哈尔滨市孕妇血清碘水平及甲状腺激素特异性参考值范围的研究

Study on serum iodine level and thyroid hormone specific reference range of pregnant women in Harbin

目的 探究孕妇不同孕期血清碘水平的变化规律,建立适用于哈尔滨市妊娠妇女不同孕期特异性甲状腺激素参考值范围。方法 招募2018年9月—2021年9月在哈尔滨市某大型三甲医院进行产检的孕妇1 189名。采用砷铈催化分光光度法检测血清碘水平;采用西门子公司化学分析仪检测其血清促甲状腺激素(TSH)、血清游离三碘甲状腺原氨酸(FT_(3))、血清游离甲状腺素(FT_(4))、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)。血清碘水平及甲状腺激素参考值范围用中位数M、四分位数间距(P_(25),P_(75))及百分位数法(P_(2.5),P_(97.5))表示。结果 (1)孕妇血清碘中位数为86.74(74.99,100.15)μg/L,不同孕期血清碘中位数差异有统计学意义(χ^(2)=8.723,P=0.013),其中孕早期血清碘中位数与孕中期相比,差异具有统计学意义(Z=-2.529,P=0.011);孕早期血清碘中位数与孕晚期相比有差异,差异具有统计学意义(Z=-2.402,P=0.016)。(2)孕早、中、晚期甲状腺激素参考值范围分别是FT_(3):4.81(3.61,6.18)、4.51(3.36,5.63)、4.53(3.36,5.63)pmol/L;FT_(4):16.01(11.84,24.16)、14.95(11.50,19.99)、14.57(11.35,20.13)pmol/L;TSH:1.17(0.01,3.87)、1.34(0.07,3.78)、1.46(0.03,3.68)mIU/L。用新建立的参考值范围对孕妇的甲状腺功能进行评估显示,甲状腺异常检出率为5.55%,低于ATA指南推荐的参考值范围检出率10.59%(χ^(2)=20.397,P<0.05)。结论 哈尔滨市孕妇血清碘中位数为86.74(74.99,100.15)μg/L,不同孕期血清碘中位数有差异。哈尔滨市正常妊娠妇女甲状腺激素呈现地区特异性变化,建立本地区妊娠期特异性甲状腺激素参考值范围,对临床诊断、治疗与监测妊娠期妇女的甲状腺疾病是非常必要的。

Objective To explore the change rule of serum iodine level in pregnant women during different pregnancies, and establish the reference range of specific thyroid hormone suitable for pregnant women in Harbin during different pregnancies.Methods A total of 1 189 pregnant women were recruited from September 2018 to September 2021 in a large grade Ⅲ,class A hospital in Harbin.Arsenic and cerium catalytic spectrophotometry was used to detect serum iodine level.Serum thyroid stimulating hormone(TSH),serum free triiodothyronine(FT_(3)),serum free thyroxine(FT_(4)),thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb) were detected by Siemens chemical analyzer.The reference ranges of serum iodine level and thyroid hormone were expressed by median, interquartile distance(P_(25),P_(75)) and percentile method(P_(2.5),P_(97.5)).Results(1)The median serum iodine of pregnant women was 86.74(74.99,100.15) μg/L,and the difference of serum iodine median of different pregnancies was statistically significant(χ^(2)=8.723,P=0.013).The difference was statistically significant(Z=-2.529,P=0.011),and there was a statistically significant difference in serum iodine median between the first trimester and the third trimester(Z=-2.402,P=0.016).(2)The reference ranges of thyroid hormone in early, middle and late gestation were FT_(3):4.81(3.61,6.18),4.51(3.36,5.63) and 4.53(3.36,5.63)pmol/L,respectively;FT_(4):16.01(11.84,24.16),14.95(11.50,19.99) and 14.57(11.35,20.13)pmol/L;TSH:1.17(0.01,3.87),1.34(0.07,3.78) and 1.46(0.03,3.68)mIU/L.Assessment of thyroid function in pregnant women using the newly established reference range showed a positive thyroid abnomal rate of 5.55%,lower than the ATA guideline recommended reference range of 10.59%(χ^(2)=20.397,P0.05).Conclusion The median serum iodine of pregnant women in Harbin is 86.74(74.99,100.15) μg/L,and there are differences in serum iodine median of different pregnancies.Thyroid hormone in normal pregnant women in Harbin showed region-specific changes.It is necessary to establish the reference range of thyroid hormone in this area for clinical diagnosis, treatment and monitoring of thyroid diseases in pregnant women.