妊娠期特异性甲状腺相关指标的参考范围 ; Establishment of reference ranges for thyroid-related indicators in normal pregnant women

目的 建立妊娠期特异性甲状腺相关指标参考范围,探讨孕早期血清促甲状腺激素(thyroid stimulating hormone,TSH)参考范围的制定方法.方法 收集2013年6月至2014年4月在北京大学第一医院就诊的早孕妇女548名;筛选上述人群中符合美国临床生化研究院推荐标准:单胎妊娠、无妊娠不良结局及产科并发症的孕妇254名,采用序贯的研究方法建立妊娠特异参考范围.检测血清TSH、总甲状腺素(TT4)、游离甲状腺素(FT4),应用热消解法检测部分孕妇的尿碘水平.本研究通过北京大学第一医院临床研究伦理委员会审查.结果 研究获得的我院妊娠期特异性甲状腺相关指标参考范围如下:T1期参考范围:TSH 0.23 ～4.08 mU/L,TT492.59～186.25 nmol/L,丌413.36 ～20.81pmol/L;T2期:TSH 0.78 ～4.25 mU/L,TT4 103.20 ～ 180.95 nmol/L,FT4 11.57 ～ 16.62 pmol/L;T3期:TSH 0.65～4.52 mU/L,TT4 78.20 ～ 174.70 nmol/L,FT410.01 ～ 20.57 pmol/L.与孕4～6周组比较,孕7～12周组血清TSH水平有降低趋势,但差异无统计学意义(P=0.063).部分孕妇T1 (n=95)、T2(n=199)、T3(n=70)期的尿碘中位数分别为211.60、195.55、198.65 μg/L,均属于碘适量范围.结论 妊娠期妇女血清甲状腺激素水平与试剂盒的参考范围存在差异,且妊娠各期之间亦存在明显不同.在早孕期,分别建立孕4～6周、孕7～12周的血清TSH参考范围可能更为合理. ; Objective To establish the gestational age-specific reference ranges for thyroid-related indicators of pregnant women in our hospital,especially for serum thyroid stimulating hormone (TSH) in the first trimester.Methods A total of 548 pregnant women in the first trimester were collected in Peking University First Hospital from June 2013 to April 2014.Among them,254 pregnant women with single fetus who conformed to the National Academy of Clinical Biochemistry criteria,without adverse pregnancy outcomes and obstetric complications,were enrolled in the current study.To establish their own self-sequential longitudinal reference intervals,serum TSH,total thyroxine (TT4) and free thyroxine (FT4) levels were measured using Siemens detection kits during three different trimesters.Urine iodine (UI) was measured using digestion instrument in some of the pregnant women.Results The gestational age-specific reference ranges for thyroid-related indicators of pregnant women in our hospital were as follows:in the first trimester:TSH 0.23-4.08 mU/L,TT4 92.59-186.25 nmol/L,FT4 13.36-20.81 pmoL/L;in the second trimester:TSH 0.78-4.25 mU/L,TT4 103.20-180.95 nmoL/L,FT4 11.57-16.62 pmol/L;in the third trinmester:TSH 0.65-4.52 mU/L,TT4 78.20-174.70 nmol/L,FT4 10.01-20.57 pmol/L.The median level of TSH during 7 to 12 ...