扬州地区妊娠妇女不同孕期甲状腺功能指标参考区间的建立与临床意义

Establishment and clinical significance of reference intervals of thyroid function indicators of pregnant women in different pregnancy in Yangzhou

目的建立扬州地区妊娠妇女各孕期游离甲状腺素(FT4)、促甲状腺激素(TSH)以及甲状腺过氧化物酶抗体(TPOAb)参考区间,并分析各指标的动态变化趋势,为临床及时、准确诊断孕期甲状腺疾病提供依据,促进优生优育.方法收集2017年10月至2018年10月扬州大学医学院附属医院扬州市妇幼保健院围产保健科门诊定期产检的3726例健康孕早(1747例)、中(1481例)、晚(498例)期妇女的临床资料,选择同期407例非妊娠妇女作为正常对照.采用美国贝克曼全自动化学发光分析仪检测观察对象血清FT4、TSH、TPOAb水平,采用双侧限值的95%参考值建立参考区间,并比较孕早、中、晚期各指标的差异.结果孕早、中、晚期,FT4水平比较差异有统计学意义(H=82.56,P<0.01),其中孕早期高于孕中期(P<0.01),孕中期高于孕晚期(P<0.01);TSH水平比较差异有统计学意义(H=91.27,P<0.01),其中孕早期低于孕中期(P<0.01),孕中期低于孕晚期(P<0.01);TPOAb水平比较差异有统计学意义(H=30.36,P<0.01),其中孕早期与孕中期比较差异无统计学意义(P>0.05),孕早、中期高于孕晚期(P均<0.01).不同孕期甲状腺功能指标参考区间,孕早期:FT4为8.28~15.66 pmol/L,TSH为0.11~4.23 mU/L,TPOAb为0.10~16.46 U/ml;孕中期:FT4为7.38~14.36 pmol/L,TSH为0.13~4.67 mU/L,TPOAb为0.10~18.97 U/ml;孕晚期:FT4为6.33~11.39 pmol/L,TSH为0.40~3.96 mU/L,TPOAb为0.10~6.17 U/ml.结论妊娠妇女不同孕期血清甲状腺功能指标有明显差异.成功建立不同孕期甲状腺功能指标参考区间,这对甲状腺疾病的诊断以及促进优生优育有重要的临床意义.

Objective By establishing the reference intervals of free thyroxine(FT4),thyroid stimulating hormone(TSH)and thyroid peroxidase antibody(TPOAb)of pregnant women in different pregnancy in Yangzhou,and analyzing the dynamic trends of each indicator,so as to provide a basis for timely and accurate diagnosis of thyroid disease during pregnancy,and promote prenatal and postnatal care.Methods Clinical data of 3726 healthy early(1747 cases),middle(1481 cases),and late(498 cases)pregnant women were collected from the Department of Perinatal and Health Care in Yangzhou Women and Children Hospital,the Affiliated Hospital of Yangzhou University Medical College from October 2017 to October 2018.At the same time,data of 407 non-pregnant women in the same period were collected as normal controls.The levels of serum FT4,TSH and TPOAb in each stage of pregnancy were detected by Beckman automatic chemiluminescence analyzer.The reference interval was established by using the 95%reference value of the bilateral limit,and the differences of early,middle and late pregnancy were compared.Results There were significant differences in FT4 levels between early,middle and late stages of pregnancy(H=82.56,P<0.01),with the early stage higher than the middle stage(P<0.01)and the middle stage higher than the late stage(P<0.01).The difference of TSH levels was statistically significant(H=91.27,P<0.01),in which the early stage was lower than the middle stage(P<0.01),and the middle stage was lower than the late stage(P<0.01).There was a statistically significant difference in TPOAb levels(H=30.36,P<0.01).There was no significant difference between the early stage and the middle stage(P>0.05),and the early and middle stages were higher than the late stage(P<0.01).The reference intervals of thyroid function index in different pregnancies were,early pregnancy:FT48.28-15.66 pmol/L,TSH 0.11-4.23 mU/L,TPOAb 0.10-16.46 U/ml;middle pregnancy:FT47.38-14.36 pmol/L,TSH 0.13-4.67 mU/L,TPOAb 0.10-18.97 U/ml;and late pregnancy:FT46.33-11.39 pmol/L,TSH 0.40-3.96 mU/L,TPOAb 0.10-6.17 U/ml.Conclusions There are significant differences in serum thyroid function indicators in different pregnant women.Establishing reference intervals of thyroid function indicators in different stages of pregnancy have important clinical significance for diagnosis of thyroid disease and eugenics.