郑州地区妊娠期妇女血清甲状腺激素水平参考值的相关研究

发布时间：2018-03-02 14:22

本文选题：妊娠期　切入点：参考值　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：甲状腺激素作为重要的内分泌激素参与人体新陈代谢、生长发育及多器官功能活动。甲状腺功能状态对妊娠的正常维持及胎儿正常发育非常重要。妊娠期甲状腺疾病使妊娠期各种并发症显著增多，并可能导致胎儿畸形、甲状腺功能异常、生长受限、低出生体重儿，还可能影响胎儿神经系统发育。妊娠期间甲状腺激素水平降低，可能造成胎儿脑发育障碍，这种发育障碍具有不可逆性，明显影响智力水平。因此，母体甲状腺功能除对妊娠本身产生影响外，对其子代亦起着重要的作用，妊娠期间正常的甲状腺激素分泌是维持子代正常发育的重要条件。正常妊娠期间，甲状腺功能面临着复杂的生理学变化，这些变化使妊娠期甲状腺激素水平发生相应变化。由于妊娠期甲状腺特殊的生理变化，妊娠期妇女甲状腺激素水平与非妊娠妇女不同，如果以非妊娠健康人甲状腺激素参考值判定妊娠期甲状腺功能，会增加妊娠期甲状腺疾病误诊和漏诊率，增加临床工作中诊断和治疗妊娠期甲状腺疾病的困难。因此2012年7月中华医学会内分泌分会与围产医学分会联合颁布我国的《妊娠和产后甲状腺疾病诊治指南》，指出不同地区、不同种族、不同的碘摄入状况以及妊娠期特殊的生理代谢对甲状腺疾病的发病率均可造成影响，建议各个地区和医院应该建立自己的妊娠期特异的血清甲状腺功能参考范围。目前国内仅少数地区建立了特异性的妊娠期参考值，河南省作为人口大省尚无孕期特异性参考值的相关研究。本研究测定郑州地区健康妊娠妇女的不同孕期的血清甲状腺激素水平，研究其变化规律，建立郑州地区汉族的妊娠期血清甲状腺激素功能指标参考值，减少妊娠期甲状腺疾病的漏诊和误诊，对妊娠期甲状腺疾病早期诊断、早期干预，以期最大程度的减少母儿不良妊娠结局，具有一定的临床意义。目的建立郑州地区健康妊娠妇女不同妊娠时期的血清甲状腺激素激素水平的正常参考范围，研究其变化规律，为早期诊断和治疗妊娠期甲状腺疾病提供临床依据。资料和方法 1研究对象与分组选择2013年9月～2013年12月在郑州大学第三附属医院就诊的20～35岁的健康妊娠期妇女，随机选取583名作为研究组，并按孕周分为妊娠早、中、晚期三组，同时选取血清甲状腺抗体阴性的非妊娠健康妇女187名作为对照组。同时选取检测血清甲状腺过氧化物酶抗体（TPOAb）阳性的妊娠期妇女166人进入TPOAb阳性组。 2入选标准入选标准参考美国临床生化学院（NABC）推荐的标准，要求无甲状腺疾病病史和家族史、无代谢综合征病史和家族史，无可触及的甲状腺肿、未服用甲状腺药物和含碘药物，生长居住于郑州地区、汉族、平时食用加碘盐。对于妊娠期妇女要求自然受孕、无妊娠期并发症、单胎。研究组和对照组妇女要求血清甲状腺抗体阴性。所有研究对象均详细询问一般情况、孕产史、健康状况、饮食习惯、有无甲状腺病史及其他病史，并进行体格检查，填写统一设计的调查表。 3实验方法所有入选者均清晨空腹抽血，静置2小时后离心取血清，采用化学发光酶免疫分析法检测血清中促甲状腺激素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）的值。 4统计学处理所有数据输入Excel表格，应用SPSS17.0软件进行统计学分析，对于正态分布的变量比较采用独立样本t检验，甲状腺激素功能指标多组比较采用非参数检验中的Kruskal-wallis检验，组间比较使用Mann-Whitney检验。所有甲状腺激素功能指标的参考值采用双侧限制的95%参考值范围，结果用中位数M及双侧限值（P2.5和P97.5）表示。a=0.05作为检验水准。结果 1妊娠期妇女不同孕期血清TSH参考值及变化妊娠期妇女甲状腺激素水平与非妊娠期妇女多组比较差异有统计学差异（P0.01）。妊娠期妇女血清TSH在妊娠早、中、晚期参考值范围分别为1.48（0.27~4.38）mIU/L、1.84（0.55~4.57）mIU/L、2.21（0.71~5.80）mIU/L。TSH在妊娠早期有明显下降，与非妊娠组TSH中位值相比妊娠早期降低了34.80%，有统计学差异（P0.01），此后TSH随孕周逐渐上升，至妊娠晚期与非妊娠期比较无统计学差异。 2妊娠期妇女不同孕期血清FT4参考值及变化妊娠期妇女血清FT4在妊娠早、中、晚期参考值范围分别为14.56（10.17~19.91）pmol/L、11.73（8.28~15.87）pmol/L、10.45（7.44~14.17）pmol/L。妊娠早期血清FT4较非妊娠组无明显统计学差异，至妊娠中期及晚期逐渐下降，妊娠中晚期较妊娠早期明显降低，较非妊娠组亦明显降低，差异有统计学意义（P0.01)，妊娠晚期血清FT4比非妊娠组中位值低28.86%。 3血清TPOAb阳性与血清TSH的关系所有妊娠期妇女中甲状腺自身抗体阳性率为7.48%，其中TPOAb阳性率占5.38%。TPOAb阳性的妊娠期早、中、晚期妇女血清TSH值明显高于TPOAb阴性的妊娠早、中、晚期妇女的血清TSH值，差异有统计学意义（P0.05）。结论 1.妊娠期妇女血清甲状腺激素水平与非妊娠期妇女存在明显差异，且妊娠各期之间亦存在明显差异，，因此建立郑州地区妊娠期妇女甲状腺激素参考值具有一定临床意义。 2.本研究参考值为郑州地区汉族妊娠期妇女特异性甲状腺激素参考范围提供了依据。
