妊娠期不同孕周的TSH和FT4水平研究

Study on the levels of TSH and FT4 in different gestational weeks of normal pregnancy

目的:探讨正常妊娠不同孕周血清促甲状腺激素(TSH)、游离甲状腺素(FT4)水平的参考值范围。方法:回顾性收集孕期行甲状腺筛查检测产妇1901人次,按检测时孕周分为妊娠早期(T1期,≤11^(+6)周)、妊娠中期(T2期,12~27^(+6)周)、妊娠晚期(T3期,≥28周)。并按照具体孕周将产妇分为妊娠0~11^(+6)周、12~19^(+6)周、20~27^(+6)周、28~35^(+6)周、≥36周共5组。建立妊娠不同时期、不同具体孕周甲状腺功能指标的血清学参考值范围。结果:不同妊娠时期产妇TSH、FT4水平间差异均有统计学意义(P<0.01),其中T3期TSH为(2.12±1.32)μU/mL,均明显高于T1、T2期的(1.78±1.01)μU/mL、(1.83±0.95)μU/mL(P<0.01),TSH参考范围上限值在T1、T2、T3期分别为3.76、3.79、4.71μU/mL;T3期FT4为(0.52±0.09)ng/dL,则明显低于T1、T2期的(0.84±0.18)ng/mL、(0.60±0.10)ng/dL(P<0.01),T2期FT4亦明显低于T1期(P<0.01)。不同孕周产妇TSH和FT4水平间差异亦均有统计学意义(P<0.01)。其中妊娠12~19^(+6)周时TSH最低(P<0.05),此后随孕周增加,TSH水平呈上升趋势(P<0.05),在妊娠≥36周时TSH最高(P<0.05);FT4则在妊娠0~11^(+6)周时水平最高(P<0.05),此后均低于0~11^(+6)周(P<0.05),随孕周增加,趋于平稳(P>0.05)。结论:妊娠不同时期TSH、FT4参考范围不同,建立孕周特异和方法特异的妊娠不同时期及具体孕周的参考值有利于指导临床妊娠期甲状腺疾病的筛查和处理。

Objective:To explore the reference value of serum thyroid stimulating hormone(TSH)and free thyroxine(FT4)levels in different gestational weeks of normal pregnancy.Methods:A total of 1901 pregnant women with screening thyroid during pregnancy were retrospectively analyzed,and divided into the first trimester(T1,≤11^(+6) weeks),second trimester(T2,12-27+6 weeks)and third trimester(T3,≥28 weeks)according to the gestational age at the time of detection.According to the specific gestational weeks,the puerpera were divided into the 0-11^(+6) weeks gestation group,12-19^(+6) weeks gestation group,20-27^(+6) weeks gestation group,28~35^(+6) weeks gestation group and≥36 weeks gestation group.The serological reference range of thyroid function indexes in different gestational weeks and periods of pregnancy were established.Results:The differences of the levels of TSH and FT4 among different stages of pregnancy were statistically significant(P<0.01),the TSH in T3 stage was(2.12±1.32)μU/mL,which was significantly higher than that in T1 and T2 stages[(1.78±1.01)μU/mL and(1.83±0.95)μU/mL](P<0.01).The upper limits of TSH reference range were 3.76,3.79 and 4.71μU/mL in T1,T2 and T3 stages,respectively.The FT4 of T3 stage was(0.52±0.09)ng/dL,which was significantly lower than that of T1 and T2 stages[(0.84±0.18)ng/dL and(0.60±0.10]ng/dL(P<0.01).The FT4 of T2 stage was also significantly lower than that of T1(P<0.01).The differences of the TSH and FT4 levels among different gestational weeks were statistically significant(P<0.01).The TSH level was the lowest at 12-19^(+6) weeks of gestation(P<0.05),then increased with the increase of gestational age(P<0.05),and the TSH level was the highest at≥36 weeks of gestation(P<0.05).The level of FT4 was the highest at 0-11^(+6) weeks of gestation(P<0.05),lower than that at 0-11^(+6) weeks of gestation(P<0.05),and tended to be stable with the increase of gestational age(P>0.05).Conclusions:The reference ranges of TSH and FT4 are different in different stages of pregnancy.The establishment of gestational age specific and method specific reference values in different stages of pregnancy and specific gestational age is helpful to guide the screening and management of thyroid diseases during pregnancy.