妊娠女性血清甲状腺功能指标参考值的建立

Investigation of reference range for serum thyroid function of pregnant women

目的探讨建立该院妊娠各期血清甲状腺功能指标的参考范围。方法该院接受孕期检查的1 357例妊娠女性纳入研究组,其中妊娠早期171例,妊娠中期680例,妊娠晚期506例,健康非妊娠育龄女性182例纳入对照组,采用化学发光免疫法测定血清促甲状腺激素（TSH）、游离甲状腺素（FT4）、抗甲状腺过氧化物酶抗体（TPOAb）、抗甲状腺球蛋白抗体（TgAb）、促甲状腺激素受体抗体（TRAb）水平,应用美国临床生化研究院（NACB）推荐的方法,初步检测出该院妊娠各期血清FT4、TSH的范围。结果血清FT4在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为11.97~22.09、9.79~17.29、9.53~16.85pmol/L;血清TSH在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为0.03~5.07、0.64~5.33、0.61~5.62mIU/L。以该参考值为标准,妊娠期临床甲状腺功能减退症（简称甲减）发病率为0.28%,亚临床甲减发病率为2.28%,临床甲状腺功能亢进症（简称甲亢）发病率为0.29%,亚临床甲亢发病率为2.28%,单纯性低甲状腺素血症的发病率为4.64%。结论妊娠各期血清甲状腺激素水平正常范围的制定有利于妊娠期甲状腺疾病的诊断和治疗。

Objective To investigate and establish the reference range for serum thyroid function index during three-trimester pregnancy in Nanjing Maternity and Child Health Care Hospital.Methods A total of 1 357 healthy pregnant women who were examined in our hospital were selected as study group based on enrollment guidelines,including 171 first trimester pregnant women,680 second trimester pregnant women and 506 third trimester pregnant women.Another 182 healthy women without pregnancy were recruited as control group.Serum levels of thyroid stimulating hormone（TSH）,free thyroxine（FT4）,thyroglobulin antibody（TgAb）,thyroid peroxidase antibody（TPOAb）,thyrotropin receptor antibody（TRAb）were detected by using chemiluminescence immunoassay method.The euthyroid reference range of serum FT4 and TSH in different trimesters of pregnancy were established based on the standard of the United States National Academy of Clinical Biochemistry（NACB）guidelines.Results The range of serum FT4 levels in the first,second and third trimester of pregnancy were 11.97-22.09,9.79-17.29,9.53-16.85pmol/L respectively.The range of serum TSH levels in the three trimesters were 0.03-5.07,0.64-5.33,0.61-5.62mIU/L respectively.According to the standard of the reference range,the gestational hypothyroidism prevalence rate was 0.28%,subclinical hypothyroidism prevalence rate was 2.28%,the gestational hyperthyroidism prevalence rate was 0.29%,subclinical hyperthyroidism prevalence rate was 2.28%,simple hypothyroxinemia prevalence rate was 4.64%.Conclusion Establishment of normal reference range of thyroid hormones for pregnant women is benefit for the diagnosis and treatment of thyroid disease in pregnancy.