發(fā)布時(shí)間：2018-03-02 14:22

  本文選題：妊娠期　切入點(diǎn)：參考值　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：甲狀腺激素作為重要的內(nèi)分泌激素參與人體新陳代謝、生長(zhǎng)發(fā)育及多器官功能活動(dòng)。甲狀腺功能狀態(tài)對(duì)妊娠的正常維持及胎兒正常發(fā)育非常重要。妊娠期甲狀腺疾病使妊娠期各種并發(fā)癥顯著增多，并可能導(dǎo)致胎兒畸形、甲狀腺功能異常、生長(zhǎng)受限、低出生體重兒，還可能影響胎兒神經(jīng)系統(tǒng)發(fā)育。妊娠期間甲狀腺激素水平降低，可能造成胎兒腦發(fā)育障礙，這種發(fā)育障礙具有不可逆性，明顯影響智力水平。因此，母體甲狀腺功能除對(duì)妊娠本身產(chǎn)生影響外，對(duì)其子代亦起著重要的作用，妊娠期間正常的甲狀腺激素分泌是維持子代正常發(fā)育的重要條件。 正常妊娠期間，甲狀腺功能面臨著復(fù)雜的生理學(xué)變化，這些變化使妊娠期甲狀腺激素水平發(fā)生相應(yīng)變化。由于妊娠期甲狀腺特殊的生理變化，妊娠期婦女甲狀腺激素水平與非妊娠婦女不同，如果以非妊娠健康人甲狀腺激素參考值判定妊娠期甲狀腺功能，會(huì)增加妊娠期甲狀腺疾病誤診和漏診率，增加臨床工作中診斷和治療妊娠期甲狀腺疾病的困難。因此2012年7月中華醫(yī)學(xué)會(huì)內(nèi)分泌分會(huì)與圍產(chǎn)醫(yī)學(xué)分會(huì)聯(lián)合頒布我國(guó)的《妊娠和產(chǎn)后甲狀腺疾病診治指南》，指出不同地區(qū)、不同種族、不同的碘攝入狀況以及妊娠期特殊的生理代謝對(duì)甲狀腺疾病的發(fā)病率均可造成影響，建議各個(gè)地區(qū)和醫(yī)院應(yīng)該建立自己的妊娠期特異的血清甲狀腺功能參考范圍。目前國(guó)內(nèi)僅少數(shù)地區(qū)建立了特異性的妊娠期參考值，河南省作為人口大省尚無孕期特異性參考值的相關(guān)研究。本研究測(cè)定鄭州地區(qū)健康妊娠婦女的不同孕期的血清甲狀腺激素水平，研究其變化規(guī)律，建立鄭州地區(qū)漢族的妊娠期血清甲狀腺激素功能指標(biāo)參考值，減少妊娠期甲狀腺疾病的漏診和誤診，對(duì)妊娠期甲狀腺疾病早期診斷、早期干預(yù)，以期最大程度的減少母兒不良妊娠結(jié)局，具有一定的臨床意義。 目的 建立鄭州地區(qū)健康妊娠婦女不同妊娠時(shí)期的血清甲狀腺激素激素水平的正常參考范圍，研究其變化規(guī)律，為早期診斷和治療妊娠期甲狀腺疾病提供臨床依據(jù)。 資料和方法 1研究對(duì)象與分組 選擇2013年9月～2013年12月在鄭州大學(xué)第三附屬醫(yī)院就診的20～35歲的健康妊娠期婦女，隨機(jī)選取583名作為研究組，并按孕周分為妊娠早、中、晚期三組，同時(shí)選取血清甲狀腺抗體陰性的非妊娠健康婦女187名作為對(duì)照組。同時(shí)選取檢測(cè)血清甲狀腺過氧化物酶抗體（TPOAb）陽(yáng)性的妊娠期婦女166人進(jìn)入TPOAb陽(yáng)性組。 2入選標(biāo)準(zhǔn) 入選標(biāo)準(zhǔn)參考美國(guó)臨床生化學(xué)院（NABC）推薦的標(biāo)準(zhǔn)，要求無甲狀腺疾病病史和家族史、無代謝綜合征病史和家族史，無可觸及的甲狀腺腫、未服用甲狀腺藥物和含碘藥物，生長(zhǎng)居住于鄭州地區(qū)、漢族、平時(shí)食用加碘鹽。對(duì)于妊娠期婦女要求自然受孕、無妊娠期并發(fā)癥、單胎。研究組和對(duì)照組婦女要求血清甲狀腺抗體陰性。所有研究對(duì)象均詳細(xì)詢問一般情況、孕產(chǎn)史、健康狀況、飲食習(xí)慣、有無甲狀腺病史及其他病史，并進(jìn)行體格檢查，填寫統(tǒng)一設(shè)計(jì)的調(diào)查表。 