维吾尔、汉族妊娠妇女孕早期甲状腺激素参考范围的建立
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摘要
目的确定本实验室维吾尔(维)、汉族妊娠妇女孕早期甲状腺激素的正常参考值范围。方法选取2016年1月~2017年6月在我科及产科门诊进行产检的孕早期单胎妊娠妇女,将符合标准的514名(维/汉:200/314)妊娠妇女进入观察组,120名育龄期正常妇女为非妊娠对照组,进行抽血化验,测定促甲状腺素(TSH)、血清游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺球蛋白抗体(Tg Ab)、甲状腺过氧化物酶抗体(TPOAb),尿碘。结果对照组、维、汉族人群妊娠妇女孕早期FT3水平的中位数及参考范围分别是5.45(4.49~6.63)pmol/L,4.68(3.52~5.96)pmol/L,4.66(3.53~6.98)pmol/L,维、汉族妊娠妇女的FT3水平明显低于对照组,差异有统计学意义(P维=0.000,P汉=0.000);维、汉妊娠妇女之间比较差异无统计学意义(P=0.896)。FT4水平的中位数及参考范围分别是14.63(10.47~20.18)pmol/L,15.44(11.20~22.95)pmol/L,16.08(11.54~24.65)pmol/L,维、汉族妊娠妇女的FT4水平明显高于对照组,差异均有统计学意义(P维=0.02,P汉=0.000);汉族人群的FT4水平明显高于维族,差异有统计学意义(P=0.001)。TSH水平的中位数及参考范围分别是4.35(0.34~6.46)ml U/L,2.96(0.04~6.25)ml U/L,2.33(0.02~6.07)ml U/L,维、汉族妊娠妇女的TSH水平低于对照组,差异均有统计学意义(P维=0.000,P汉=0.000);维族人群的TSH水平明显高于汉族、差异有统计学意义(P=0.000)。尿碘水平分别是136.5(37.03-198.08)ug/L,158.50(51.02~337.97)ug/L,177.15(39.29~345.38)ug/L,维、汉族妊娠妇女的尿碘水平明显高于对照组,差异均有统计学意义(P维=0.034,P汉=0.002),汉族的尿碘水平明高于维族,差异无统计学意义(P=0.244)。结论妊娠妇女甲状腺激素较非妊娠妇女明显变化,维,汉族人群甲状腺激素参考范围不同,每地区应该制定种族特异性参考范围。
Objective To determine the normal range of normal reference value of thyroid hormone in the early pregnancy of Uyghur and Han nationality pregnant women. Methods From January 2016 to June 2017. The early pregnant women with a singleton pregnancy in our hospital and maternity clinics, according to the standard 514(Uyghur/Han: 200/314) pregnant women in the observation group, 120 normal women of childbearing age for non pregnant control group, blood tests, determination of thyroid stimulating hormone(TSH), serum free thyroxine(FT4), free three triiodothyronine(FT3), thyroglobulin antibody(Tg Ab), thyroid peroxidase antibody(TPOAb), urinary iodine. Results In the control group, Uyghur, Han FT3 level in the early pregnancy women the median and the reference range were 5.45(4.49~6.63) pmol/L, pmol/L 4.68(3.52~5.96), 4.66(3.53~6.98) pmol/L,Uyghur,Han pregnant women compared with the control group, the differences were statistically signifi cant(PUyghur =0.000, PHan=0.000), the differences between Uyghur and Han pregnant women had no significant difference(P=0.896).the median and the reference range of FT4 levels were 14.63(10.47~20.18)pmol/L,15.44(11.20~22.95)pmol/L,16.08(11.54~24.65)pmol/L,Uygur, Han pregnant women compared with the control group there were statistically significant differences(PUyghur=0.02, PHan=0.000), the differences between Uyghur and Han pregnant women was statistically significant(P=0.001).the median and the reference range of TSH levels were 4.35(0.34~6.46)ml U/L,2.96(0.04~6.25)ml U/L,2.33(0.02~6.07)ml U/L,Uygur,Han pregnant women compared with the control group differences were statistically significant(PUyghur =0.000,PHan=0.000),the differences between Uyghur and Han pregnant women was statistically signifi cant(P=0.000), urinary iodine level 136.5(37.03~198.08) ml U/L, 158.50(51.02~337.97) ml U/L, 177.15(39.29~345.38) ml U/L, Uygur, Han pregnant women compared with the control group, the differences were statistically signifi cant(PUyghur =0.034, PHan=0.002),the differences between Uyghur and Han pregnant women had no signifi cant difference(P=0.244). Conclusion Thyroid hormones in pregnant women were signifi cantly different from those in non pregnant women. The reference range of thyroid hormone is different in Uygur and Han population and the ethnic specifi c reference range should be formulated in each region.
