正常孕妇妊娠期甲状腺功能变化研究
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摘要
目的分析正常孕妇妊娠期甲状腺功能的变化。方法选取2012年1月至2014年12月在香河县人民医院产科就诊的正常孕妇妊娠早期400例为A组、妊娠中期440例为B组,妊娠晚期370例为C组,同期选取非妊娠妇女410例为对照组。采用化学发光免疫法检测4组妇女的甲状腺激素和甲状腺自身抗体。分析妊娠期甲状腺功能的变化特点,测定正常孕妇妊娠期血清促甲状腺激素(TSH)、游离甲状腺素(FT_4)和游离三碘甲状腺原氨酸(FT_3)的参考范围,探讨妊娠期甲状腺功能异常的患病率。结果 A组、B组、C组TSH和FT_4水平显著低于对照组[(1.18±0.45)mU/L、(1.63±0.32)mU/L、(2.35±0.59)mU/L比(3.03±0.84)mU/L;(15.6±1.6)pmol/L、(15.0±1.3)pmol/L、(12.6±1.1)pmol/L比(17.3±1.6)pmol/L],差异有统计学意义(P<0.05)。A组FT_3水平与对照组比较差异无统计学意义[(4.92±0.41)pmol/L比(4.97±0.43)pmol/L](P>0.05)。B组、C组FT_3水平显著低于对照组[(4.71±0.35)pmol/L、(3.85±0.24)pmol/L比(4.97±0.43)pmol/L](P<0.05)。正常妊娠期妇女妊娠早、中、晚期血清TSH的参考值分别为0.03~3.73 mU/L、0.10~3.85 mU/L、0.35~4.76 mU/L,血清FT_4的参考值分别为11.24~20.13 pmol/L、10.06~17.57 pmol/L、9.45~15.26 pmol/L,血清FT_3的参考值分别为3.62~6.01 pmol/L、3.44~5.87 pmol/L、2.85~5.04 pmol/L。妊娠期甲状腺功能异常总患病率为6.78%(82/1210),显著高于对照组2.93%(12/410),差异有统计学意义(P<0.05)。A组、B组、C组发病率显著高于对照组[8.25%(33/400)、6.14%(27/440)、5.95%(22/370)比2.93%(12/410)],差异有统计学意义(P<0.05)。结论妊娠期孕妇甲状腺相关激素受到内分泌变化的影响,与非妊娠期妇女存在较大的差异。
Objective Analysis of thyroid function in normal pregnant women. Methods The normal pregnant women and non pregnant women in the Department of Obstetrics and Gynecology of Xianghe People's Hospital were selected. Group A included 400 women with early pregnancy,group B included 440 women with second trimester of pregnancy,group C included 370 women with late pregnancy,the control group included 410 non pregnant women. Took serum thyroid hormones and thyroid autoantibodies were measured by chemiluminescent method. Analyzes the Thyroid function in the early and middle period of pregnancy change. The reference range of serum thyroid stimulating hormone( TSH),free thyroid hormone( FT_4) and free three iodine( FT_3) in normal pregnant women was determined. To explore the prevalence of maternal thyroid disorders. Results TSH and FT_4 levels of group A,group B,group C,were significantly lower than the control group [( 1.18 ± 0.45) mU / L,( 1.63 ± 0.32) mU / L,( 2.35 ± 0.59) mU / L vs( 3.03 ±0.84) mU / L;( 15.6 ± 1.6) pmol / L,( 15.0 ± 1.3) pmol / L,( 12.6 ± 1.1) pmol / L vs( 17.3 ±1.6) pmol / L],the difference was statistically significant( P < 0. 05). Compared with the control group,the levelof FT_3 in the group A was not statistically significant [( 4. 92 ± 0. 41) pmol / L vs( 4.97 ± 0.43) pmol / L]( P >0. 05). The level of FT_3 in group B and group C was significantly lower than that in control group[( 4. 71± 0. 35) pmol / L,( 3.85 ± 0.24) pmol / L vs( 4.97 ± 0.43) pmol / L]( P < 0. 05). The normal reference range of normal pregnant women in early,middle and late pregnancy serum TSH were 0.03-3.73 mU / L,0. 10-3. 85 mU / L,0.35-4.76 mU / L; serum FT_4 reference values were 11. 24-20. 13 pmol / L,10. 06-17. 57 pmol / L,9. 45-15. 26 pmol / L; serum FT_3 reference values respectively 3. 62-6. 01 pmol / L,3.44-5.87 pmol / L,2.85-5.04 pmol / L. The total prevalence of thyroid dysfunction during pregnancy was 6.78%(82 /1210),which was significantly higher than that in the control group [2.93%(12 /410) ],the difference was statistically significant( P < 0.05). The incidence of A group,B group and C group was significantly higher than that in control group[8.25%(33 /400),6. 14%( 27 /440),5. 95%( 22 /370) vs 2. 93%( 12 /410) ],the difference was statistically significant(P < 0.05). Conclusion Pregnancy women' s thyroid hormone changes because the endocrine change,and there are differences with non pregnancy women.
