CAJ | 학술논문

目的：探讨妊娠20周前甲状腺功能参考范围及甲状腺功能异常患病率。方法选取行产检的健康单胎初产妇1706例及同期健康检查的非妊娠女性为研究对象，测定其甲状腺功能，分析甲状腺功能变化特点。结果促甲状腺激素（ TSH）中位数值最低、最高分别为孕8周、孕19＋6周，分别为0．90 mU／L、2．74 mU／L；游离甲状腺素（ FT4）中位数值最低、最高分别为孕9周、孕19＋6周，分别为11．34 pmol／L、8．75 pmol／L；TSH随妊娠时间的延长，逐渐增加，而FT4逐渐降低。与非妊娠女性相比，孕8～12＋6周孕妇TSH中位数下降28．48％，34例孕妇FSH低于非妊娠期参考范围，占5．54％。 FT4较非妊娠女性中位数增加7．98％，39例孕妇FT4高于非妊娠期参考范围，占6．35％。以第2．5百分数和第97．5百分位为甲状腺功能正常参考范围，非妊娠女性、孕8～12＋6周、孕13～16＋6周、孕17～19＋6周TSH 参考范围分别为0．16～5．90 mU／L、0．03～3．66 mU／L、0．06～3．75 mU／L、0．32～4．32 mU／L， FT4分别为6．70～14．04 pmol／L、7．99～18．67 pmol／L、6．19～16．23 pmol／L、6．43～13．50 pmol／L。在1706例妊娠20周前孕妇中，41例存在甲状腺功能异常，总患病率为2．40％，其中1例甲亢、1例甲减、33例亚临床甲减、6例低T4血症，最常见的为亚临床甲减。甲状腺过氧化物酶自身抗体（TPOAb）阳性率为18．70％。结论 TSH于妊娠8～12＋6周逐渐下降，后逐渐升高；而FT4于妊娠8～12＋6周逐渐升高，后逐渐降低；甲状腺功能异常中以亚临床甲减最为常见，建议妊娠早期常规行甲状腺功能检查。
목적：탐토임신20주전갑상선공능삼고범위급갑상선공능이상환병솔。방법선취행산검적건강단태초산부1706례급동기건강검사적비임신녀성위연구대상，측정기갑상선공능，분석갑상선공능변화특점。결과촉갑상선격소（ TSH）중위수치최저、최고분별위잉8주、잉19＋6주，분별위0．90 mU／L、2．74 mU／L；유리갑상선소（ FT4）중위수치최저、최고분별위잉9주、잉19＋6주，분별위11．34 pmol／L、8．75 pmol／L；TSH수임신시간적연장，축점증가，이FT4축점강저。여비임신녀성상비，잉8～12＋6주잉부TSH중위수하강28．48％，34례잉부FSH저우비임신기삼고범위，점5．54％。 FT4교비임신녀성중위수증가7．98％，39례잉부FT4고우비임신기삼고범위，점6．35％。이제2．5백분수화제97．5백분위위갑상선공능정상삼고범위，비임신녀성、잉8～12＋6주、잉13～16＋6주、잉17～19＋6주TSH 삼고범위분별위0．16～5．90 mU／L、0．03～3．66 mU／L、0．06～3．75 mU／L、0．32～4．32 mU／L， FT4분별위6．70～14．04 pmol／L、7．99～18．67 pmol／L、6．19～16．23 pmol／L、6．43～13．50 pmol／L。재1706례임신20주전잉부중，41례존재갑상선공능이상，총환병솔위2．40％，기중1례갑항、1례갑감、33례아림상갑감、6례저T4혈증，최상견적위아림상갑감。갑상선과양화물매자신항체（TPOAb）양성솔위18．70％。결론 TSH우임신8～12＋6주축점하강，후축점승고；이FT4우임신8～12＋6주축점승고，후축점강저；갑상선공능이상중이아림상갑감최위상견，건의임신조기상규행갑상선공능검사。
Objective To investigate the development of thyroid function before 20 weeks of pregnancy refer-ence range and prevalence of thyroid dysfunction.Methods 1 706 healthy routine check early single births over the same period of non-pregnant women and maternal health check were chosen for the study.Thyroid function were meas-ured,characteristics of thyroid function changes were analyzed.Results TSH median values minimum and maximum eight weeks of pregnancy,respectively,19 +6 weeks of gestation,respectively 0.90mU/L,2.74mU/L,FT4 median value minimum and maximum respectively nine weeks pregnant, pregnant 19 +6 week, respectively 11.34mpmol/L, 8.75pmol/L,TSH with the extension of time to pregnancy gradually increase, while FT4 decreased.Compared with non-pregnant women,pregnant 8 to 12 +6 weeks pregnant median TSH decreased 28.48%,FSH level in 34 cases of pregnant women during pregnancy was lower than the reference range,accounting for 5.54%.FT4 than non-pregnant women the median increased 7.98%,39 cases of pregnant women during pregnancy than non-FT4 reference range,ac-counting for 6.35%.In section 2.5% and 97.5% of euthyroid reference range, non-pregnant females, 8 to 12 +6 weeks of pregnancy,13 to 16+6 weeks of pregnancy,17 to 19 +6 weeks of gestation TSH reference range was 0.16-5.90mU/L, 0.03-3.66mU/L, 0.06-3.75mU/L, 0.32-4.32mU/L, FT4 respectively 6.70-14.04pmol/L, 7.99-18.67pmol/L,6.19-16.23pmol/L,6.43-13.50pmol/L.In 1 706 cases of pregnant women before 20 weeks of pregnancy,41 cases of thyroid dysfunction exists,the total prevalence of 2.40%,including one case of hyperthyroid-ism,1 case of hypothyroidism,subclinical hypothyroidism in 33 cases,6 cases of low FT4 hyperlipidemia,most common subclinical hypothyroidism.Thyroid peroxidase autoantibodies ( TPOAb ) positive rate was 18.70%.Conclusion Pregnancy 20 weeks pregnant TSH and FT4 before presenting specific changes,TSH at 8 to 12 +6 weeks of pregnancy decreased gradually,gradually increased,while the FT4 in 8 to 12 +6 weeks of pregnancy increased gradually,gradually reduce;thyroid dysfunction prevalence is higher,to subclinical hypothyroidism is most common in early pregnancy,so we recommend routine thyroid function tests.