延安地区妊娠期妇女甲状腺激素水平参考范围的建立及甲状腺功能分析

Establishment of Reference Range of Thyroid Hormone Levels of Pregnant Women in Yan’an Area and Analysis of Thyroid Function

摘要: 目的：建立延安地区不同妊娠期妇女特异性甲状腺功能指标的参考范围，为本地区妊娠期妇女甲状腺疾病的诊治及管理提供依据。方法：选择2019年1月至12月在延安大学附属医院产科门诊健康体检的妊娠妇女1026例，作为本研究妊娠期甲状腺激素水平参考范围的“标准人群”，选择同期门诊孕前检查的育龄期非妊娠期妇女311例作为对照。化学发光法检测受检者血清TSH、FT4、FT3、TG-Ab、TPO-Ab水平，中位数(M)及双侧限值95% (P 2.5~P 97.5)建立甲状腺功能指标的参考范围。结果：1) 妊娠早期血清TSH、FT4、FT3分别为：(0.07~4.62) mIU/L，(11.76~21.59) pmol/L，(3.57~5.85) pmol/L；妊娠中期TSH、FT4、FT3分别为(0.13~4.89) mIU/L，(10.53~19.53) pmol/L，(3.25~5.49) pmol/L；妊娠晚期TSH、FT4、FT3分别为：(0.36~5.69) mIU/L，(8.39~16.88) pmol/L；(2.63~4.89) pmol/L。血清TSH在孕早期较低，随妊娠周数的增加而上升，至孕晚期达高峰，妊娠期与非妊娠期比较，不同妊娠期组内比较，均呈升高趋势，差异有统计学意义(P < 0.01)，血清FT4在孕早期较非孕期高，此后随妊娠周数增加而下降，至孕晚期降至最低水平，各组内比较血清FT4降低趋势有统计学差异(P < 0.01)；血清FT3在孕早期和孕前相当(P > 0.05)，此后随着妊娠周数的增加而降低，至孕晚期达最低，各组降低趋势有统计学意义(P < 0.01)；2) 按本研究建立的妊娠期参考值范围诊断标准：妊娠期甲减、亚甲减、甲亢、亚甲亢、低甲状腺素血症的总患病率(N%)约为0.58%、7.12%、0.58%、1.36%、2.05%。结论：延安地区妊娠期妇女血清甲状腺激素水平与非妊娠期存在差异，不同妊娠期妇女血清甲状腺激素水平呈现地区特异性变化。建立本地区甲状腺激素水平参考范围，以有效减少妊娠期甲状腺疾病的漏诊和误诊。

Abstract: Objective: To establish the reference peripheries of the specific thyroid function indexes of different pregnant women in Yan’an area, so as to provide the basis for the diagnosis, treatment and management of thyroid diseases in pregnant women in this area. Methods: A total of 1026 pregnant women who had a healthy physical examination in the obstetrical clinic of Yan’an University Affiliated Hospital from January to December 2019 were selected as the “standard population” for the reference range of thyroid hormone levels during pregnancy established in this study, and the childbearing age for pre-pregnancy examinations in the outpatient clinic during the same period was selected. 311 non-pregnant women served as controls. Chemiluminescence method was used to detect serum TSH, FT4, FT3, TG-Ab, TPO-Ab levels, median (M) and bilateral limit 95% (P 2.5 - P 97.5) to establish the reference range of thyroid function indexes Results: 1) Serum TSH, FT4 and FT3 in early pregnancy were: (0.07 - 4.62) mIU/L, (11.76 - 21.59) pmol/L, (3.57 - 5.85) pmol/L; TSH, FT4, FT3 in the second trimester They are (0.13 - 4.89) mIU/L, (10.53 - 19.53) pmol/L, (3.25 - 5.49) pmol/L; TSH, FT4 and FT3 in the third trimester are: (0.36 - 5.69) mIU/L, (8.39 - 16.88) pmol/L; (2.63 - 4.89) pmol/L. The median serum TSH is lower in the first trimester, and rises with the increase in the number of weeks of pregnancy, reaching a peak in the third trimester and exceeding the non-pregnancy level; comparisons between the pregnancy period and the non-pregnancy period, and the comparison within different pregnancy periods, all show an increase high trend, the difference was statistically significant (P < 0.01). The median serum FT4 was higher in the first trimester than in the non-pregnancy period, and then decreased with the increase in the number of weeks of pregnancy, and reached the lowest level in the third trimester. Compare serum FT4 in each group, the decreasing trend was statistically different (P < 0.01); the median serum FT3 was the same in the first trimester and before pregnancy, and then decreased with the increase in the number of weeks of pregnancy, and reached the lowest point in the third trimester. The difference between the groups was statistically significant (P < 0.01); 2) According to the diagnostic criteria of the pregnancy reference value range established in this study: the total prevalence (N%) of hypothyroidism, hypothyroidism, hyperthyroidism, hyperthyroidism, and hypothyroxinemia during pregnancy is about 0.58%, 7.12%, 0.58%, 1.36%, 2.05%. Conclusion: The serum thyroid hormone levels of pregnant women in Yan’an are different from those in non-pregnant women, and the serum thyroid hormone levels of women in different pregnancy periods show regional specific changes. Establish the reference range of the laboratory in this region to effectively reduce the missed diagnosis and misdiagnosis of thyroid diseases during pregnancy.