Objective Analysis of thyroid function in normal pregnant women. Methods The normal pregnant women and non pregnant women in the Department of Obstetrics and Gynecology of Xianghe People's Hospital were selected. Group A included 400 women with early pregnancy,group B included 440 women with second trimester of pregnancy,group C included 370 women with late pregnancy,the control group included 410 non pregnant women. Took serum thyroid hormones and thyroid autoantibodies were measured by chemiluminescent method. Analyzes the Thyroid function in the early and middle period of pregnancy change. The reference range of serum thyroid stimulating hormone( TSH),free thyroid hormone( FT_4) and free three iodine( FT_3) in normal pregnant women was determined. To explore the prevalence of maternal thyroid disorders. Results TSH and FT_4 levels of group A,group B,group C,were significantly lower than the control group [( 1.18 ± 0.45) mU / L,( 1.63 ± 0.32) mU / L,( 2.35 ± 0.59) mU / L vs( 3.03 ±0.84) mU / L;( 15.6 ± 1.6) pmol / L,( 15.0 ± 1.3) pmol / L,( 12.6 ± 1.1) pmol / L vs( 17.3 ±1.6) pmol / L],the difference was statistically significant( P < 0. 05). Compared with the control group,the levelof FT_3 in the group A was not statistically significant [( 4. 92 ± 0. 41) pmol / L vs( 4.97 ± 0.43) pmol / L]( P >0. 05). The level of FT_3 in group B and group C was significantly lower than that in control group[( 4. 71± 0. 35) pmol / L,( 3.85 ± 0.24) pmol / L vs( 4.97 ± 0.43) pmol / L]( P < 0. 05). The normal reference range of normal pregnant women in early,middle and late pregnancy serum TSH were 0.03-3.73 mU / L,0. 10-3. 85 mU / L,0.35-4.76 mU / L; serum FT_4 reference values were 11. 24-20. 13 pmol / L,10. 06-17. 57 pmol / L,9. 45-15. 26 pmol / L; serum FT_3 reference values respectively 3. 62-6. 01 pmol / L,3.44-5.87 pmol / L,2.85-5.04 pmol / L. The total prevalence of thyroid dysfunction during pregnancy was 6.78%(82 /1210),which was significantly higher than that in the control group [2.93%(12 /410) ],the difference was statistically significant( P < 0.05). The incidence of A group,B group and C group was significantly higher than that in control group[8.25%(33 /400),6. 14%( 27 /440),5. 95%( 22 /370) vs 2. 93%( 12 /410) ],the difference was statistically significant(P < 0.05). Conclusion Pregnancy women' s thyroid hormone changes because the endocrine change,and there are differences with non pregnancy women.
引文
[1]于曼,邵勇,张建华.妊娠期甲状腺功能异常的筛查及诊断研究进展[J].中华内分泌外科杂志,2012,6(2):127-130.
[2]贺译平,贺同强,徐钊,等.妊娠20周前甲状腺功能异常对妊娠影响的研究[J].中国妇幼健康研究,2013,24(5):695-697,700.
