宁波市妊娠期妇女甲状腺功能指标参考区间的建立

目的 建立宁波地区正常孕妇孕早期、中期、晚期促甲状腺激素(TSH)、游离甲状腺激素(FT₄)、游离三碘甲状腺原氨酸(FT₃)参考值范围。 方法 序贯收集2014年1月—2015年12月宁波大学医学院附属医院产科门诊就诊的正常孕妇妊娠早期(T1期，妊娠9～12周)、妊娠中期(T2期，妊娠16～24周)、妊娠晚期(T3期，妊娠32～36周)有效血清281例，同时选择158例育龄非孕妇女做正常对照；采用美国贝克曼DX-800检测系统分别检测妊娠不同时期孕妇血清TSH、FT₄、FT₃水平，采用百分位数(P_2.5~P_97.5)制订妊娠不同时期TSH、FT₄、FT₃的正常参考值范围。 结果 不同妊娠期TSH参考值范围为:T1:0.05～3.97 mIU/L，T2:0.12～4.28 mIU/L，T3:0.30～6.01 mIU/L，对照:0.08～3.81 mIU/L；FT₃的参考范围:T1:3.33～5.78 pmol/L，T2:3.10～5.23 pmol/L，T3:2.83～4.99 pmol/L，对照:3.90～5.54 pmol/L；FT4的参考范围:T1:7.25～15.52 pmol/L，T2:6.88～13.27 pmol/L，T3:5.31～10.79 pmol/L，对照:6.46～14.17 pmol/L；在妊娠不同时期检测结果与育龄非孕对照组结果差异均有统计学意义(FT₃:F=76.431，P＜0.01；FT₄:F=116.753，P＜0.01；TSH:F=53.670，P＜0.01)，各孕期之间差异亦有统计学意义。 结论 孕妇的甲状腺激素水平与非妊娠妇女存在明显差异，且妊娠不同时期女性甲状腺功能指标参考范围不同，建立本地区各孕期的甲状腺激素参考范围临床意义重大。 

Establishment of reference intervals of thyroid hormones in pregnant women for Ningbo city

Objective To establish the reference ranges of thyroid stimulating hormone(TSH),free thyroid hormone(FT₄) and three free triiodothyronine(FT₃) in different gestation periods. Methods This study was based at the Hospital affiliated to Ningbo University School of Medicine.A total valid of 281 pregnant women who visited the hospital between January,2014 and December,2015 were recruited in this study according to the National Academy of Clinical Biochemistry(NACB) criteria.Blood samples were sequentially collected from the women at the first(T1,9-12 weeks),the second(T2,16-24 weeks) and the third (T3,32-36 weeks)trimesters to determine the serum FT₃,FT₄ and TSH levels using Beckman DX800 detection system,meanwhile,158 cases of non-pregnant women of childbearing age were selected as healthy controls.The percentile(P_2.5-P_97.5) was employed to indicate the reference ranges of FT₃,FT₄ and TSH in different periods of pregnancy. Results TSH reference ranges were T1:0.05-3.97 mIU/L,T2:0.12-4.28 mIU/L,T3:0.30-6.01 mIU/L,control:0.08-3.81 mIU/L respectively,FT₃ reference ranges were T1:3.33-5.78 pmol/L,T2:3.10-5.23 pmol/L,T3:2.83-4.99 pmol/L,control:3.90-5.54 pmol/L respectively,FT4 reference ranges were T1:7.25-15.52 pmol/L,T2:6.88-13.27 pmol/L,T3:5.31-10.79 pmol/L,control:6.46-14.17 pmol/L respectively;the results between different pregnant periods and control were statistically significant differences in different periods (FT₃:F=76.431,P<0.01;FT₄:F=116.753,P<0.01;TSH:F=53.670,P<0.01). Conclusion The thyroid hormone levels between pregnant women and in non-pregnant women are different significantly,moreover,the results among different periods during pregnancy are not the same at all,it is significant and necessary to establish the according reference intervals of various thyroid hormones for each pregnant period in Ningbo city.