不同孕期特异性甲状腺激素水平探讨

Pregnancy-specific thyroid hormone levels in different pregnancy

目的:探讨各孕期妇女甲状腺激素水平的变化,建立本地区孕期特异性甲状腺激素水平参考值范围.方法:筛选产检并分娩的各孕期正常孕妇共600例,采用化学发光法测定促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3),制定各孕期特异性甲状腺激素水平参考值范围.收集各孕期孕妇3 770例,评估本研究参考值,并与2011年及2017年美国甲状腺医师学会(ATA)指南的诊断标准进行比较.结果:(1)妊娠早、中、晚各期血清TSH的质量浓度中位数及97. 5%参考范围分别为1. 06 m IU/L(0. 013～3. 01 m IU/L),1. 31m IU/L(0. 35～4. 08 m IU/L),1. 51 m IU/L(0. 20～4. 05 m IU/L),孕早期TSH值显著低于孕中、晚期.(2)以2017年ATA标准对妊娠中、晚期亚甲减的诊断率与本研究制定的参考值范围相似,但对早孕期亚甲减的诊断,漏诊率高达68. 4%.(3)约69%的孕妇第一次检查甲状腺功能在孕中期,孕早期监测者仅占约14%.结论:(1)TSH值在早孕期明显低于中晚孕期,不建议使用4. 0 m IU/L TSH质量浓度值作为本地区早孕期TSH参考上限.(2)本地区早孕期筛查率低,应加强宣教,提高早孕期检测率.

Objective: To explore the changes of thyroid levels during pregnancy locally and establish a regional reference range of the specific thyroid hormone levels during pregnancy. Methods: Specific thyroid hormone screened in 600 normal pregnant women of different trimesters from July 2016 to September 2017 in The First Affiliated Hospital of Jinan University were selected as the “Reference”.The chemiluminescence method was used to measure values of thyroid stimulating hormone (TSH),free thyroxine (FT4) and free triiodothyronine (FT3). Formulate a range of reference values for specific thyroid hormone levels during pregnancy. Subsequently, the other 3 770 cases of pregnant women during pregnancy and delivery from June 2016 to September 2017 in different trimesters were collected to evaluate the reference value of this study and compare with the diagnostic crietria of 2011 ATA and 2017 ATA to find out the difference among these three values of reference range. Results:①The median and 97.5% reference ranges of serum TSH concentration in the first, second and third trimesters during pregnancy were 1.06 mIU/L (0.013 to 3.01 mIU/L), 1.31 mIU/L (0.35 to 4.08 mIU/L), and 1.5 mIU/L(0.20 to 4.05 mIU/L). The TSH values of the first trimester was significantly lower than the second and third trimester.②The diagnostic rate of the second and third trimester hypothyroidism according to the 2017 ATA standard is similar to the reference range established in this study. However, the missed diagnostic rate of hypothy roidism in the first trimester was as high as 68.4%.③This research found out the fact that the first time of the pregnant women who performed the thyroid function test was in the second trimester commonly and the percentage was approximately 69% in our hospital, and only about 14% of the early pregnancy monitors. Conclusion:①The TSH value is significantly lower in the early pregnancy than in the middle and late pregnancy. We do not recommended to use 4.0 mIU/L as the criteria TSH reference range for early pregnancy in this region.②The screening rate in early pregnancy in this region was low, and education should be enhanced to improve the detection rate in early pregnancy.