[Abstract]:Thyroid hormone as an important endocrine hormone involved in human growth and development and The new supersedes the old., organ function activities. Thyroid function on the maintenance of normal pregnancy and fetal normal development is very important. Gestational thyroid disease to pregnancy complications were significantly increased, and may cause fetal malformation, abnormal thyroid function, growth retardation, low birth weight infants. May also affect the development of fetal nervous system. To reduce the level of thyroid hormone during pregnancy may cause fetal brain development, the disorder has not reversible, significantly affect the level of intelligence. Therefore, the effects of maternal thyroid function in pregnancy itself, the offspring also plays an important role in normal thyroid hormone during pregnancy during secretion is an important condition for maintaining the normal development of the offspring.
During normal pregnancy, thyroid function is facing the complex physiological changes, these changes make pregnancy thyroid hormone level changes. Due to physiological changes during pregnancy thyroid specific, thyroid hormone levels in different pregnant women and non pregnant women, if the non pregnant healthy thyroid hormone determination of reference value of thyroid function in pregnancy will increase of thyroid disease in pregnancy misdiagnosis and missed diagnosis rate, increase the diagnosis and treatment of thyroid diseases during pregnancy. Therefore difficulties in the clinical work of the Chinese Medical Association in July 2012 jointly issued the endocrine branch and perinatal medicine branch of China "and the diagnosis and treatment of pregnancy postpartum thyroid disease guidelines >, pointed out that different regions, different races, different iodine intake and metabolism during pregnancy specific incidence of thyroid disease rate may affect all regions and hospitals should be recommended The reference range of serum thyroid function in the establishment of their own specific pregnancy. At present, only a few regions to establish a pregnancy specific reference value, related research in Henan Province as a big province in population there is no pregnancy specific reference value. This study was in Zhengzhou healthy pregnant women in different pregnancy serum levels of thyroid hormones, research the variation of the pregnancy hormone serum thyroid function index of Han nationality in Zhengzhou area establish the reference value, reduce the misdiagnosis and missed diagnosis of thyroid diseases during pregnancy on pregnancy, early diagnosis of thyroid disease, early intervention, in order to reduce the maximum degree of maternal and fetal adverse pregnancy outcomes, has certain clinical significance.
objective
Objective to establish the normal reference range of serum thyroid hormone levels in healthy pregnant women in Zhengzhou area during different pregnancy periods, and to study their changing rules, so as to provide a clinical basis for early diagnosis and treatment of thyroid diseases during pregnancy.
