广东中山地区正常妊娠女性甲状腺功能指标的检测及其临床意义

Detection of thyroid function indices of normal pregnant women in Zhongshan and their clinical significance

目的检测中山地区正常妊娠女性各时期甲状腺功能水平,建立该地区妊娠女性正常甲状腺功能的参考范围。方法按标准纳入正常妊娠期妇女397名,并根据妊娠期不同分为3组,分别为早期妊娠(112例)、中期妊娠(130例)和晚期妊娠(155例);同时选取120例体检的非妊娠期健康女性作为正常组。采用免疫发光化学法(ICMA)测定以上人群的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和血清促甲状腺激素(TSH)水平,并对结果进行统计学分析。结果妊娠早、中、晚期,血清FT3的参考标准分别为3.32~5.98、3.36~5.21和2.92~5.01 pmol/L,血清FT4参考标准分别为13.12~18.25、8.91~17.28和6.75~16.91 pmol/L,血清TSH的参考标准分别为1.34~2.45、1.51~3.16和1.80~3.51 mU/L。与正常组相比,妊娠早、中、晚期FT3水平明显降低(P<0.01),妊娠中、晚期FT4水平低于正常组和妊娠早期组;妊娠早、中期的TSH水平低于正常组,中、晚期TSH水平高于早期,差异均有统计学意义(P<0.01)。以本文参考范围为标准,妊娠期临床甲减的发生率为0.5%,亚临床甲减发生率为3.8%,单纯低T4血症的发病率为2.0%,与美国甲状腺协会ATA标准比较差异无统计学意义(P>0.05)。结论制定中山地区正常妊娠女性各时期甲状腺功能的正常范围有利于妊娠期甲状腺疾病的预防和诊治。

Objective To detect the level of free triiodothyronine （FT3）, free thyroxine （FT4） and thyroid stimulating hormone （TSH） of normal pregnant women at all stages in Zhongshan and establish the gestational reference range of thyroid function. Methods A total of 397 pregnant women were selected as the Observation Group based on inclusion criteria and divided into Early Pregnancy （120 cases）, Midtrimester Pregnancy （130 cases） and Late Pregnancy （155 cases）. Another 120 healthy non-pregnant women receiving the physical examination were served as the Control Group. ICMA was used to detect the levels of FT3, FT4 and TSH. All the data were subject to statistical analysis. Results The reference range of FT3 in the early, midtrimester and late pregnancy was 3.32-5.98 pmol/L, 3.36-5.21 pmol/L and 2.92-5.01 pmol/L, respectively： The reference range of FT4 in the early, midtrimester and late pregnancy was 13.12-18.25 pmol/L, 8.91-17.28 pmol/L and 6.75- 16.91 pmol/L, respectively. The reference range of TSH in the early, midtrimester and late pregnancy was 1.34-2.45 mU/L, 1.51-3.16 mU/L and 1.80-3.51 mU/L, respectively. Compared with the Control Group, the FT3 level in the early, midtrimester and late pregnancy was decreased dramatically. There was statistical difference among the 4 groups; FT4 level in the midtrimester and late pregnancy was lower than that in the Control Group and that in the early pregnancy. The TSH level in the early and midtrimester pregnancy was lower than the Control Group, that in the midtrimester and late pregnancy was higher than that in the early pregnancy, and the difference was statistically significant （P〈0.01）. Taking the reference range in this paper as the criteria, the incidence of gestational hypothyroidism was 0.5%, that of subclinical hypothyroidism was 0.5% and that of simple hypothyroxinemia was 3.8%, and there was no statistical difference compared with the criteria of American Thyroid Association （P〉0.05）. Conclusion The normal range of thyroid hormones established for pregnant women in Zhongshan can contribute to the diagnosis and treatment of thyroid diseases in pregnancy.