Objective To determine the normal range of normal reference value of thyroid hormone in the early pregnancy of Uyghur and Han nationality pregnant women. Methods From January 2016 to June 2017. The early pregnant women with a singleton pregnancy in our hospital and maternity clinics, according to the standard 514(Uyghur/Han: 200/314) pregnant women in the observation group, 120 normal women of childbearing age for non pregnant control group, blood tests, determination of thyroid stimulating hormone(TSH), serum free thyroxine(FT4), free three triiodothyronine(FT3), thyroglobulin antibody(Tg Ab), thyroid peroxidase antibody(TPOAb), urinary iodine. Results In the control group, Uyghur, Han FT3 level in the early pregnancy women the median and the reference range were 5.45(4.49~6.63) pmol/L, pmol/L 4.68(3.52~5.96), 4.66(3.53~6.98) pmol/L,Uyghur,Han pregnant women compared with the control group, the differences were statistically signifi cant(PUyghur =0.000, PHan=0.000), the differences between Uyghur and Han pregnant women had no significant difference(P=0.896).the median and the reference range of FT4 levels were 14.63(10.47~20.18)pmol/L,15.44(11.20~22.95)pmol/L,16.08(11.54~24.65)pmol/L,Uygur, Han pregnant women compared with the control group there were statistically significant differences(PUyghur=0.02, PHan=0.000), the differences between Uyghur and Han pregnant women was statistically significant(P=0.001).the median and the reference range of TSH levels were 4.35(0.34~6.46)ml U/L,2.96(0.04~6.25)ml U/L,2.33(0.02~6.07)ml U/L,Uygur,Han pregnant women compared with the control group differences were statistically significant(PUyghur =0.000,PHan=0.000),the differences between Uyghur and Han pregnant women was statistically signifi cant(P=0.000), urinary iodine level 136.5(37.03~198.08) ml U/L, 158.50(51.02~337.97) ml U/L, 177.15(39.29~345.38) ml U/L, Uygur, Han pregnant women compared with the control group, the differences were statistically signifi cant(PUyghur =0.034, PHan=0.002),the differences between Uyghur and Han pregnant women had no signifi cant difference(P=0.244). Conclusion Thyroid hormones in pregnant women were signifi cantly different from those in non pregnant women. The reference range of thyroid hormone is different in Uygur and Han population and the ethnic specifi c reference range should be formulated in each region.
引文
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[6]单忠艳.甲状腺疾病与妊娠[J].中国实用内科杂志,2010(4):386-388.
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[8]徐海耿,毛亚飞,王晔恺,等.舟山海岛地区不同孕期妇女甲状腺激素参考值范围的建立[J].现代实用医学,2014(03):261-262.
[9]连冬梅,黄海洲,高添艺.北海地区正常孕妇不同孕期甲状腺激素的参考值范围[J].中国优生与遗传杂志,2013(10):69.
[10]王淑贞,刘杰,林丽娅.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[J].中外医疗,2016,35(12):61-63.
[11]Choi H W,Han Y J,Kwak D W,et al.Maternal Thyroid Function during the First Trimester of Pregnancy in Korean Women[J].International Journal of Thyroidology,2017,10(1):36.
[12]孟祥颖,邢金芳,田伟芳,等.健康孕妇妊娠期甲状腺激素水平分析及参考范围研究[J].中国卫生检验杂志,2015(3):365-367.
