现代妇产科进展2016，Vol.25Issue(4)：269-272,4.DOI:10.13283/j.cnki.xdfckjz.2016.04.008
成都地区妊娠期特异性甲状腺激素水平参考值范围的探讨及临床分析
Establishing the reference range of pregnancy-specific thyroid hormone levels in chengdu area
黄璐 1罗丹 1王利民 1周新娥 1王露颖1
作者信息
- 1. 成都市妇女儿童中心医院，成都 610000
- 折叠
摘要
Abstract
Objective:To establish the reference range of values of trimester-specific thyroid functions in Chengdu area. Method:After screening pregnant women in different trimes-ters of pregnancy who visit Chengdu Women and Children's Central Hospital,600 cases were selected as the "standard group". The chemiluminescence method was used to measure values of thyroid stimulating hormone (TSH),free thyroxine (FT4) and free triiodothyronine (FT3). Characteristics of how these values change during each trimester were analyzed,and the refer-ence range of each trimester-specific thyroid function parameter was established. Subsequently,3 ,249 cases of pregnant women in different trimesters were collected to validate whether the ref-erence range complies with the standard of diagnosing subclinical hyperthyroidism ( SHT) . Re-sults:(1)The median value of serum TSH as well as the 95% reference range during the 1st trimester were 1. 29 mIU/L(0. 27~3. 87 mIU/L),with FT3 being 4. 98pg/ml (4. 5~5. 58pg/ml) and FT4 being 1. 22 ng/dl (1~1. 45ng/dl);the serum TSH during the 2nd trimester was 1. 86mIU/L (0. 13~4. 19mIU/L),with FT3 being 4. 94pg/ml (4. 37 ~5. 6pg/ml) and FT4 being 1. 16ng/dl (0. 97~1. 42ng/dl);the serum TSH during the 3rd trimester was 2. 24mIU/L (0. 36~4. 63mIU/L),with FT3 being 4. 61 pg/ml (4. 08 ~5. 21pg/ml) and FT4 being 1. 01ng/dl (0. 84~1. 54ng/dl). (2)Diagnoses were made according to the trimester-specific reference range of values as proposed by guidelines of American Thyroid Association ( ATA) in 2011,the criteria of reference values established in this study,and the standard applicable to non-gestation as made by our hospital respectively. The overall prevalence of SHT was 21. 2%(688/3249),6. 5% (210/3249) and 2. 5% (82/3249). Conclusion:(1) Levels of thyroid functions parameters in pregnancy fluctuate as the gestation age increases. The TSH value was lowest during the 1st trimester,gradually rising as pregnancy progresses and reaching the high-est level during the 3rd trimester. Values of FT4 and FT3 were highest during the 1st trimester, gradually falling as pregnancy progresses and reaching the lowest level during the 3rd trimester. (2)Accuracy of the reference range established in this study in diagnosing SHT in pregnancy and figuring out the prevalence was basically as high as that presented in other domestic case reports. However,the prevalence of SHT as diagnosed based on the ATA standard was apparent-ly higher than that based on the reference range established in this study,and the difference was statistically significant,which shows the ATA standard of diagnosis was unsuitable for acting as the basis of diagnosing SHT pregnant women in our area develop. (3)The prevalence of SHT as diagnosed based on the trimester-specific reference range established in this study was apparent-ly higher than that diagnosed using non-gestation standards,and the difference was statistically significant. Therefore,using the reference level of thyroid functions during non-gestational peri-ods may lead to misdiagnosis and missed diagnosis of pregnancy associated with thyroid disea-ses,and it is of vital importance to work out the reference range of pregnancy-specific values ap-plicable to our area.关键词
妊娠/参考值范围/促甲状腺素/游离甲状腺素Key words
Pregnancy/Reference range of values/Thyroid stimulating hormone/Free thyroxine分类
医药卫生引用本文复制引用
黄璐,罗丹,王利民,周新娥,王露颖..成都地区妊娠期特异性甲状腺激素水平参考值范围的探讨及临床分析[J].现代妇产科进展,2016,25(4):269-272,4.
