建立该地区妊娠各期甲状腺激素参考范围及甲状腺激素变化的探讨

目的：建立徐州地区健康孕妇妊娠各期甲状腺激素的参考值，探讨其变化规律。方法整群选取2015年1—5月正常单胎妊娠孕妇，按孕早、中、晚期分组，以年龄匹配非妊娠健康妇女作为对照组，用电化学发光法测定其甲状腺激素水平并建立各自的参考范围。其中孕早、中、晚期各988、1734、1052例，非妊娠妇女1203例，孕期患甲状腺疾病的483例。结果早、中、晚期孕妇及非妊娠妇女的甲状腺激素水平均呈偏态分布，参考值选择95%可信区间。TSH在早1.93(0.37~5.79）]、中1.97(0.46~5.10）]、晚孕期2.28(0.48~6.37）]逐渐上升，晚孕期略高于非妊娠妇女2.14(0.79~5.30）]但差异无统计学意义(P>0.05）。 FT3和 FT4在早5.71(4.03~6.26）；16.65(12.86~22.45）]、中4.71(3.59~5.99）；15.24(9.89~20.63）]、晚孕期4.28(3.36~5.54）；12.33(8.82~16.82）]逐渐降低，早孕期低于非妊娠妇女5.95(4.17~6.60）；17.28(13.01~21.30）]且差异有统计学意义(P<0.05）。亚临床甲减、甲减和甲亢的发生率分别是9.07%、2.03%、0.23%。结论正常孕妇的甲状腺激素水平不同于非妊娠妇女，各孕期之间差异有统计学意义；妊娠期孕激素的变化不足以引起其甲状腺功能的紊乱。

Study on Establishing the Reference Range of Thyroid Hormone in Each Pe-riod of Pregnancy in This Region and Changes of Thyroid Hormone

Objective To discuss its change law by establishing the reference value of thyroid hormone in each period of pregnancy of healthy pregnant women in Xuzhou region. Methods The normal singleton pregnant women treated from Jan-uary 2015 to May 2015 were selected and divided into the early, middle and late periods of pregnancy groups with 988, 1 734 and 1 052 cases in each group, and 1 203 cases of healthy and non-pregnancy women at the same age were regarded as the control group, and the thyroid hormone levels were measured by the electrochemiluminescence method and each ref-erence range was established, and there were 483 cases with thyroid disease in pregnancy. Results The thyroid hormone levels of pregnant women in early, middle and late periods of pregnancy and non-pregnancy women showed a biased distri-bution, 95% confident interval was selected as the reference value, TSH in the early, middle and late periods of pregnancy were respectively 1.93 (0.37~5.79)], 1.97 (0.46~5.10)] and 2.28 (0.48~6.37)], which gradually increased, and the TSH in late period of pregnancy was slightly higher than that in non-pregnancy women, which was 2.14 (0.79-5.30)], but he differ-ence had no statistical significance (P>0.05), the FT3 and FT4 in early, middle and late periods of pregnancy were respec-tively 5.71 (4.03~6.26); 16.65 (12.86~22.45)], 4.71 (3.59~5.99); 15.24 (9.89~20.63)] and 4.28 (3.36~5.54); 12.33 (8.82~16.82)], which gradually decreased, and the FT3 and FT4 in early period of pregnancy were lower than those in non-preg-nancy women, which were 5.95 (4.17~6.60); 17.28 (13.01~21.30)], and the differences had statistical significance(P<0.05), the incidence rates of subclinical hypothyroidism, hypothyroidism and hyperthyreosis were respectively 9.07%, 2.03% and 0.23%. Conclusion The thyroid hormone level of normal pregnant women is different from that of non-pregnancy women, and there were obvious differences between each periods of pregnancy, and the changes of progestational hormone in preg-nancy are not enough to cause the disorder of thyroid function.