妊娠期甲状腺激素的变化及临床意义

Changes of Thyroid Hormone in Pregnancy and Its Clinical Significance

目的探讨妊娠早、中、晚期促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT_3)、游离甲状腺素(FT_4)的生理变化特点以及妊娠期检测甲状腺激素的必要性。方法妊娠期妇女289例,其中T1期(孕周≤12周)89例,T2期(孕期13~28周)159例,T3期(孕期>28周)41例,同龄健康非孕妇女46例为对照,罗氏e601电化学发光分析仪检测研究对象的TSH、FT_3、FT_4激素水平,并进行统计分析。结果观察者中1例为临床甲亢占0.3%,妊娠甲减的患病率为8.65%(其中临床甲减3例占1.03%,亚临床甲减22例占7.61%);妊娠期TSH从T1期(1.23±0.77)到T2期(2.33±1.28)再到T3期(2.21±1.03)呈逐渐上升趋势,而FT_3、FT_4呈逐渐下降趋势;T1期TSH明显低于对照(2.59±0.90),FT_3、FT_4与对照无差异;T2、T3期TSH无差异,而FT_3、FT_4有差异。结论妊娠各期甲状腺激素与健康非孕妇女有一定差异,应建立妊娠各期相应的甲状腺激素参考区间;妊娠期妇女甲减患病率高于同龄非孕妇女,有必要对妊娠期妇女做甲状腺功能筛查以提高优生优育。

Objective To investigate the physiological changes of thyroid stimulating hormone （TSH）, free Triiodothyro- nine（ FT3 ）and free Thyroxine（ FT4 ）in early, middle and late stage of pregnancy, and the necessity of detecting thyroid hormone during pregnancy. Methods 289 cases of pregnant women are included, consisting of 89 cases if Tl stage （ gestational week 〈 12w）, 159 cases of T2 stage（ gestational week between 13w and 28w）and 41 cases of T3 stage（ gestational week 〉 28w） ,46 cases of healthy non-pregnant women as control group. Roche E601 electrochemiluminescence analyzer was used to determine TSH, FT3 and FTa level of research objects and do statistical analysis. Results Among these research objects, there was 1 case of clinical hyperthyroidism,accounting for 0. 3% and the morbidity of gestational hypothyroidism was 8.65% ,including 3 cases of clinical hy- pothyroidism, accounting for 1.03% and 22 cases of subclinical hypothyroidism, accounting for 7.61%. TSH level during pregnan- cy gradually rose from （ 1.23 ± 0. 77 ） of T1 stage to （ 2. 33 ±1. 28 ） of T2 stage and then to （2. 21 ± 1.03 ） of T3 stage, while FT 3 and FI？4 presented a downtrend. TSH level of T1 stage was significantly lower than that of control group （2. 59 ± 0. 90） , while there was no statistically significant difference between the two as for FT3 and FT4. TSH level of T2 stage presented no statistically significant difference with that of T3 stage, contrary to the resuhs of F＇F3 and FT4. Conclusion Thyroid hormone of women in either stage of pregnancy has difference with healthy non-pregnant women and reference interval of thyroid hormone in each stage of pregnancy should be established. Morbidity of hypothyroidism in pregnant women is higher than non-pregnant women of the same age, so there is necessity to screen thyroid function to promote Eugenics.