海岛地区不同孕期及孕龄孕妇甲状腺激素水平的检测及参考范围研究

Thyroid hormone level analysis of island area pregnant women in different pregnant periods and gestational age

目的分析海岛地区不同孕期和孕龄孕妇机体的甲状腺激素水平变化。方法以海岛地区3 000例健康孕妇作为观察组,并以600例健康体检的非妊娠女性作为对照组,比较不同孕期、不同年龄段孕妇血清总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)以及促甲状腺激素(TSH)水平,采用中位数(M)和双侧限值(P_(2.5),P_(97.5))表示甲状腺激素水平的参考值范围。结果与对照组相较,孕早、中、晚期组的TT_3和TT_4水平均升高(P<0.05);孕早、中、晚期组的FT_3、FT_4及孕早、中期TSH水平均降低(P<0.05)。20~30岁组、31~35岁及36~45岁组的TT_3、TT_4均较对照组升高(P<0.05),FT_3、FT_4及TSH均较对照组降低(P<0.05);与36~45岁组比较,仅20~30岁组FT_3、FT_4及TSH有差异,31~35岁组的各项指标差异无统计学意义(P>0.05)。结论妊娠期甲状腺激素水平在不同孕期有明显变化,且与孕龄密切相关,孕妇尤其是35岁以上的高龄孕妇应尽早进行甲状腺功能检查,以降低不良妊娠结局的发生率,提高人口和生育质量。

Objective To analyze thyroid hormones changes of island area pregnant women in different pregnant periods and gestational age. Methods Totally 3000 healthy pregnant women in island area were taken as the observation group and 600 healthy pregnant women were taken as the control group. The levels of serum total triiodothyronine （TT3）,total thyroxine TT4,free FT3,FT4 and TSH levels were compared in different pregnant periods and gestational age. Median （M） and bilateral limit（P（2.5）,P（97.5）） were adopted to indicate reference range for thyroid hormone levels Results Compared with the control group,the levels of TT3 and TT4 in the early,middle and late stage of pregnancy increased significantly （P 0.05）. The levels of FT3 and FT4 in early,middle and late stage of pregnancy and the levels of TSH in early and middle stage of pregnancy were lower significantly （P〈0.05）. TT3 and TT4 in 20 to 30 years old,31 to 35 years old and 36 to 45 years old groups were much higher than those of the control group （P〈0.05）. FT3,FT4 and TSH were significantly lower than those of the control group （P〈0.05）. Levels of FT3,FT4 and TSH were significantly different between 20 to 30 years old group and 36 to 45 years old group,and there was no significant difference between 31 - 35 years old group and 36 - 45 years old group （P〉0.05） as to various indicators. Conclusion The thyroid hormones during pregnancy change obviously in different gestational stages,and have close relationship with gestational ages. Pregnant women,especially those over 35 years old,should carry out thyroid function tests as early as possible to reduce the incidence of adverse pregnancy outcomes and improve our population and reproductive quality.