[3]杜伟,郝凤杰,孙艳萍,等.妊娠早中期甲状腺功能相关指标参考区间的初步研究[J].河北医学,2015,21(7):1172-1174.
[4]肖海群.甲状腺功能减退对妊娠及其结局的影响[J].中国现代医学杂志,2012,22(18):53-57.
[5]中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南——甲状腺功能亢进症[J].中华内科杂志,2007,46(10):876-882.
[6]中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.甲状腺疾病诊治指南——甲状腺功能减退症[J].中华内科杂志,2007,46(11):967-971.
[7]张明会,吕玲玲.北京市平谷区正常孕妇妊娠早中晚期甲状腺功能变化研究[J].中国妇产科临床杂志,2014,15(5):454-455.
[8]熊娟,刘纯珊.孕妇甲状腺激素水平研究进展[J].国际检验医学杂志,2015,36(21):3143-3145.
[9]滕卫平.论母体甲状腺激素不足对胎儿神经智力发育的影响[J].中华内分泌代谢杂志,2005,21(2):97-98.
[10]樊向维.妊娠期母体甲状腺功能变化及其对胎儿的影响[J].国际妇产科学杂志,2015,42(3):330-334.
[11]高劲松,边旭明.妊娠合并甲状腺功能减退症的研究进展[J].中华妇产科杂志,2012,47(9):687-700.
[12]褚晓秋,刘超.甲状腺功能减退症患病因素思考[J].中国实用内科杂志,2014,34(4):313-316.
[13]刘思诗,刘彩霞.妊娠期临床甲状腺功能减退症的诊断标准及危害和处理[J].实用妇产科杂志,2015,31(12):888-890.
[14]郑莹,徐春,夏义欣,等.北京地区妊娠早期血清促甲状腺激素筛查的临床意义[J/CD].中华临床医师杂志:电子版,2013,7(7):3198-3199.
[15]贾学元,何恒君.妊娠早期母体TSH水平异常对其妊娠结局的影响[J].海南医学,2012,23(24):64-66.
[16]杨小猛,赵丹,陈书恩,等.正常孕妇妊娠各期甲状腺激素参考范围的建立及其临床意义[J].分子诊断与治疗杂志,2014,6(1):33-36.
[17]孙彬,白光亮,周南南,等.妊娠期妇女甲状腺功能检查结果分析[J].标记免疫分析与临床,2015,22(5):383-385.
[18]黄璐,罗丹,王利民,等.成都地区妊娠期特异性甲状腺激素水平参考值范围的探讨及临床分析[J].现代妇产科进展,2016,25(4):269-272.
[19]阎玉芹,董作亮,董玲,等.我国四地区正常孕妇的尿碘水平分析[J].中华内分泌代谢杂志,2011,27(4):307-310.
[20]Stagnaro-Green A,Abalovich M,Alexander E,et al.Guidelines of the American Thyroid Association foe the diagnosis and management of thyoid disease during pregnancy and postpartum[J].Thyroid,2011,21(10):1081-1125.
[21]王伟涛,徐丹丹,张健,等.妊娠早中晚期甲状腺激素参考值范围[J].标记免疫分析与临床,2014,21(4):468-470.
[22]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,2015,25(3):365-367.
[23]范建霞,宋梦帆.妊娠期甲状腺功能特异性参考值的意义[J].中华围产医学杂志,2012,15(2):69-72.
[24]万晓华,文江平,宋新,等.妊娠早期甲状腺功能指标参考区间的初步调查[J].中国医药导报,2013,10(11):121-123.
[25]刘素筠,刘知建.碘摄入量与甲状腺功能减退症调查研究[J].中国医疗前沿,2009,4(15):137.
[26]李晨嫣,单忠艳.妊娠期碘营养与甲状腺功能[J].中华地方病学杂志,2016,35(3):161-165.
[27]吴辉.甲状腺功能检测在妊娠妇女中的应用价值[J].国际检验医学杂志,2012,33(12):1508-1509.
[2]贺译平,贺同强,徐钊,等.妊娠20周前甲状腺功能异常对妊娠影响的研究[J].中国妇幼健康研究,2013,24(5):695-697,700.
