乌鲁木齐市妊娠早中晚期甲状腺激素水平的参考范围

目的 评估乌鲁木齐市妊娠期妇女各期特异性血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4),血清促甲状腺激素(TSH)的正常参考范围.方法 选取新疆维吾尔自治区人民医院妇产科门诊进行常规孕期检查的正常妊娠妇女663例作为研究组,非妊娠期妇女185例作为对照组,根据美国国家临床生化研究院(NACB)指南的推荐,采用电化学发光法测定FT3、FT4、血清TSH、抗甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb).结果 妊娠早、中、晚期血清FT3三组比较差异有统计学意义,F=155.20,P<0.05;随着孕期增加,FT3水平呈下降趋势,妊娠早、中、晚期两两比较差异均有统计学意义(t值分别为0.18、0.19、0.76,均P<0.05);血清FT3在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为:3.43~9.94pmol/L、3.53~5.74pmol/L、3.56~5.19pmol/L.妊娠早、中、晚期血清FT4三组比较差异有统计学意义,F=100.78,P<0.05;随着孕期增加,FT4水平呈下降趋势,妊娠早、中、晚期两两比较差异均有统计学意义(t值分别为0.71、0.74、0.94,均P<0.05);血清FT4在妊娠早期、妊娠中期、妊娠晩期的参考值范围分别为:9.94~20.21pmol/L、9.69~17.77pmol/L、7.28~15.99pmol/L.妊娠早、中、晚期血清TSH三组比较差异有统计学意义,H=59.88,P<0.05;随着孕期增加,TSH水平呈上升趋势,妊娠早、中、晚期两两比较差异均有统计学意义(t值分别为0.34、0.23、-1.15,均P<0.05);血清TSH在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为:0.06~4.80mIU/L、0.29~5.84mIU/L、0.65~7.64mIU/L.结论 乌鲁木齐市妊娠期妇女的血清甲状腺激素水平具备地域上的特异性,与非妊娠期差异较大,与美国甲状腺学会(ATA)建议的妊娠期甲状腺功能指标参考范围结果差别较大.

Reference range for thyroid hormone level in early,middle and late stage of pregnancy in Urumqi City

Objective To establish normal reference ranges for specific serum FT3, FT4 and TSH in different pregnancy stages of pregnant women in Urumqi City.Methods A total of 663 normal pregnant women receiving routine prenatal examination in department of obstetrics and gynecology of Xinjiang Uygur Autonomous Region People''s Hospital were chosen as study group, and 185 non-pregnant women were chosen as control group.According to the guidelines of United States National Institute of Clinical Biochemical (NACB), FT3, FT4, serum TSH, thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) were detected by electrochemiluminescence method.Results Difference in serum FT3 in early, middle and late stage of pregnancy was statistically significant among three groups (F=155.20, P<0.05).FT3 level declined with increase of pregnancy and difference in pairwise comparison among early, middle and late pregnancy stage had statistical significance (t value was 0.18, 0.19 and 0.76, respectively, all P<0.05).Reference range of serum FT3 in early, middle and late stage was 3.43-9.94pmol/L, 3.53-5.74pmol/L and 3.56-5.19pmol/L, respectively.Difference in serum FT4 in early, middle and late pregnancy stage had statistical significance (F=100.78, P<0.05).FT4 level decreased with pregnancy time increase and difference in pairwise comparison among early, middle and late pregnancy stage had statistical significance (t value was 0.71, 0.74 and 0.94, respectively, all P<0.05).Reference range of serum FT4 in early, middle and late pregnancy stage was 9.94-20.21pmol/L, 9.69-17.77pmol/L and 7.28-15.99pmol/L, respectively.Difference in serum TSH in early, middle and late pregnancy stage showed statistical significance (H=59.88, P<0.05).TSH level increased with advancing of pregnancy stage and difference in pairwise comparison among early, middle and late pregnancy stage was statistically significant (t value was 0.34, 0.23 and-1.15, respectively, all P<0.05).Reference range of serum TSH in early, middle, and late stage was 0.06-4.80mIU/L, 0.29-5.84mIU/L and 0.65-7.64mIU/L, respectively.Conclusion Thyroid hormone level of pregnant women in Urumqi has region specificity and it is very different from that of non-pregnant women and from thyroid function index reference range suggested by American Thyroid Association (ATA).