摘要
目的分析健康初产妇妊娠20周前甲状腺功能的变化，建立妊娠20周前孕周特异的甲状腺功能参考范嗣，探讨妊娠期甲状腺功能异常的患病情况。方法对2010年9月至2011年6月期间在首都医科大学附属北京友谊医院产科门诊行产前检查的1605例单胎健康初产妇和200例同期行妊娠前检查的健康非妊娠妇女进行研究，其中1243例排除甲状腺疾病高危因素的初产妇作为制定正常参考范围的“标准人群”。采用化学发光免疫法检测促甲状腺激素（thyroid stimulating hormone，TSH）、游离甲状腺素（free thyroxine，FL）及甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）。分析妊娠20周前甲状腺功能的变化特点，建立妊娠期特异的TSH和FT：参考范围，探讨妊娠期甲状腺功能异常的患病情况。结果（1）TSH中位数值于妊娠8周最低（0．91mU／L），较非妊娠期下降29.56％，妊娠12周后逐渐升高；FT4中位数值在妊娠9周最高，为11．33pmol／L，较非妊娠妇女升高7．79％，妊娠12周后逐渐下降。（2）非妊娠期、妊娠8～12周、13～16周、17～19^＋6周TSH[中位数（第2．5，第97．5百分位）]分别为1．59（0．15，5．91）、1．12（0．03，3．67）、1．21（0．05，3．74）、1．50（0．31，4．33）mU/L：FT4[中位数（第2．5，第97．5百分位）]分别为9．91（6．69，14．03）、10．68（7．98，18．66）、10．04（6．18，16．22）、9．40（6．44．13．51）pmol／L。（3）妊娠20周前1605例妊娠妇女甲状腺功能异常（包括甲状腺功能亢进、临床甲状腺功能减低、亚临床甲状腺功能减低和低T4血症）的总患病率为3．55％（57／1605），其中妊娠8～12^＋6、13～16^＋6、17～19^＋6周甲状腺功能亢进的患病率分别为0．00％（0／611）、0．13％（1／761）、0．00％（0／233）；临床甲状腺功能减低的患病率分别为0．00％（0／611）、0．13％（1／761）、0．00%（0／233）；亚临床甲状腺功能减低的患病率分别为3．60％（22／611）、2．76％（21／761）、3．00％（7／233）；低T4血症的患病率分别为0．16％（1／611）、0．26％（2／761）、0．86％（2／233）。TPOAb总阳性率为18．82％（302／1605），其中妊娠8～12^＋6、13～16^＋6、17～20周TPOAb的阳性率分别为22．91％（140／611）、16．56％（126／761）、15．45％（36／233），TPOAb中位数值分别为38．90、41．87、39．10mU／L。结论妊娠20周前孕妇甲状腺功能发生特定变化，妊娠8～12^＋6周TSH水平下降，后逐渐升高；而FL水平在妊娠8～12^＋6周升高，后逐渐下降。妊娠期无甲状腺疾病史的妇女中，甲状腺功能异常并不少见。以孕周特异的甲状腺功能参考范围为标准，妊娠20周前甲状腺功能异常中以亚临床甲状腺功能减低最常见，建议妊娠早期筛查甲状腺功能。
Objective To analyze the changes of thyroid function of healthy primipara before 20 weeks of gestation to establish normal gestational age specific reference interval of thyroid hormones, and to investigate the prevalence of maternal thyroid disorders during the first half of pregnancy, Methods A total of 1605 healthy primipara without risk factors of thyroid diseases before 20 gestational weeks and 200 non-pregnant healthy women who accepted preconception care in Beiiing Friendship Hospital from September 2010 to June 2011 were tested for serum thyroidstimulating hormone （TSH）, free thyroxine （FT4） and thyroid peroxidase antibody （TPOAb） by chemiluminometric immunoanalysis. One thousand two hundred and fourty-three pregnant women among them with negative thyroid antibooly and without previons thyroid diseases were selected as the standard population for normal interval. Gestational age-specific percentile categories for TSH and FT4 were calculated. The prevalence of maternal thyroid disorders was examined by gestational age- specific intervals. Results （1） Compared with non-pregnant women, the median value of serum TSH in pregnant women decreased by 29.56% to the value of 0.91 mU/L; while that of FT4 rose by 7.79% to the value of 11.33 pmol/L before 12 weeks; and TSH increased while FT4 decreased during 13 to 20 weeks. （2） The median values and reference intervals （2.5th percentile, 97.5th percentile） for TSH were I. 59 mU/L （0.15 mU/L, 5.19 mU/L） in no-pregnant women, 1.12 mU/L （0.03 mU/L, 3.67 mU/L） at 8-12^＋6 gestational weeks, 1.21 mU/L （0.05 mU/L, 3.74 mU/L） at 13-16^＋6 gestational weeks, 1.50 mU/L （0.31 mU/L, 4.33 mU/L） at 17-19^＋6 gestational weeks; and the median values and reference intervals （2. 5th percentile, 97. 5th percentile） for FT4 were 9. 91 pmol/L （6.69 pmol/L, 14.03 pmol/L）, 10.68 pmol/L （7.98 pmol/L, 18.66 pmol/L）, 10.04 pmol/L （6.18 pmol/L, 16.22 pmol/L）, 9.40 pmol/L （6.44 pmol/L, 13.51 pmol/L） respectively. （3） According to gestational age-specific reference intervals, the general prevalence of maternal thyroid disorders, including hyperthyroidism, hypothyroidism, subclinical hypothyroidism and hypothyroinemia, was 3.55% （57/1605）. At 8-12^＋6 gestational weeks, 13-16^＋6 gestational weeks and 17-19^＋6 gestational weeks, the occurrence of hyperthyroidism was 0.00%, 0.13% and 0.00% ; that of hypothyroidism was 0.00%, 0. 13% and 0.00% ; the incidence of subclinical hypothyroidism was 3.60%, 2.76% and 3.00% ; the occurrence of hypothyroxinemia was 0.16%, 0： 26% and 0.86%, respectively. The positive rate of TPOAb at 8 12^＋6 , 13-16^＋6 and 17-19^＋6 gestational weeks were 22. 91% （140/611）, 16. 56% （126/761） and 15.45%（36/233）, and the total positive rate of TPOAb was 18.82% （302/1605）. The median level of TPOAb was 38. 90, 41.87 and 39.10 mU/L, respectively. Conclusions Before 20 gestational weeks, specific changes occur in maternal thyroid function. TSH level decreases during 8 to 12 gestational weeks, and then increases gradually; while FT4 level increases during 8 to 12 weeks, and then decreases gradually. Thyroid dysfunction during pregnancy is common and subclinical hypothyroidisum is the leading problem in thyroid disorders. Screening for thyroid function during early pregnancy is suggested.
出处
《中华围产医学杂志》
CAS
北大核心
2012年第12期737-742,共6页
Chinese Journal of Perinatal Medicine
基金
北京市科委科研课题（D101100050010033）
北京友谊医院科研启动基金