[3]杜伟,郝凤杰,孙艳萍,等.妊娠早中期甲状腺功能相关指标参考区间的初步研究[J].河北医学,2015,21(7):1172-1174.
[4]肖海群.甲状腺功能减退对妊娠及其结局的影响[J].中国现代医学杂志,2012,22(18):53-57.
[5]中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南——甲状腺功能亢进症[J].中华内科杂志,2007,46(10):876-882.
[6]中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.甲状腺疾病诊治指南——甲状腺功能减退症[J].中华内科杂志,2007,46(11):967-971.
[7]张明会,吕玲玲.北京市平谷区正常孕妇妊娠早中晚期甲状腺功能变化研究[J].中国妇产科临床杂志,2014,15(5):454-455.
[8]熊娟,刘纯珊.孕妇甲状腺激素水平研究进展[J].国际检验医学杂志,2015,36(21):3143-3145.
[9]滕卫平.论母体甲状腺激素不足对胎儿神经智力发育的影响[J].中华内分泌代谢杂志,2005,21(2):97-98.
[10]樊向维.妊娠期母体甲状腺功能变化及其对胎儿的影响[J].国际妇产科学杂志,2015,42(3):330-334.
[11]高劲松,边旭明.妊娠合并甲状腺功能减退症的研究进展[J].中华妇产科杂志,2012,47(9):687-700.
[12]褚晓秋,刘超.甲状腺功能减退症患病因素思考[J].中国实用内科杂志,2014,34(4):313-316.
[13]刘思诗,刘彩霞.妊娠期临床甲状腺功能减退症的诊断标准及危害和处理[J].实用妇产科杂志,2015,31(12):888-890.
[14]郑莹,徐春,夏义欣,等.北京地区妊娠早期血清促甲状腺激素筛查的临床意义[J/CD].中华临床医师杂志:电子版,2013,7(7):3198-3199.
[15]贾学元,何恒君.妊娠早期母体TSH水平异常对其妊娠结局的影响[J].海南医学,2012,23(24):64-66.
[16]杨小猛,赵丹,陈书恩,等.正常孕妇妊娠各期甲状腺激素参考范围的建立及其临床意义[J].分子诊断与治疗杂志,2014,6(1):33-36.
[17]孙彬,白光亮,周南南,等.妊娠期妇女甲状腺功能检查结果分析[J].标记免疫分析与临床,2015,22(5):383-385.
[18]黄璐,罗丹,王利民,等.成都地区妊娠期特异性甲状腺激素水平参考值范围的探讨及临床分析[J].现代妇产科进展,2016,25(4):269-272.
[19]阎玉芹,董作亮,董玲,等.我国四地区正常孕妇的尿碘水平分析[J].中华内分泌代谢杂志,2011,27(4):307-310.
[20]Stagnaro-Green A,Abalovich M,Alexander E,et al.Guidelines of the American Thyroid Association foe the diagnosis and management of thyoid disease during pregnancy and postpartum[J].Thyroid,2011,21(10):1081-1125.
[21]王伟涛,徐丹丹,张健,等.妊娠早中晚期甲状腺激素参考值范围[J].标记免疫分析与临床,2014,21(4):468-470.
[22]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,2015,25(3):365-367.
[23]范建霞,宋梦帆.妊娠期甲状腺功能特异性参考值的意义[J].中华围产医学杂志,2012,15(2):69-72.
[24]万晓华,文江平,宋新,等.妊娠早期甲状腺功能指标参考区间的初步调查[J].中国医药导报,2013,10(11):121-123.
[25]刘素筠,刘知建.碘摄入量与甲状腺功能减退症调查研究[J].中国医疗前沿,2009,4(15):137.
[26]李晨嫣,单忠艳.妊娠期碘营养与甲状腺功能[J].中华地方病学杂志,2016,35(3):161-165.
[27]吴辉.甲状腺功能检测在妊娠妇女中的应用价值[J].国际检验医学杂志,2012,33(12):1508-1509.