清远地区妊娠期孕妇甲状腺功能相关指标参考值的探讨

摘要

Objective To establish the reference intervals for specific serum thyroid function index at different stages of pregnancy for normal pregnant women in Qingyuan region, providing evidence for standardizing the thyroid disease screening during the pregnancy period.Methods The change rules of thyroid stimulating hormone ( TSH ) , free thyroxine ( FT4 ) , serum free triiodothyronine ( FT3 ) , thyroid peroxidase antibody (TPOAb) and thyroglobulin antibodies (TgAb) were tested and compared at different stages of pregnancy for 1061 cases of pregnant women under antenatal care and hospitalized delivery in this hospital from March to August in 2013 according to the standard of the US National Academy of Clinical Biochemistry ( NACB) and the normal population sorted out after exclusion of the cases in abortion and multiple pregnancy.Results Comparison of normal values of biochemical indexes FT3, FT4 and TSH of different gestation periods T1, T2 and T3 and non-gestation period:multi-group comparisons and pairwise comparisons many are statistically different.there is still no reason to believe that antibody abnormal ( antibody positive ) and normal proportion difference of different gestation periods are statistically significant (P>0.05).Conclusions The reference intervals for serum thyroid function index at different stages of pregnancy are established in different regions according to the experimental apparatuses, experimental methods and service objects.In this study, the cases selected from the inquiry and physical examination have total prevalence rate of 14.3% in thyroid disease, so it is necessary to carry out the thyroid function screening during the normal stage of pregnancy.%目的：建立清远地区本单位和所用仪器方法正常孕妇不同妊娠时期特异的血清甲状腺功能指标参考值范围，为规范开展妊娠期甲状腺疾病的筛查提供证据。方法对2013年3—8月在我院门诊产检及住院分娩的1061例孕妇，依据美国国家临床生化研究院NACB）的标准及排除流产、多胎妊娠筛查出“正常人群”，检测比较促甲状腺激素（ TSH）、游离甲状腺素（ FT4）和血清游离三碘甲腺原氨酸（ FT3）及甲状腺过氧化物酶抗体（ TPOAb）、甲状腺球蛋白抗体（ TgAb）在妊娠各期的变化规律。结果不同孕期T1、T2、T3期和非孕期生化指标FT3、FT4、TSH正常值的比较多组对比及两两对比大多数均有统计学差异；无理由认为不同孕周抗体阳性分布情况有统计学意义（P＞0．05）。结论不同地区根据自己所用实验仪器和方法以及服务的对象建立不同妊娠时期的血清甲状腺功能指标参考值范围，本研究用问诊及体格检查入选病例甲状腺疾病总患病率为14．3％，所以在孕期常规开展甲状腺功能筛查是必要的。