复合参考区间在妊娠期亚甲减诊断中的应用
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摘要
目的探讨妊娠期妇女年龄、孕周、甲状腺过氧化物酶抗体与促甲状腺激素(TSH)水平的相关性;建立TSH和游离甲状腺素(FT4)二维复合参考区间,探讨其在诊断妊娠期亚临床甲状腺功能减退症(SCH)的适用性。方法选择2016年1月至2017年7月在四川省妇幼保健院进行产前检查的人群中,符合纳入标准的健康妊娠妇女2 556例,检测空腹血清TSH、FT4及甲状腺过氧化物酶抗体(TPO-Ab)水平。分别将妊娠早、中、晚期TSH和FT4经过正态转换,得到TSH和FT4的Skewness系数和Kurtosis系数。用以上系数根据Mahalanobis距离原理建立二维复合参考区间公式。结果①妊娠期妇女TSH水平与FT4呈负相关(r=-0.305,P<0.001),与TPO-Ab呈正相关(r=0.255,P<0.001);②以传统参考区间作为诊断标准,诊断SCH 190例,TPO-Ab阳性组诊断出43例;以二维复合参考区间作为诊断标准,诊断SCH 44例;TPO-Ab阳性组诊断出20例。结论基于妊娠期妇女TSH和FT4水平建立的二维复合参考区间可能更适于诊断SCH,能减少误判风险,使疾病诊断趋于精准。
Objective To detective the correlation of thyroid stimulation hormone(TSH) level with age, gestational week and thyroid peroxidase antibodies(TPO-Ab) in pregnant women, and to establish composite reference intervals for TSH and free thyroxine(FT4) and their effect in diagnosis of subclinical hypothyroidism(SCH).Methods From January 2016 to July 2017, 2 556 healthy pregnant women from those taking prenatal checkup in Sichuan Provincial Hospital for Women and Children were recruited. Their serum levels of TSH,FT4 and TPO-Ab were determined. The serum TSH and FT4 data in the first, second and third trimester were transformed into normal distributions, with outliers being eliminated and a correction for skewness and kurtosis. The composite reference intervals were established according to the Mahalonobis distance formula. Results Serum TSH was negatively correlated with FT4(r=-0.305,P<0.001) but positively correlated with TPO-Ab(r=0.255,P<0.001). Using conventional reference standards,190 participants were identified with SCH, which included 43 showing TPO-Ab positive. In contrast, using composite reference intervals, 44 participants were identified with SCH, which included 20 showing TPO-Ab positive. Conclusion The composite reference intervals based on TSH and FT4 may lead to a better definition of SCH with fewer false positives. It could make the diagnosis of the disease more precise.
Objective To detective the correlation of thyroid stimulation hormone(TSH) level with age, gestational week and thyroid peroxidase antibodies(TPO-Ab) in pregnant women, and to establish composite reference intervals for TSH and free thyroxine(FT4) and their effect in diagnosis of subclinical hypothyroidism(SCH).Methods From January 2016 to July 2017, 2 556 healthy pregnant women from those taking prenatal checkup in Sichuan Provincial Hospital for Women and Children were recruited. Their serum levels of TSH,FT4 and TPO-Ab were determined. The serum TSH and FT4 data in the first, second and third trimester were transformed into normal distributions, with outliers being eliminated and a correction for skewness and kurtosis. The composite reference intervals were established according to the Mahalonobis distance formula. Results Serum TSH was negatively correlated with FT4(r=-0.305,P<0.001) but positively correlated with TPO-Ab(r=0.255,P<0.001). Using conventional reference standards,190 participants were identified with SCH, which included 43 showing TPO-Ab positive. In contrast, using composite reference intervals, 44 participants were identified with SCH, which included 20 showing TPO-Ab positive. Conclusion The composite reference intervals based on TSH and FT4 may lead to a better definition of SCH with fewer false positives. It could make the diagnosis of the disease more precise.
引文
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[6]江东.不同孕期孕妇甲状腺激素水平变化及其与TPO-Ab的关系研究[J].国际检验医学杂志,2017,38(9):1286-1287.
[7]卢雪玲,阿丽娅·吉力力,王宁.乌鲁木齐市汉族孕妇甲状腺功能与碘营养状态的相关性[J].中华临床营养杂志,2018,26(2):83-89.
[8]Zhang Yixin, Du Cong, Wang Wei, et al.Effect of maternal and neonatal factors on neonatal thyroid stimulating hormone:results from a population-based prospective cohort study in China[J].J Trace Elem Med Biol,2018,49:151-156.
[9]王文美,余晓敏.孕早、中期甲状腺功能减退与年龄因素的相关性分析[J].中国妇幼健康研究,2015,26(3):499-500.
[2]孔德华,孙颖,黄玮,等.不同妊娠期孕妇甲状腺激素水平的检验分析[J].国际检验医学杂志,2016,37(20):2889-2891.
[3]Alexander E K, Pearce E N, Brent G A, et al.2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid,2017,27(3):315–389.
[4]Springer D, Jiskra J, Limanova Z, et al.Thyroid in pregnancy:from physiology to screening[J].Critical Reviews in Clinical Laboratory Sciences,2017,54(2):102-116.
[5]Maraka S, Singh Ospina N M, Mastorakos G, et al.Subclinical hypothyroidism in women planning conception and during pregnancy:who should Be treated and how?[J].J Endocr Soc,2018,2(6):533-546.
[6]江东.不同孕期孕妇甲状腺激素水平变化及其与TPO-Ab的关系研究[J].国际检验医学杂志,2017,38(9):1286-1287.
[7]卢雪玲,阿丽娅·吉力力,王宁.乌鲁木齐市汉族孕妇甲状腺功能与碘营养状态的相关性[J].中华临床营养杂志,2018,26(2):83-89.
[8]Zhang Yixin, Du Cong, Wang Wei, et al.Effect of maternal and neonatal factors on neonatal thyroid stimulating hormone:results from a population-based prospective cohort study in China[J].J Trace Elem Med Biol,2018,49:151-156.
[9]王文美,余晓敏.孕早、中期甲状腺功能减退与年龄因素的相关性分析[J].中国妇幼健康研究,2015,26(3):499-500.