古蔺县妊娠早、中、晚期血清甲状腺功能相关指标参考值的建立和临床分析

The establishment and clinical analysis of the reference interval of serum thyroid function related indexes in the early,middle and late stages of pregnancy in Gulin County

目的建立古蔺县不同孕期甲状腺功能相关指标的正常参考值,为规范甲状腺疾病的诊断和治疗提供依据。方法选取2019年1~12月于古蔺县人民医院接受孕期检查的855例妊娠女性作为研究组,同期健康未妊娠育龄期妇女180例作为对照组。检测促甲状腺激素(thyroid stimulating hormone,TSH)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)水平,制定妊娠各期甲状腺激素指标参考值;采用制定的孕期参考值、非孕期参考值、2011年美国甲状腺学会(American Thyroid Association,ATA)参考值筛检1070例妊娠孕妇,分析3种参考值诊断甲状腺功能减退、甲状腺功能亢进检出率。结果妊娠早、中、晚期甲状腺激素水平不同,TSH于早、中、晚期分别为(0.32~3.51)mIU/L、(0.31~3.98)mIU/L和(0.39~4.38)mIU/L;FT3分别为(3.70~5.47)pmol/L、(3.34~5.31)pmol/L和(3.03~4.96)pmol/L;FT4分别为(10.44~16.25)pmol/L、(9.68~14.81)pmol/L和(8.99~13.60)pmol/L。FT3、FT4均在早孕期较高,中晚孕期逐渐降低,差异均有统计学意义(P<0.05);采用孕期、ATA、非孕期3种参考值检出甲状腺功能减退率分别为2.52%、6.4%、35.5%,检出甲状腺功能亢进率分别为0.56%、5.61%、7.48%。结论妊娠妇女FT4,FT3及TSH与非妊娠妇女存在明显差异,ATA指南的参考值范围并不适合本地区孕妇甲减及甲亢的诊断;为减少妊娠合并甲状腺疾病的误诊和漏诊,当地需建立妊娠妇女早、中、晚孕期甲状腺激素正常参考值。

Objective To establish reference intervals for thyroid function testing in different pregnancy periods in Gulin County to provide a basis for standardizing the diagnosis and treatment of thyroid diseases.Methods Selected 855 pregnant women who underwent pregnancy checkups at Gulin County People’s Hospital from January 2019 to December 2019 as the research group.During the same period,180 healthy non-pregnant women of childbearing age served as the control group.The levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)were detected,and the reference intervals of different stages of thyroid hormone were established.The detection rates of hypothyroidism and hyperthyroidism were analyzed by screening 1070 pregnant women using pregnancy reference intervals of pregnancy,non-pregnancy reference intervals and 20 l1 of the American Thyroid Association(ATA)reference intervals.Results The levels of TSH in early、middle and late pregnancy were(0.32~3.51)mIU/L,(0.31~3.98)mIU/L and(0.39~4.38)mIU/L,respectively;the levels of FT3 in early、middle and late pregnancy were(3.70~5.47)pmol/L,(3.34~5.31)pmol/L and(3.03~4.96)mIU/L,respectively;and the levels of FT4 in early、middle and late pregnancy were(10.44~16.25)pmol/L,(9.68~14.81)pmol/L and(8.99~13.60)pmol/L,respectively.FT3 and FT4 levels were higher in early pregnancy,gradually decreased in middle and late pregnancy,and the difference was statistically significant(P<0.05).With the guidance of reference intervals of pregnancy,ATA and non-pregnancy,the detection rate of hypothyroidism was 2.52%,6.4%,35.5%,respectively,and the rates of hyperthyroidism detected were 0.56%,5.61%,and 7.48%,respectively.Conclusion The FT4,FT3 and TSH of pregnant women are significantly different from those of non-pregnant women.The reference value range of the ATA guidelines is not suitable for the diagnosis of hypothyroidism and hyperthyroidism in pregnant women in this region;in order to reduce the misdiagnosis and missed diagnosis of pregnancy complicated with thyroid disease,it is necessary to establish the normal local reference interval of thyroid hormones in early,middle and late pregnancy.