CAJ | 학술논문

目的观察正常妊娠妇女甲状腺功能评估指标妊娠特异性参考范围及其动态变化.方法 139名正常妊娠妇女进入自我纵向随访序列,分别在妊娠8周、12周、16周、20周、28周、36周及产后3个月、6个月采样并检测甲状腺功能相关指标.301名育龄正常妇女为非妊娠对照组.结果血清促甲状腺激素(TSH)中位数于妊娠早期最低,妊娠中期、晚期升高,TSH参考范围分别为0.20 ～ 4.01 mIU/L、0.43～3.97 mIU/L、0.57～3.96 mIU/L.游离甲状腺素(FT4)自妊娠12周至产后6个月逐渐降低且低于非妊娠水平.总T4(TT4)妊娠12周显著增加,此后较稳定至产后恢复正常.游离三碘甲状腺原氨酸(FT3)妊娠12周至28周逐渐降低,产后逐渐恢复正常.总T3(TT3)在妊娠第12周显著增加,此后较稳定至产后恢复正常.妊娠早期TSH和FT4之间存在显著负相关(P＜0.01).整个妊娠期TSH和TT4之间没有相关性(P＞0.05).从妊娠12周至产后6个月,FT4和TT4、FT3和TT3呈正相关(P＜0.01).结论采用自我纵向序列人群建立的妊娠期TSH参考范围缩窄,但上限仍高于国外指南的建议.
목적 관찰정상임신부녀갑상선공능평고지표임신특이성삼고범위급기동태변화.방법 139명정상임신부녀진입자아종향수방서렬,분별재임신8주、12주、16주、20주、28주、36주급산후3개월、6개월채양병검측갑상선공능상관지표.301명육령정상부녀위비임신대조조.결과 혈청촉갑상선격소(TSH)중위수우임신조기최저,임신중기、만기승고,TSH삼고범위분별위0.20 ～ 4.01 mIU/L、0.43～3.97 mIU/L、0.57～3.96 mIU/L.유리갑상선소(FT4)자임신12주지산후6개월축점강저차저우비임신수평.총T4(TT4)임신12주현저증가,차후교은정지산후회복정상.유리삼전갑상선원안산(FT3)임신12주지28주축점강저,산후축점회복정상.총T3(TT3)재임신제12주현저증가,차후교은정지산후회복정상.임신조기TSH화FT4지간존재현저부상관(P＜0.01).정개임신기TSH화TT4지간몰유상관성(P＞0.05).종임신12주지산후6개월,FT4화TT4、FT3화TT3정정상관(P＜0.01).결론 채용자아종향서렬인군건립적임신기TSH삼고범위축착,단상한잉고우국외지남적건의.
Objective To evaluate the trimester specific reference ranges and dynamic changes of thyroid functional indicators during gestation of healthy pregnant women.Methods According to the selection criteria,139 cases were selected as the normal pregnant population to establish a self-sequential longitudinal reference range.We collected samples eight times in every case throughout the gestation(including the 8th,12th,16th,20th,28th,36th week of prenatal,the 3rd and the 6th month postpartum) and detected the indicators of thyroid funciton.Meanwhile,301 healthy non-pregnant women of childbearing age were selected as the control group.Results The median of TSH was lowest in the first trimester,and then was increased in the second and third trimesters.The reference ranges of TSH were 0.20-4.01 mIU/L,0.43-3.97 mIU/L,and 0.57-3.96 mIU/L in the above trimesters.The free thyroxine (FT4) level from the 12th week of gestation to the 6th month of postpartum was gradually decreased and was lower than the non-pregnant level.The total thyroxine (TT4) was significantly increased at the 12th week of gestation and thereafter it was stable and returned to normal after childbirth.The free triiodothyronine(FT3) was gradually declined from the 12th week to the 28th week and returned to normal postpartum.Total triiodothyronine(TT3) was significantly increased at the 12th week and thereafter was stable,and returned to normal after childbirth.There was a significant negative correlation between TSH and FT4 in the first trimester(P＜0.01).There was no correlation between TSH and TT4 during the whole gestation.There were positive correlations between FT4 and TT4,FT3 and TT3 since the 12th week of gestation (P ＜ 0.01).Conclusions The gestational specific reference range of TSH based on the selfsequential longitudinal study was narrow,however,the upper limit was still higher than that recommended in foreign guidelines.