吴敏 马亦良 陈旭日

【摘要】 目的：进一步对深圳市宝安区甲状腺过氧化物酶抗体（TPOAb）阴性健康孕妇妊娠期血清甲状腺激素的参考值及其变化情况进行探究。方法：选择2016年6月-2017年11月本院产科门诊行甲状腺功能筛查的TPOAb阴性健康孕妇1 043例为研究对象。根据不同孕期分为孕早期组（≤12周）、孕中期组（13～27周）和孕晚期组（28周至分娩）。采用化学发光免疫分析法对三组妊娠期孕妇的TSH、FT4、TT3、FT3及TT4进行检测，采用横断面研究方法建立三组不同孕期孕妇各检测指标的正常范围，并对各指标的变化趋势进行统计分析。结果：经化学发光免疫分析法测定，孕早期组、孕中期组、孕晚期组的TSH、FT4、TT3、FT3、TT4水平比较，差异均有统计学意义（P<0.05）。孕早期组、孕中期组、孕晚期组不良妊娠反应发生率分别为0.29%、7.34%、2.33%，比较差异有统计学意义（字2=11.322，P=0.016）。结论：对于TPOAb阴性健康孕妇，不同孕期其甲状腺激素水平具有明显差异，建立有效的妊娠期甲状腺参考值并对其变化情况进行探究不仅有助于妊娠期甲状腺疾病的早期诊断，而且在保证胎儿正常发育及孕妇健康方面意义重大。

【关键词】 妊娠期； 孕早期； 孕中期； 孕晚期； TPOAb阴性健康孕妇； 甲状腺激素

【Abstract】 Objective：To further study on serum thyroid hormone reference value and its change during pregnancy of TPOAb negative healthy pregnant women in Baoan District of Shenzhen.Method：A total of 1 043 healthy pregnant women with negative TPOAb in our hospital from June 2016 to November 2017 were retrospectively analyzed.According to the difference of pregnancy time，they were divided into early pregnancy group （≤12 weeks），second trimester group（13-27 weeks）and third trimester group（28 weeks to delivery）.CLIA was used to detect the levels of TSH，FT4，TT3，FT3 and TT4 in the three groups of pregnant women.Then the cross-sectional study method was used to establish the normal range of the three groups of pregnant women in different pregnancy，and the change trend of each index was statistically analyzed.Result：There were statistically significant in TSH，FT4，TT3，FT3，TT4 among three groups through CLIA（P<0.05）.There were statistically significant in the adverse reaction rate of the pregnant women among early pregnancy group（0.29%），second trimester group（7.34%），third trimester group（2.33%）（字2=11.322，P=0.016）。Conclusion：There are significant differences in thyroid hormone levels between pregnant women with TPOAb negative healthy pregnant women.To establish an effective reference value of thyroid hormone levels in pregnancy and to explore its changes are not only helpful for the early diagnosis of thyroid disorders in pregnancy，but also great significance in ensuring the normal development of the fetus and the health of pregnant women.

【Key words】 Pregnancy； Early pregnancy； Second trimester； Third trimester； TPOAb negative healthy pregnant women； Thyroid hormone

First-authors address：Shenzhen Baoan District Maternal and Child Health Hospital，Shenzhen 518000，China

doi：10.3969/j.issn.1674-4985.2018.18.037

作为产科门诊常见疾病，妊娠期甲状腺功能紊乱不仅会大大提升孕妇早产、流产的概率，而且会导致胎儿先天性畸形，甚至死胎等情况。随着我国全面二胎政策的实施，我国妊娠期孕妇迅猛增加，这也使得妊娠期甲状腺疾病的发病率日益升高，严重威胁着孕妇及胎儿的健康[1]。大量研究表明，健康孕妇在妊娠早期阶段会因其体内人绒毛膜促性腺激素（hCG）的作用，加之雌激素水平的改變、碘的异常代谢与胎盘Ⅲ型脱碘酶（MID-Ⅲ）活性的增加等多种因素的变化会造成孕妇体内甲状腺激素指标的异常变化，最终将会直接影响孕妇妊娠期甲状腺的正常功能。而妊娠期孕妇甲状腺的异常不仅会严重影响孕妇的身心健康，而且对其腹内胎儿也会有显著的影响，严重者将造成娩出胎儿智力水平的下降及脑部的发育[2]。……