3實(shí)驗(yàn)方法 所有入選者均清晨空腹抽血，靜置2小時(shí)后離心取血清，采用化學(xué)發(fā)光酶免疫分析法檢測(cè)血清中促甲狀腺激素（TSH）、游離甲狀腺素（FT4）、甲狀腺過氧化物酶抗體（TPOAb）的值。 4統(tǒng)計(jì)學(xué)處理 所有數(shù)據(jù)輸入Excel表格，應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，對(duì)于正態(tài)分布的變量比較采用獨(dú)立樣本t檢驗(yàn)，甲狀腺激素功能指標(biāo)多組比較采用非參數(shù)檢驗(yàn)中的Kruskal-wallis檢驗(yàn)，組間比較使用Mann-Whitney檢驗(yàn)。所有甲狀腺激素功能指標(biāo)的參考值采用雙側(cè)限制的95%參考值范圍，結(jié)果用中位數(shù)M及雙側(cè)限值（P2.5和P97.5）表示。a=0.05作為檢驗(yàn)水準(zhǔn)。 結(jié)果 1妊娠期婦女不同孕期血清TSH參考值及變化 妊娠期婦女甲狀腺激素水平與非妊娠期婦女多組比較差異有統(tǒng)計(jì)學(xué)差異（P0.01）。妊娠期婦女血清TSH在妊娠早、中、晚期參考值范圍分別為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在妊娠早期有明顯下降，與非妊娠組TSH中位值相比妊娠早期降低了34.80%，有統(tǒng)計(jì)學(xué)差異（P0.01），此后TSH隨孕周逐漸上升，至妊娠晚期與非妊娠期比較無統(tǒng)計(jì)學(xué)差異。 2妊娠期婦女不同孕期血清FT4參考值及變化 妊娠期婦女血清FT4在妊娠早、中、晚期參考值范圍分別為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較非妊娠組無明顯統(tǒng)計(jì)學(xué)差異，至妊娠中期及晚期逐漸下降，妊娠中晚期較妊娠早期明顯降低，較非妊娠組亦明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.01)，妊娠晚期血清FT4比非妊娠組中位值低28.86%。 3血清TPOAb陽(yáng)性與血清TSH的關(guān)系 所有妊娠期婦女中甲狀腺自身抗體陽(yáng)性率為7.48%，其中TPOAb陽(yáng)性率占5.38%。TPOAb陽(yáng)性的妊娠期早、中、晚期婦女血清TSH值明顯高于TPOAb陰性的妊娠早、中、晚期婦女的血清TSH值，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論 1.妊娠期婦女血清甲狀腺激素水平與非妊娠期婦女存在明顯差異，且妊娠各期之間亦存在明顯差異，，因此建立鄭州地區(qū)妊娠期婦女甲狀腺激素參考值具有一定臨床意義。 2.本研究參考值為鄭州地區(qū)漢族妊娠期婦女特異性甲狀腺激素參考范圍提供了依據(jù)。
[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.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.256

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相關(guān)期刊論文 前1條

1 李昭瑛,楊瑞芬,陳祖培,馬泰;甲狀腺激素缺乏對(duì)大鼠海馬區(qū)乙酰膽堿相關(guān)酶發(fā)育影響的觀察[J];中華內(nèi)分泌代謝雜志;1998年06期

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