正常孕妇妊娠期甲状腺功能变化研究

Studies on Changes in Thyroid Function in Normal Pregnant Women

目的分析正常孕妇妊娠期甲状腺功能的变化。方法选取2012年1月至2014年12月在香河县人民医院产科就诊的正常孕妇妊娠早期400例为A组、妊娠中期440例为B组,妊娠晚期370例为C组,同期选取非妊娠妇女410例为对照组。采用化学发光免疫法检测4组妇女的甲状腺激素和甲状腺自身抗体。分析妊娠期甲状腺功能的变化特点,测定正常孕妇妊娠期血清促甲状腺激素（TSH）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）的参考范围,探讨妊娠期甲状腺功能异常的患病率。结果 A组、B组、C组TSH和FT4水平显著低于对照组[（1.18±0.45）mU/L、（1.63±0.32）mU/L、（2.35±0.59）mU/L比（3.03±0.84）mU/L;（15.6±1.6）pmol/L、（15.0±1.3）pmol/L、（12.6±1.1）pmol/L比（17.3±1.6）pmol/L],差异有统计学意义（P<0.05）。A组FT3水平与对照组比较差异无统计学意义[（4.92±0.41）pmol/L比（4.97±0.43）pmol/L]（P>0.05）。B组、C组FT3水平显著低于对照组[（4.71±0.35）pmol/L、（3.85±0.24）pmol/L比（4.97±0.43）pmol/L]（P<0.05）。正常妊娠期妇女妊娠早、中、晚期血清TSH的参考值分别为0.033.73 mU/L、0.103.85 mU/L、0.354.76 mU/L,血清FT4的参考值分别为11.2420.13 pmol/L、10.0617.57 pmol/L、9.4515.26 pmol/L,血清FT3的参考值分别为3.626.01 pmol/L、3.445.87 pmol/L、2.855.04 pmol/L。妊娠期甲状腺功能异常总患病率为6.78%（82/1210）,显著高于对照组2.93%（12/410）,差异有统计学意义（P<0.05）。A组、B组、C组发病率显著高于对照组[8.25%（33/400）、6.14%（27/440）、5.95%（22/370）比2.93%（12/410）],差异有统计学意义（P<0.05）。结论妊娠期孕妇甲状腺相关激素受到内分泌变化的影响,与非妊娠期妇女存在较大的差异。

Objective Analysis of thyroid function in normal pregnant women. Methods The normal pregnant women and non pregnant women in the Department of Obstetrics and Gynecology of Xianghe People's Hospital were selected. Group A included 400 women with early pregnancy,group B included 440 women with second trimester of pregnancy,group C included 370 women with late pregnancy,the control group included 410 non pregnant women. Took serum thyroid hormones and thyroid autoantibodies were measured by chemiluminescent method. Analyzes the Thyroid function in the early and middle period of pregnancy change. The reference range of serum thyroid stimulating hormone( TSH),free thyroid hormone( FT_4) and free three iodine( FT_3) in normal pregnant women was determined. To explore the prevalence of maternal thyroid disorders. Results TSH and FT_4 levels of group A,group B,group C,were significantly lower than the control group [( 1.18 ± 0.45) mU / L,( 1.63 ± 0.32) mU / L,( 2.35 ± 0.59) mU / L vs( 3.03 ±0.84) mU / L;( 15.6 ± 1.6) pmol / L,( 15.0 ± 1.3) pmol / L,( 12.6 ± 1.1) pmol / L vs( 17.3 ±1.6) pmol / L],the difference was statistically significant( P < 0. 05). Compared with the control group,the levelof FT_3 in the group A was not statistically significant [( 4. 92 ± 0. 41) pmol / L vs( 4.97 ± 0.43) pmol / L]( P >0. 05). The level of FT_3 in group B and group C was significantly lower than that in control group[( 4. 71± 0. 35) pmol / L,( 3.85 ± 0.24) pmol / L vs( 4.97 ± 0.43) pmol / L]( P < 0. 05). The normal reference range of normal pregnant women in early,middle and late pregnancy serum TSH were 0.03-3.73 mU / L,0. 10-3. 85 mU / L,0.35-4.76 mU / L; serum FT_4 reference values were 11. 24-20. 13 pmol / L,10. 06-17. 57 pmol / L,9. 45-15. 26 pmol / L; serum FT_3 reference values respectively 3. 62-6. 01 pmol / L,3.44-5.87 pmol / L,2.85-5.04 pmol / L. The total prevalence of thyroid dysfunction during pregnancy was 6.78%(82 /1210),which was significantly higher than that in the control group [2.93%(12 /410) ],the difference was statistically significant( P < 0.05). The incidence of A group,B group and C group was significantly higher than that in control group[8.25%(33 /400),6. 14%( 27 /440),5. 95%( 22 /370) vs 2. 93%( 12 /410) ],the difference was statistically significant(P < 0.05). Conclusion Pregnancy women' s thyroid hormone changes because the endocrine change,and there are differences with non pregnancy women.