目的 探讨妊娠各期孕妇的甲状腺激素变化及其甲状腺功能状态.方法 采用ACS-180化学发光分析仪检测623例孕妇的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、促甲状腺激素(TSH)和人绒毛膜促性腺激素(hCG);利用碘催化砷铈反应原理,采用冷消解快速尿碘定量检测方法 测定孕妇一次随意尿的尿碘含量.结果 妊娠早、中期的FT3、FT4和hCG高于妊娠晚期(F=53.19,78.00,58.77,P＜0.05),而TSH低于妊娠晚期(F=5.68,P＜0.05).孕妇甲状腺功能紊乱发生率为7.54%,妊娠各期孕妇的甲状腺功能紊乱发生率的差异无统计学意义(χ2=3.92,P＞0.05).亚临床甲减、亚临床甲亢、甲减和甲亢的发生率分别是3.53%、2.57%、1.12%和0.32%.妊娠早期和妊娠晚期均以亚临床甲减居多,妊娠中期以亚临床甲亢居多.结论 孕妇妊娠晚期的甲状腺功能相对孕早、中期而言处于一种轻微甲状腺功能减低的代偿状态,孕期激素变化不是引起孕妇甲状腺功能紊乱的主要因素.%Objective To investigate the state of thyroid hormones and thyrotropin level in different gestation periods. Methods FT3, FT4, TSH and hCG were measured in 623 patients by ACS-180 automatic chemiluninescence analyzer. The urinary iodine was random measured by the use of iodine catalytic reaction mechanism of Arsenic-Cerium, rapid urinary iodine was detected with cold digestion method of quantitative detection. Result Serum FT3,FT4 ,and hCG levels in the first and second trimester were higher than in the third trimester ( F =53. 19,78.00,58.77, P ＜0. 05) ,and TSH levels were lower than in the third trimester ( F =5.68, P ＜0.05). The incidence of thyrotropin level disorder was 7. 54%, there were no significant differences in the gestation periods ( χ2 = 3.92, P ＞ 0. 05 ). The incidence of subclinical hypothyroidism,subclinical hyperthyroidism, hypothyroidism and hyperthyroidism were 3.53%, 2. 57%, 1.12% and 0. 32%, respectively. The incidence of subclinical hypothyroidism in the first and third trimester was high, while the incidence of subclinical hyperthyroidism in the second trimester was high. Conclusions Thyrotropin level in the third trimester was lower than that of the first and second trimester. HCG changes were not the main reason that caused the thyrotropin level disorder during the pregnancy.
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