Information and methods
1 research objects and groups
Between September 2013 and December 2013 in the Affiliated Hospital of Zhengzhou University third healthy 20~35 year old pregnant women, 583 were randomly selected as the study group, and according to gestational age divided into early pregnancy, in late three, non pregnancy group, 187 healthy women as control group were serum thyroid antibody negative. At the same time selection of detection of serum thyroid peroxidase antibody (TPOAb) positive pregnant women 166 people into the TPOAb positive group.
2 criteria for admission
The selected standard reference to the Clinical Biochemistry Institute (NABC) recommended standard, no history of thyroid disease and family history, no history and family history of metabolic syndrome, no palpable goiter, not taking thyroid medicines and drugs containing iodine, growth of living in the Zhengzhou area, the Han nationality, usually eat iodized salt for pregnant women. Natural pregnancy, no pregnancy complications, single fetus. The study group and the control group of women's serum thyroid antibody negative. All subjects were asked in detail about the general situation, pregnancy history, health status, diet habit, there is no history of thyroid and other medical history and physical examination, fill out the questionnaire.
3 experimental method
All the subjects were fasting blood in the morning. After 2 hours of stationary blood, serum was extracted by centrifugation. Serum thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibody (TPOAb) were detected by chemiluminescent enzyme immunoassay.
4 statistical treatment
All the data were input into Excel form, SPSS17.0 software was used for statistical analysis, the normal distribution of the variables were compared using independent samples t test, multiple thyroid hormone function index Kruskal-wallis test was used to compare nonparametric test, comparison between groups using Mann-Whitney test. All the thyroid hormone function index of the reference value of the bilateral 95% reference value limit results the median range, M and bilateral limits (P2.5 and P97.5).A=0.05 as the standard test.
Result
1 pregnant women's serum TSH reference values and changes during different stages of pregnancy
There were significant differences in pregnancy thyroid hormone level and the difference between the non pregnant women group (P0.01). Serum TSH in pregnant women in late pregnancy early, the reference value range was 1.48 (0.27~4.38) mIU/L, 1.84 (0.55~4.57) mIU/L, 2.21 (0.71~5.80) mIU/L.TSH were significantly decreased in early pregnancy, and compared with non pregnancy early pregnancy reduced 34.80% value in the TSH group, there was significant difference (P0.01), then TSH with the gestational weeks increased gradually in late trimester of pregnancy and non pregnancy had no significant difference.
2 pregnant women's serum FT4 reference values and changes during different stages of pregnancy
Pregnant women serum FT4 in early pregnancy, and the late reference range were 14.56 (10.17~19.91) pmol/L, 11.73 (8.28~15.87) pmol/L, 10.45 (7.44~14.17) pmol/L. early pregnancy serum FT4 than non pregnant group there were no significant differences between the middle and late pregnancy, to gradually decline, early was significantly lower than that in late pregnancy compared with the non pregnant group, also significantly reduced, the difference was statistically significant (P0.01), low 28.86%. value of the late pregnancy group than in serum FT4
The relationship between serum TPOAb positive and serum TSH in 3
The positive rate of thyroid autoantibodies in all pregnant women was 7.48%, of which the positive rate of TPOAb was 5.38%.TPOAb positive. The serum TSH value of middle and late stage women was significantly higher than that of TPOAb negative women. The difference of serum TSH between middle and late women was statistically significant (P0.05).
conclusion
1. there is a significant difference in serum thyroid hormone levels between pregnant women and non pregnant women, and there are significant differences between different stages of pregnancy. Therefore, establishing thyroid hormone reference value of pregnant women in Zhengzhou area has certain clinical significance.
2. the reference value of the study provides a basis for the reference range of specific thyroid hormone for pregnant women of the Han nationality in Zhengzhou.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

【参考文献】