific reference ranges of thyroid hormones after rigorous screening through the survey questionnaire and laboratory tests. The reference range of each hormone was calculated as median （the 50th percentile value） and two sided limits （the 2.5th and 97.5th percentile values）. [Results] The median of FT3, FT4 and TSH was 4.72 pmol/L, 15.61 pmol/L and 1.63 uIU/ml respectively. The reference ranges of FT3, FT4 and TSH was 3.53-6.68 pmol/L, 11.15-22.81 pmol/L and 0.09-5.06 ulU/ml respectively. The serum levels of FT3 and FW4 were significantly different between 13-20 week and 0-12 week （P 〈 0.01）, but the serum levels of TSH and urine iodine were not significantly different （P 〉 0.05）. [Conclusions ] The thyroid hormone levels during the first half of pregnancy completely differ from those of the non-pregnant individuals. Therefore, to establish specific reference data of thyroid hormones during the first half of pregnancy may be important for clinical practice.