[13]Walker J A,Illions E H,Huddleston J F,et al.Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period[J].Obstetrics&Gynecology,2005,106(6):1365-1371.
[14]La'Ulu S L,Roberts W L.Ethnic differences in fi rst-trimester thyroid reference intervals.[J].Clinical Chemistry,2011,57(6):913-915.
[15]La'Ulu S L,Roberts W L.Second-trimester reference intervals for thyroid tests:the role of ethni city.[J].Clinical Chemistry,2007,53(9):1658.
[16]Benhadi N,Wiersinga W M,Reitsma J B,et al.Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy[J].Clinical Endocrinology,2007,66(6):765-770.
[17]Veltri F,Belhomme J,Kleynen P,et al.Maternal thyroid parameters in pregnant women with different ethnic backgrounds:do ethnicityspecific reference ranges improve the diagnosis of subclinical hypothyroidism?[J].Clinical Endocrinology,2017,86(6).
[18]Arthur B B.Results and Conclusions[J].Counseling&Values,2011,11(3):171-192.
[2]Spencer L,Bubner T,Bain E,et al.Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health[J].Cochrane Database of Systematic Reviews,2015,9(9):D11263.
[3]Stricker R,Echenard M,Eberhart R,et al.Evaluation of maternal thyroid function during pregnancy:the importance of using gestational age-specifi c reference intervals.[J].European Journal of Endocrinology,2007,157(4):509-514.
[4]Spencer C.Laboratory support for the diagnosis and monitoring of thyroid disease[J].Pathology,2001,41(Sup 1):17.
[5]中华医学会内分泌学分会.妊娠和产后甲状腺疾病诊治指南[J].中华内分泌代谢杂志,2012,28(5):354-367.
[6]单忠艳.甲状腺疾病与妊娠[J].中国实用内科杂志,2010(4):386-388.
[7]Andersson M,De B B,Delange F,et al.Prevention and control of iodine defi ciency in pregnant and lactating women and in children less than 2-years-old:conclusions and recommendations of the Technical Consultation.[J].Public Health Nutrition,2007,10(12A):1606.
[8]徐海耿,毛亚飞,王晔恺,等.舟山海岛地区不同孕期妇女甲状腺激素参考值范围的建立[J].现代实用医学,2014(03):261-262.
[9]连冬梅,黄海洲,高添艺.北海地区正常孕妇不同孕期甲状腺激素的参考值范围[J].中国优生与遗传杂志,2013(10):69.
[10]王淑贞,刘杰,林丽娅.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[J].中外医疗,2016,35(12):61-63.
[11]Choi H W,Han Y J,Kwak D W,et al.Maternal Thyroid Function during the First Trimester of Pregnancy in Korean Women[J].International Journal of Thyroidology,2017,10(1):36.
[12]孟祥颖,邢金芳,田伟芳,等.健康孕妇妊娠期甲状腺激素水平分析及参考范围研究[J].中国卫生检验杂志,2015(3):365-367.
[13]Walker J A,Illions E H,Huddleston J F,et al.Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period[J].Obstetrics&Gynecology,2005,106(6):1365-1371.
[14]La'Ulu S L,Roberts W L.Ethnic differences in fi rst-trimester thyroid reference intervals.[J].Clinical Chemistry,2011,57(6):913-915.
[15]La'Ulu S L,Roberts W L.Second-trimester reference intervals for thyroid tests:the role of ethni city.[J].Clinical Chemistry,2007,53(9):1658.
[16]Benhadi N,Wiersinga W M,Reitsma J B,et al.Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy[J].Clinical Endocrinology,2007,66(6):765-770.
[17]Veltri F,Belhomme J,Kleynen P,et al.Maternal thyroid parameters in pregnant women with different ethnic backgrounds:do ethnicityspecific reference ranges improve the diagnosis of subclinical hypothyroidism?[J].Clinical Endocrinology,2017,86(6).
[18]Arthur B B.Results and Conclusions[J].Counseling&Values,2011,11(3):171-192.