正常孕妇不同孕期甲状腺激素参考值范围的建立及其临床意义

Establishment and Clinical Significance of the Reference Range of Thyroid Hormone During Different Gestation Periods Among Normal Pregnant Women

目的:对本院早、中、晚孕期的正常孕妇进行甲状腺激素检测并分析,建立佛山地区孕妇的甲状腺激素各项指标的界定值,并为妊娠期妇女不同时期的甲状腺激素提供临床检测依据,指导优生优育。方法:选取来本院检测的本地区单胎健康孕妇共1182例为研究组,分为妊娠早、中、晚孕期三部分,其中含孕早期468例、孕中期412例以及孕晚期302例;另外选取本院体检的健康非妊娠女性共150例为对照组,分别检测两组的甲状腺激素水平,分析并建立早、中、晚孕期及正常女性的甲状腺激素水平界定值(采用中位数M与双侧极限值P_(2.5)~P_(97.5)来表示),比较研究组早、中、晚孕期甲状腺激素水平的差异以及研究组与对照组的差异。结果:(1)研究组孕早期妇女的TSH水平为1.12(0.26~3.72)m IU/L,孕中期妇女的TSH水平为2.10(1.13~3.98)m IU/L,孕晚期妇女的TSH水平为2.68(1.36~4.25)m IU/L,早、中、晚孕期妇女的TSH水平两两比较,差异均有统计学意义(P<0.05);对照组正常女性的TSH水平为2.71(1.06~5.16)m IU/L,与早、中孕期妇女比较,差异均有统计学意义(P<0.05),略高于晚孕期妇女,但差异无统计学意义(P>0.05)。(2)研究组孕早期妇女的FT_3与FT_4水平分别为4.76(4.18~6.20)pmol/L、17.48(12.05~22.08)pmol/L;孕中期妇女的FT_3与FT_4水平分别为4.37(3.75~5.23)pmol/L、14.65(9.50~19.85)pmol/L;孕晚期妇女的FT_3与FT_4水平分别4.09(3.85~4.62)pmol/L、11.98(10.23~15.10)pmol/L,早、中、晚孕期妇女的FT_3与FT_4两两比较,差异均有统计学意义(P<0.05);对照组的FT_3与FT_4水平分别为4.98(4.00~6.16)pmol/L、18.65(14.50~22.01)pmol/L,均高于研究组,与中、晚孕期比较,差异均有统计学意义(P<0.05),与孕早期比较,差异无统计学意义(P>0.05)。结论:妊娠期妇女与健康的正常女性的甲状腺激素各项指标值均不同,同时,妊娠期妇女在其早、中、晚孕期的各项指标的界定值也不同,因此建立妊娠期不同时期的甲状腺指标界定值对孕妇产检时诊断甲状腺功能是否紊乱及优生优育有重要的临床指导意义。

Objective： To establish the indicators of different gestation periods thyroid hormone of normal pregnant women in Foshan for prepotency guide, detecte and analyse the range of thyroid hormone during different gestation periods among normal pregnant women in our hospital.Method： 1182 healthy pregnant women in our hospital were selected as the study group, which including 468 cases in early gestation, 412 cases in middle gestation and 302 cases in late gestation, 150 non-pregnant women were selected as the control group, the thyroid hormone levels and the range of thyroid hormones in the two groups （ represented by the median M and two-sided limits P2.5-P97.5 ） were compared and analyzed.Result： （ 1 ） In the study group, the early gestation TSH level was 1.12 （ 0.26-3.72 ） mIU/L, the medium-gestation TSH level was 2.10 （ 1.13-3.98 ） mIU/L in pregnant women in the middle pregnancy, the late gestation TSH level was 2.68 （ 1.36-4.25 ） mIU/L, the TSH levels of women in early middle and late pregnancy were compared, the differences were statistically significant （ P〈0.05 ） ; the TSH level of the control group was 2.71 （ 1.06-5.16 ） mIU/L, there were significant differences compared with the early and middle gestation （ P〈0.05 ）, but there was no significant difference compared with the late gestation （ P〉0.05 ） . （ 2 ） In the study group, the early gestation FT3 and FT4 levels were 4.76 （ 4.18-6.20 ） pmol/L and 17.48 （ 12.05-22.08 ） pmol/L, the medium-gestation FT3 and FT4 levels were 4.37 （ 3.75-5.23 ） pmol/L and 14.65 （ 9.50-19.85 ） pmoFL, the late gestation FT3 and FT4 levels were 4.09 （ 3.85-4.62 ） pmol/L and 11.98 （ 10.23-15.10 ） pmol/L, there were signifieant differences in FT3 and FT4 levels among all the three groups （ P〈0.05 ） ; the FT3 and FT4 of the control group were 4.98 （ 4.00-6.16 ） pmol/L and 18.65 （ 14.50-22.01 ） pmol/L, higher than those of the study group, compared with the middle and late pregnancy, the differences were statistically significant （P〈0.05）, compared with the early pregnancy, the difference was not statistieally significant （P〉0.05） .Conclusion： The thyroid hormone levels of normal pregnant women are different from those of non-pregnant women, and the levels show signifieant deviation during different gestation periods.Therefore, establish trimester-specific reference ranges of thyroid hormones among normal pregnaney is important for clinical practice.