妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率
임신20주전갑상선공능삼고범위화갑상선공능이상환병솔
Maternal thyroid function during the first half of pregnancy
  • 万方数据
    中华围产医学杂志 중화위산의학잡지
    CHINESE JOURNAL OF PERINATAL MEDICINE
    2012年 12期 737-742 ,共6页

    龙燕%时娟娟%张晓璐%蔺莉

    룡연%시연연%장효로%린리

    妊娠%促甲状腺素%甲状腺素%参考值%甲状腺功能减退症%患病率 妊娠%促甲狀腺素%甲狀腺素%參攷值%甲狀腺功能減退癥%患病率
    임신%촉갑상선소%갑상선소%삼고치%갑상선공능감퇴증%환병솔
    Pregnancy%Thyrotropin%Thyroxine%Reference values%Hypothyroidism%Prevalence
    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围,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,FT4)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FT4参考范围,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(0.91 mU/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11.33 pmol/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+、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、39.10 mU/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FT4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.
    목적 분석건강초산부임신20주전갑상선공능적변화,건립임신20주전잉주특이적갑상선공능삼고범위,탐토임신기갑상선공능이상적환병정황. 방법 대2010년9월지2011년6월기간재수도의과대학부속북경우의의원산과문진행산전검사적1605례단태건강초산부화200례동기행임신전검사적건강비임신부녀진행연구,기중1243례배제갑상선질병고위인소적초산부작위제정정상삼고범위적“표준인군”.채용화학발광면역법검측촉갑상선격소(thyroid stimulating hormone,TSH)、유리갑상선소(free thyroxine,FT4)급갑상선과양화물매항체(thyroid peroxidase antibody,TPOAb).분석임신20주전갑상선공능적변화특점,건립임신기특이적TSH화FT4삼고범위,탐토임신기갑상선공능이상적환병정황. 결과 (1)TSH중위수치우임신8주최저(0.91 mU/L),교비임신기하강29.56％,임신12주후축점승고；FT4중위수치재임신9주최고,위11.33 pmol/L,교비임신부녀승고7.79％,임신12주후축점하강.(2)비임신기、임신8～12주、13～16주、17～19+6주TSH[중위수(제2.5,제97.5백분위)]분별위1.59 (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[중위수(제2.5,제97.5백분위)]분별위9.91(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)임신20주전1605례임신부녀갑상선공능이상(포괄갑상선공능항진、림상갑상선공능감저、아림상갑상선공능감저화저T4혈증)적총환병솔위3.55％ (57/1605),기중임신8～12+6、13～16+6、17～19+6주갑상선공능항진적환병솔분별위0.00％(0/611)、0.13％(1/761)、0.00％(0/233)；림상갑상선공능감저적환병솔분별위0.00％(0/611)、0.13％(1/761)、0.00％(0/233);아림상갑상선공능감저적환병솔분별위3.60％(22/611)、2.76％ (21/761)、3.00％ (7/233)；저T4혈증적환병솔분별위0.16％ (1/611)、0.26％(2/761)、0.86％(2/233).TPOAb총양성솔위18.82％ (302/1605),기중임신8～12+6、13～16+、17～20주TPOAb적양성솔분별위22.91％ (140/611)、16.56％ (126/761)、15.45％ (36/233),TPOAb중위수치분별위38.90、41.87、39.10 mU/L. 결론 임신20주전잉부갑상선공능발생특정변화,임신8～12+6주TSH수평하강,후축점승고；이FT4수평재임신8～12+6주승고,후축점하강.임신기무갑상선질병사적부녀중,갑상선공능이상병불소견.이잉주특이적갑상선공능삼고범위위표준,임신20주전갑상선공능이상중이아림상갑상선공능감저최상견,건의임신조기사사갑상선공능.
    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 pre-conception care in Beijing Friendship Hospital from September 2010 to June 2011 were tested for serum thyroid stimulating hormone (TSH),free thyroxine (FT4) and thyroid peroxidase antihody (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 agespecific 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 1.59 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％ (57/1606).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.
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