【摘要】：目的探討成都地區(qū)妊娠期婦女甲狀腺激素正常參考值范圍、妊娠婦女甲狀腺自身抗體陽性比率及甲狀腺自身抗體對孕婦甲狀腺功能的影響。方法隨機抽取2013年6月至2014年3月間在成都市婦女兒童中心醫(yī)院產(chǎn)科門診進行妊娠常規(guī)檢測的妊娠婦女696例,分別進行問卷調(diào)查、體格檢查、甲狀腺彩超和血清甲狀腺激素水平測定。妊娠期正常參考值范圍依據(jù)百分位數(shù)法確定,為同孕期健康妊娠婦女各指標的第2.5百分位數(shù)到第97.5百分位數(shù)范圍(P2.5~P97.5)。同時納入非妊娠婦女50例作為對照。結果在696例孕婦中,甲狀腺自身抗體陰性579例,甲狀腺自身抗體陽性117例,抗體陽性者占16.81%。579例甲狀腺自身抗體陰性的孕婦中包括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期的促甲狀腺激素(TSH)正常參考值范圍分別為:0.02~4.03mIU/L、0.02~4.05mIU/L、0.24~5.41mIU/L;游離甲狀腺素(FT4)正常參考值范圍分別為11.93~21.04pmol/L、11.23~19.22pmol/L、11.10~17.00pmol/L;游離三碘甲腺原氨酸(FT3)正常參考范圍分別為:3.85~6.27pmol/L、3.51~5.82pmol/L、3.18~4.97pmol/L。與非妊娠婦女相比,妊娠婦女無論甲狀腺自身抗體是否陽性,隨著孕周的增大,TSH中位數(shù)水平均逐漸增加,FT4和FT3的中位數(shù)水平均逐漸降低;但與甲狀腺自身抗體陰性的孕婦相比,甲狀腺自身抗體陽性的孕婦變化幅度更加明顯。在甲狀腺自身抗體陽性的孕婦中,臨床甲狀腺功能減退、亞臨床甲狀腺功能減退、亞臨床甲狀腺功能亢進的發(fā)病率分別為0.85%、15.38%、0.85%。結論妊娠期婦女甲狀腺激素水平不同于非妊娠狀態(tài),建立妊娠期特異性甲狀腺激素參考值范圍非常有必要。對于甲狀腺自身抗體陽性的孕婦,應在妊娠期全程監(jiān)測甲狀腺激素功能的變化。
[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.
【作者單位】： 四川大學華西醫(yī)院內(nèi)分泌代謝科;成都市第二人民醫(yī)院內(nèi)分泌科;成都市婦女兒童中心醫(yī)院婦產(chǎn)科;
【分類號】：R714.1

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