汕头地区孕妇甲状腺功能参考值的建立及甲状腺功能异常的筛查

doi:10.3877/cma.j.issn.2095-3259.2016.02.012

目的

建立汕头地区妊娠妇女甲状腺激素功能指标的参考值范围，并依据该参考值了解本地区妊娠妇女甲状腺功能异常的发生情况。

方法

对2013年1月至2015年12月期间在汕头大学医学院第二附属医院妇产科门诊就诊的837名妊娠妇女，进行血清甲状腺激素和甲状腺自身抗体检测。其中，2013年1月至2014年6月符合入组标准的367名妊娠妇女的甲状腺功能资料，用于建立本研究妊娠各期血清促甲状腺激素(Thyroid stimulating hormone, TSH)、游离甲状腺素(Free thyroxine, FT₄)的参考值。根据本研究初步建立的参考值，对2014年7月至2015年12月在汕头大学医学院第二附属医院妇产科门诊就诊的470名妊娠妇女进行甲状腺功能异常的筛查。

结果

(1)初步建立的汕头地区妊娠妇女孕早、中和晚期血清TSH的正常参考范围分别为：0.07～5.34 mIU/L、0.09～4.96 mIU/L、0.05～6.59 mIU/L，血清FT₄的正常参考范围分别为：8.71～15.53 pmol/L、5.58～11.84 pmol/L、5.57～21.91 pmol/L；(2)本院就诊孕妇甲状腺功能异常的发生率：临床甲亢为1.91%(9/470)、亚临床甲亢为0.64%(3/470)、临床甲减为0、亚临床甲减为1.06%(5/470)。

结论

建立汕头地区妊娠妇女甲状腺功能的参考值有利于本地区妊娠妇女甲状腺功能疾病的及时诊断和早期干预，从而减少疾病对孕妇及胎儿造成的影响。

关键词: 妊娠, 促甲状腺激素, 甲状腺素, 参考值

Objective

To establish the reference value of thyroid function for pregnant women in Shantou area and screen the occurrence rate of thyroid function disorder for pregnant women in this area.

Methods

This study enrolled 837 pregnant women, who were conducted antenatal care in the Second Affiliated Hospital of Shantou University Medical College from January 2013 to December 2015. The serum of the patients was collected to detect thyroid hormones and thyroid autoantibodies. The values of serum thyroid stimulating hormone (TSH) and free thyroxine (FT₄) for 367 pregnant women during January 2013 to June 2014 were established reference standard. Four hundred and severty pregnant women, who were conducted antenatal care in our hospital from July 2014 to December 2015, were assessed thyroid function by using this reference standard.

Results

(1) The reference value of serum TSH in first, second and third trimester of pregnancy were 0.07-5.34 mIU/L, 0.09-4.96 mIU/L and 0.05-6.59 mIU/L, respectively; And the reference value of serum FT₄ in the three different trimesters were 8.71-15.53 pmol/L, 5.58-11.84 pmol/L and 5.57-21.91 pmol/L, respectively. (2) The incidence rates of clinical hyperthyroidism, subclinical hyperthyroidism and subclinical hypothyroidism were 1.91% (9/470), 0.64% (3/470) and 1.06% (5/470). There were no one had clinical hypothyroidism.

Conclusion

Establish reference value of thyroid function for pregnancy in Shantou area is conducive to early diagnosis and treatment, which can reduce the damage to the mothers and fetuses.

