5000例妊娠妇女甲状腺激素水平分析及参考值建立

Analysis of thyroid hormone level of 5000 healthy pregnant women and the establishment of the reference value ranges

目的:探讨本地区健康妊娠早、中、晚期孕妇血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)水平变化及参考值范围。方法:回顾性收集2018年1月—2020年6月两院产前检查的健康孕妇临床资料5000例,按照检测时间分为孕早期(孕0~13周)组1806例、孕中期(孕14~27周)组1573例及孕晚期(孕28~40周)组1621例。采用化学发光免疫分析法检测血清FT3、FT4、TSH水平,均以[P50(P2.5~P97.5)]制定参考范围。Spearman检验各孕期血清FT4与TSH水平相关性。结果:孕晚期组、孕中期组血清FT3、FT4水平均低于孕早期组,TSH水平均高于孕早期组(P<0.05);孕晚期组血清FT4水平低于孕中期组,血清TSH水平高于孕中期组(P<0.05)。孕早、中、晚期妇女血清FT3水平参考值范围分别为3.80~5.36 pmol/L、3.49~6.01 pmol/L、3.57~5.83 pmol/L,血清FT4水平参考值范围分别为11.04~22.85 pmol/L、10.53~20.72 pmol/L、9.26~16.87 pmol/L,血清TSH水平参考值范围分别为0.05~4.36 mIU/L、0.43~5.12 mIU/L、0.70~6.25 mIU/L。孕早、中期妇女血清FT4与TSH水平均呈负相关(P<0.05),而孕晚期妇女血清FT4与TSH水平无相关性(P>0.05)。结论:本研究建立的甲状腺激素参考范围,可能为本地区妊娠期甲状腺疾病的诊治提供参考。

Objective:To investigate the changes and the reference value ranges of the serum free triiodothyronine(FT3),free thyroxine(FT4),and thyroid stimulating hormone(TSH)levels of healthy pregnant women during the first,the second,and the third trimester of pregnancy in Jiayuguan area.Methods:The clinical data of 5000 healthy pregnant women from January 2018 to December 2019 were collected retrospectively.According to the gestational weeks,these women were divided into group A(1806 women with 0-13 gestational weeks),group B(1573 women with 14-27 gestational weeks),and group C(1621 women with gestational weeks).The levels of serum FT3,FT4 and TSH of these women were detected by chemiluminescence immunoassay,which reference ranges were determined based on the 50th percentile(2.5th percentile-97.5th percentile)[P50(P2.5-P97.5)].Spearman test was used to analyze the correlation between the serum FT4 level of the women during the different gestational weeks and their TSH levels.Results:The serum FT3,FT4 levels of the women in group B and group C were significant lower than those of the women in group A,but the TSH level of the women in group B and group C was significant higher(P<0.05).The serum FT4 level of the women in group C was significant lower than that of the women in group B,but the TSH level of the women in group C was significant higher(P<0.05).The reference range of serum FT3 level of the women during the first,the second,and the third trimester of pregnancy were 3.80-5.36 pmol/L,3.49-6.01 pmol/L,and 3.57-5.83 pmol/L,respectively.The reference range of serum FT4 level of the women during the first,the second,and the third trimester of pregnancy were11.04-22.85 pmol/L,10.53-20.72 pmol/L,and 9.26-16.87 pmol/L,respectively.The reference range of serum TSH level of the women during the first,the second,and the third trimester of pregnancy were 0.05-4.36 mIU/L,0.43-5.12 mIU/L,and 0.70-6.25 mIU/L,respectively.The serum FT4 level of the women during the first and the second trimester of pregnancy were negatively correlated with their serum TSH level(P<0.05),but the serum FT4 level of the women during the third trimester of pregnancy wasn’t correlated with their serum TSH level(P>0.05).Conclusion:The reference range of thyroid hormones established in this study may provide evidence for the diagnosis and treatment of thyroid diseases during pregnancy in Jiayuguan area.