正常孕妇早中晚孕期甲状腺激素参考值范围的研究

Trimester Specific Reference Data and Variation of Thyroid Hormones for Normal Pregnancy

目的建立正常孕妇孕早中晚期参考值范围。方法用化学发光免疫测定方法测定健康妊娠妇女及年龄匹配的非妊娠妇女甲状腺激素水平,其中孕早期（T1）204例,孕中期（T2）238例,孕晚期（T3）172例,非妊娠妇女193例,分别建立甲状腺激素参考值范围。结果以中位数（M）及双侧限值P2.5%~P97.5%区间的方式表示,T1、T2及T3期的T3、T4、FT4、FT3及T1、T2期的TSH不同于非妊娠妇女（P〈0.05）。T3期的TSH与对照组比较没有统计学意义（P〉0.05）。1TSH值在不同孕期间两两比较差异显著（P〈0.01）,T1期最低,随着孕周的增加,TSH水平逐渐回升,至孕晚期达到最高;2FT3值在不同孕期间两两比较差异显著（P〈0.05）,T1最高,随着孕周的增加,FT3水平逐渐降低,至T3达到最低,T1高于非妊娠妇女,T2、T3期低于非妊娠妇女（P〈0.05）;3FT4值在不同孕期间两两比较差异显著（P〈0.05）,T1期最高,随着孕周的增加,FT4水平逐渐降低,至T3期达到最低,T1、T2高于非妊娠妇女,T3期低于非妊娠妇女（P〈0.05）;4T3、T4值在不同孕期间两两比较差异不显著（P〉0.05）,不同孕期均高于非妊娠妇女（P〈0.05）。结论妊娠期血清甲状腺激素随不同孕期有明显的变化,与正常非妊娠妇女不同,建立孕期甲状腺激素参考范围有助于临床及时、准确判断孕期甲状腺疾病。

Objective To set up the trimester specific reference ranges and variation of thyroid hormones for normal pregnancy.Methods The thyroid hormones level was measured using automated chemiluminescence immunoassay for normal singleton pregnant women and age-matched non-pregnant women in iodine sufficient areas.The trimester-specific reference ranges of thyroid hormones was established with 204 cases of the early pregnancy,238 cases of the second trimester,172 cases of the third trimester,and 193 non-pregnant women.Results The reference range of each trimester hormone was calculated as median（M value） and two-sided limits（the 2.5thand 97.5thpercentile values）.Except TSH at the third trimester pregnancy,there were statistically differences with the rest thyroid hormone between all trimesters pregnancy and non pregnant women.TSH level was the lowest during the early pregnancy,the highest during the 3rd trimester.There were statistical differences of TSH level among all trimesters.FT4 level was higher during the early pregnancy than that during the 2nd and 3rd trimester（P〈0.05）.FT3 level was the highest during early pregnancy and the lowest during the 3rd trimester.There were statistical differences in FT3 level among all trimesters（P〈0.05）.T4 level was higher during the 2nd trimester than that during the 3rd trimesters（P〈0.05）.T3 level was the highest during the 2nd trimester and the lowest during 3rd trimester.There were statistical differences in TT3 level among all trimesters（P〈0.05）.Conclusion There were significant differences in the thyroid hormone level between pregnancy and non-pregnant women,and there was also the significant difference among all trimesters.Therefore,to establish trimester specific reference data of thyroid hormones during normal pregnancy may be important for clinical practice.