Key words: Pregnancy, Thyrotropin, Thyroxine, Referece values

表1 367例孕妇妊娠早、中、晚期血清TSH和FT₄参考值的比较[M(P_2.5～P_97.5)]

孕期	例数	FT₄ (pmol/L)	TSH (mIU/L)
早孕期	126	11.69(8.71～15.53)	1.30(0.07～5.34)
中孕期	121	8.26(5.58～11.84)^a	1.27(0.09～4.96)
晚孕期	120	8.19(5.57～21.91)^b	1.32(0.05～6.59)
χ²值	?	170.928	0.695
P值	?	<0.001	0.706

表1 367例孕妇妊娠早、中、晚期血清TSH和FT₄参考值的比较[M(P_2.5～P_97.5)]

孕期	例数	FT₄ (pmol/L)	TSH (mIU/L)
早孕期	126	11.69(8.71～15.53)	1.30(0.07～5.34)
中孕期	121	8.26(5.58～11.84)^a	1.27(0.09～4.96)
晚孕期	120	8.19(5.57～21.91)^b	1.32(0.05～6.59)
χ²值	?	170.928	0.695
P值	?	<0.001	0.706

表2 470例孕妇在妊娠各期不同参考值检测血清TSH异常情的况比较[例数(%)]

参考值	TSH降低			TSH升高
参考值	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期
R1	6/187(3.2)	4/159(2.5)	2/124(1.6)	3/187(1.6)	0(0)	2/124(1.6)
R2	8/187(4.3)	9/157(5.7)	5/124(4.0)	27/187(14.4)	8/159(5.0)	9/124(7.3)
χ²值	0.297	2.005	1.323	20.874	8.206	4.661
P值	0.586	0.257	0.446	0.001	0.007	0.060

表2 470例孕妇在妊娠各期不同参考值检测血清TSH异常情的况比较[例数(%)]

参考值	TSH降低			TSH升高
参考值	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期
R1	6/187(3.2)	4/159(2.5)	2/124(1.6)	3/187(1.6)	0(0)	2/124(1.6)
R2	8/187(4.3)	9/157(5.7)	5/124(4.0)	27/187(14.4)	8/159(5.0)	9/124(7.3)
χ²值	0.297	2.005	1.323	20.874	8.206	4.661
P值	0.586	0.257	0.446	0.001	0.007	0.060

表3 470例孕妇在妊娠各期不同参考值检测甲状腺功能障碍的比较情况[例数(%)]

参考值	临床甲亢			亚临床甲亢			临床甲减			亚临床甲减
参考值	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期
R1	5/187(2.7)	4/159(2.5)	0(0)	1/187(0.5)	0(0)	2/124(1.6)	0(0)	0(0)	0(0)	3/187(1.6)	0(0)	2/124(1.6)
R3	3/187(1.6)	2/159(1.3)	1/124(0.8)	5/187(2.7)	7/159(4.4)	4/124(3.2)	13/187(6.9)	7/159(4.4)	8/124(6.5)	14/187(7.5)	1/159(0.6)	1/124(0.8)
χ²值	0.511	0.679	1.002	2.710	7.158	0.683	13.468	7.158	8.267	7.457	1.003	0.337
P值	0.724	0.685	1.000	0.215	0.015	0.684	0.001	0.015	0.007	0.011	1.000	1.000

表3 470例孕妇在妊娠各期不同参考值检测甲状腺功能障碍的比较情况[例数(%)]

参考值	临床甲亢			亚临床甲亢			临床甲减			亚临床甲减
参考值	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期	早孕期	中孕期	晚孕期
R1	5/187(2.7)	4/159(2.5)	0(0)	1/187(0.5)	0(0)	2/124(1.6)	0(0)	0(0)	0(0)	3/187(1.6)	0(0)	2/124(1.6)
R3	3/187(1.6)	2/159(1.3)	1/124(0.8)	5/187(2.7)	7/159(4.4)	4/124(3.2)	13/187(6.9)	7/159(4.4)	8/124(6.5)	14/187(7.5)	1/159(0.6)	1/124(0.8)
χ²值	0.511	0.679	1.002	2.710	7.158	0.683	13.468	7.158	8.267	7.457	1.003	0.337
P值	0.724	0.685	1.000	0.215	0.015	0.684	0.001	0.015	0.007	0.011	1.000	1.000

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Establish reference value of thyroid function and screen thyroid function disorder for pregnant women in Shantou area

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Establish reference value of thyroid function and screen thyroid function disorder for pregnant women in Shantou area