妊娠妇女血清TSH、FT3、FT4、TT3、TT4参考区间的建立及变化趋势探究

Establishment of the reference intervals of TSH,FT3,FT4,TT3,and TT4 in serum of pregnant women and study on changing trend

目的建立正常妊娠妇女血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)的参考区间,并探究其变化趋势。方法参照美国国家临床生化学院(NACB)指南标准一共筛选出孕前体检及产前检查的妇女1907人,其中孕前体检328例,妊娠期妇女1579例,分别对其进行血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)水平的测定,对测定结果进行统计学分析,建立相应的参考区间,并分析TSH、FT3、FT4、TT3、TT4水平在不同妊娠时期的变化趋势。结果(1)妊娠早期(孕周5~13周,589人),TSH参考区间:0.06~4.12μIU/ml,FT3参考区间:3.82~7.34 pmol/L,FT4参考区间:11.41~23.56 pmol/L,TT3参考区间:0.94~2.27 ng/ml,TT4参考区间:6.21~14.7μg/dl;妊娠中期(孕周14~27周,557人),TSH参考区间:0.25~4.21μIU/ml,FT3参考区间:3.40~6.91 pmol/L,FT4参考区间:8.88~19.79 pmol/L,TT3参考区间:1.06~2.68 ng/ml,TT4参考区间:6.73~17.64μg/dl;妊娠晚期(孕周28~40周,433人),TSH参考区间:0.32~5.25μIU/ml,FT3参考区间:3.01~6.51 pmol/L,FT4参考区间:7.33~18.93 pmol/L,TT3参考区间:1.05~2.57 ng/ml,TT4参考区间:6.62~17.25μg/dl。(2)随着妊娠时期的进展,TSH水平在妊娠早期明显下降,后逐步回升,至妊娠晚期回升至略高于未妊娠期水平;FT3、FT4水平在妊娠早期略微上升,后逐步下降;TT3、TT4水平在妊娠早期明显上升,至中期上升至最高水平,后开始下降,但妊娠期间均高于未妊娠组。结论妊娠期妇女甲状腺激素水平与未妊娠妇女存在明显差异,妊娠各期之间亦存在差异,妊娠期妇女不能单纯地采用非妊娠期妇女甲状腺激素参考区间,本研究结果有助于妊娠期妇女甲状腺疾病的诊断与治疗。

Objective To establish the reference intervals of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),total triiodothyronine(TT3),total thyroxine(TT4)of normal pregnant women.Methods A total of 1579 pregnant women received antenatal care and 328 non-pregnant healthy women were studied according to the screening criteria of the National Academy of Clinical Biochemistry(NACB).The levels of serum TSH,FT3,FT4,TT3,and TT4 were measured,the results were statistically analyzed to establish corresponding reference intervals and the changing trends of TSH,FT3,FT4,TT3,and TT4 levels at different stages were analyzed.Results(1)The reference intervals of TSH,FT3,FT4,TT3,and TT4 in the first trimester of pregnancy(5-13 weeks,589 cases)were 0.06-4.12μIU/ml,3.82-7.34 pmol/L,11.41-23.56 pmol/L,0.94-2.27 ng/ml,and 6.21-14.7μg/dl;the reference intervals of TSH,FT3,FT4,TT3,and TT4 in the second trimester of pregnancy(14-27 weeks,557 cases)were 0.25-4.21μIU/ml,3.40-6.91 pmol/L,8.88-19.79 pmol/L,1.06-2.68 ng/ml,and 6.73-17.64μg/dl;the reference intervals of TSH,FT3,FT4,TT3,and TT4 in the third trimester of pregnancy(28-40 weeks,433 cases)were 0.32-5.25μIU/ml,3.01-6.51 pmol/L,7.33-18.93 pmol/L,1.05-2.57 ng/ml,and 6.62-17.25μg/dl.(2)With the progress of pregnancy,the level of TSH decreased significantly in the first trimester,and then gradually increased to the level of slightly higher than the third trimester.The levels of FT3 and FT4 increased slightly in the first trimester,then gradually decreased.The levels of TT3 and TT4 increased significantly in the first trimester,rose to the highest level in the second trimester of pregnancy,and then began to decline,but the level of pregnant group was higher than that of the non-pregnant group.Conclusions The thyroid hormone levels in pregnant women are significantly different from those in non-pregnant women,there are also differences between different stages of pregnancy.The reference intervals of thyroid hormones in non-pregnant women cannot be simply used for the reference intervals of pregnant women.Our study is conducive to the diagnosis and treatment of thyroid disease in pregnant women.