成都地区妊娠妇女甲状腺激素正常参考值建立及甲状腺自身抗体对孕妇甲状腺功能的影响

发布时间：2018-08-22 07:32

【摘要】：目的探讨成都地区妊娠期妇女甲状腺激素正常参考值范围、妊娠妇女甲状腺自身抗体阳性比率及甲状腺自身抗体对孕妇甲状腺功能的影响。方法随机抽取2013年6月至2014年3月间在成都市妇女儿童中心医院产科门诊进行妊娠常规检测的妊娠妇女696例,分别进行问卷调查、体格检查、甲状腺彩超和血清甲状腺激素水平测定。妊娠期正常参考值范围依据百分位数法确定,为同孕期健康妊娠妇女各指标的第2.5百分位数到第97.5百分位数范围(P2.5~P97.5)。同时纳入非妊娠妇女50例作为对照。结果在696例孕妇中,甲状腺自身抗体阴性579例,甲状腺自身抗体阳性117例,抗体阳性者占16.81%。579例甲状腺自身抗体阴性的孕妇中包括T1期(孕1~12周)257例、T2期(孕13~27周)202例、T3期(孕28~40周)120例。T1、T2、T3期的促甲状腺激素(TSH)正常参考值范围分别为:0.02~4.03mIU/L、0.02~4.05mIU/L、0.24~5.41mIU/L;游离甲状腺素(FT4)正常参考值范围分别为11.93~21.04pmol/L、11.23~19.22pmol/L、11.10~17.00pmol/L;游离三碘甲腺原氨酸(FT3)正常参考范围分别为:3.85~6.27pmol/L、3.51~5.82pmol/L、3.18~4.97pmol/L。与非妊娠妇女相比,妊娠妇女无论甲状腺自身抗体是否阳性,随着孕周的增大,TSH中位数水平均逐渐增加,FT4和FT3的中位数水平均逐渐降低;但与甲状腺自身抗体阴性的孕妇相比,甲状腺自身抗体阳性的孕妇变化幅度更加明显。在甲状腺自身抗体阳性的孕妇中,临床甲状腺功能减退、亚临床甲状腺功能减退、亚临床甲状腺功能亢进的发病率分别为0.85%、15.38%、0.85%。结论妊娠期妇女甲状腺激素水平不同于非妊娠状态,建立妊娠期特异性甲状腺激素参考值范围非常有必要。对于甲状腺自身抗体阳性的孕妇,应在妊娠期全程监测甲状腺激素功能的变化。
[Abstract]:Objective to investigate the normal reference range of thyroid hormones in pregnant women, the positive rate of thyroid autoantibodies and the effect of thyroid autoantibodies on thyroid function of pregnant women in Chengdu area. Methods A total of 696 pregnant women were randomly selected from June 2013 to March 2014 for routine pregnancy examination in the Department of Obstetrics and Obstetrics Department of Chengdu Women and Children's Central Hospital. Thyroid ultrasound and serum thyroid hormone levels were measured. The normal reference range of pregnancy was determined by the method of percentile, which was the range from the 2.5 percentile to the 97.5 percentile (P2.5~P97.5) of the healthy pregnant women during the same pregnancy. At the same time, 50 cases of non-pregnant women were included as control. Results among the 696 pregnant women, 579 were thyroid autoantibody negative and 117 were thyroid autoantibody positive. The normal reference range of thyroid stimulating hormone (TSH) of 120 cases of T _ 3 stage (gestation 2840 weeks) and 120 cases of T _ 3 + T _ 2T _ 3 stage were as follows:% 0.024.03mIUP / L 0.02mIUL / L = 0.245.41mIUP / L, respectively, among 16.81.579 pregnant women with negative thyroid autoantibodies, including 257 cases of stage T _ 1 (1 / 12 weeks of pregnancy), 202 cases of stage T _ 3 (gestation 2840 weeks) and 120 cases (n = 120) of T _ 1T _ 2T _ 3. The normal reference ranges of thyrotropin (TSH) were as follows:% 0.024.03mIUP / L 0.02mIUL / L The normal reference range of thyroxine (FT4) is 11.93 / 21.04pmol / L ~ (11.23) ~ 19.22 pmol / L ~ (11.10) ~ 17.00 pmol / L, and the normal reference range of free triiodothyronine (FT3) is 3.515.82pmol / L ~ (3.1897) pmol / L ~ (-1) ~ 3.1897 pmol 路L ~ (-1), respectively, and the normal reference range of free triiodothyronine (FT3) is 3.515.82pmol / L ~ (3.1897) pmol 路L ~ (-1). No matter whether thyroid autoantibodies were positive or not, the median levels of FT4 and FT3 decreased gradually with the increase of gestational weeks in pregnant women, but compared with those of pregnant women with negative thyroid autoantibodies, the median levels of FT4 and FT3 decreased gradually in pregnant women with negative thyroid autoantibodies. The changes of thyroid autoantibody positive pregnant women were more obvious. The incidence of clinical hypothyroidism and subclinical hyperthyroidism in pregnant women with positive thyroid autoantibodies was 0.85 / 15.38 / 0.85 respectively. Conclusion the level of thyroid hormone in pregnant women is different from that in non-pregnant women, so it is necessary to establish the reference range of specific thyroid hormones during pregnancy. For pregnant women with positive thyroid autoantibodies, thyroid hormone function should be monitored throughout pregnancy.
【作者单位】：四川大学华西医院内分泌代谢科;成都市第二人民医院内分泌科;成都市妇女儿童中心医院妇产科;
【分类号】：R714.1

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