杜永峰　朱楠

[摘要] 目的 探讨西安地区孕妇血清甲状腺功能[促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）]检测结果参考范围。 方法 选取2018年2月至2020年2月西安地区常住妊娠妇女500例作为观察组，50例健康体检妇女作为对照组，对两组患者甲状腺激素水平进行分析，建立相关参考范围，并进行两种标准下亚临床甲减发生率分析。 结果 两组FT3、FT4水平比较，差异无统计学意义（P>0.05），观察组TSH水平低于对照组，差异有统计学意义（P<0.05）。根据年龄进行分组，18～23岁组FT3水平高于24～30岁组，差异有统计学意义（P<0.05），24～30岁组FT4水平高于31～40岁组，差异有统计学意义（P<0.05）。根据胎次分组，初胎组FT4水平高于二胎组，差异有统计学意义（P<0.05）。西安地区孕妇妊娠期甲状腺激素水平中位数和参考范围为TSH 1.93（0.05～5.62）μU/mL、FT3 2.73（2.15～3.48）pg/mL、FT4 1.08（0.71～1.60）μg/dL。妊娠期ATA指南亚临床甲减发病率为31.40%（157/500），本研究亚临床甲减发病率为3.20%（16/500）。ATA推荐TSH参考范围为0.1～0.4 μU/mL，TSH参考范围为0.05～5.62 μU/mL。 结论 西安地区正常妊娠孕妇与没有妊娠妇女TSH水平有差异，年龄不同的妇女甲状腺激素水平有差异，为减少妊娠不良结局应正确把握妊娠期孕妇的甲状腺激素水平。

[关键词] 甲状腺功能;妊娠;激素;内分泌

[中图分类号] R714.2          [文献标识码] B          [文章編号] 1673-9701（2021）04-0090-04

The test results of serum thyroid function in pregnant women in Xi'an area and the establishment of reference range

DU Yongfeng1   ZHU Nan2

1.Department of Endocrinology and Metabolism， First Affiliated Hospital of Air Force Military Medical University， Xi′an   710032， China; 2.Cadre Health Care Office of the Second Affiliated Hospital of Xi′an Jiaotong University， Xi′an   710004， China

[Abstract] Objective To explore the reference range of serum thyroid function （thyroid stimulating hormone[TSH]， free triiodothyronine[FT3]， free thyroxine[FT4]） in pregnant women in Xi'an. Methods A total of 500 pregnant women who were resident in Xi′an from February 2018 to February 2020 were selected as the observation group， and 50 healthy women were selected as the control group. Thyroid hormone levels of the two groups were analyzed， and the relevant reference range was established. The incidence of subclinical hypothyroidism was analyzed. Results There was no statistically significant differences between the two groups at level of FT3 and FT4（P>0.05）. The level of TSH in the observation group was lower than that in the control group（P<0.05）. Group by age， the level of FT3 in 18-23 years old group was higher than that in 24-30 years old group（P<0.05）. The level of FT4 in 24-30 years old group was higher than that in 31-40 years old group（P<0.05）. Group according to parity， the level of FT4 in the first group was higher than that in the second group， the difference was statistically significant（P<0.05）. The median and reference range of thyroid hormone levels of pregnant women in Xi′an were TSH 1.93（0.05-5.62） μU/mL， FT3 2.73（2.15-3.48） pg/mL， FT4 1.08（0.71-1.60） μg/dL.The incidence rate of ATA in pregnancy is 31.40%（157/500） in South Asia. The incidence rate of subclinical hypothyroidism in this study is 3.20%（16/500）. The reference range of TSH recommended by ATA is 0.1-0.4 μU/mL， and the reference range of TSH is 0.05-5.62 μU/mL. Conclusion There are differences in TSH levels between normal pregnant women and non-pregnant women in Xi′an. There are differences in thyroid hormone levels in women at different ages. In order to reduce adverse pregnancy outcomes， the thyroid hormone levels of pregnant women should be correctly monitored.

[Key words] Thyroid function; Pregnancy; Hormones; Endocrine

妊娠期甲状腺疾病是近十年来内分泌学界和围产医学界研讨的热点问题之一。妊娠期甲状腺疾病的症状和体征复杂多样，缺乏特异性，尤其在妊娠早期发病易被孕期生理现象所掩盖，通过实验室检查才能确诊，容易漏诊误诊。妊娠期妇女胎盘和胎儿分泌的各种激素可导致母体内分泌紊乱或使原有的内分泌疾病加重。近年来，由于临床对甲状腺疾病筛査的重视，发病率呈逐年增高趋势，妊娠妇女甲状腺激素异常会影响妊娠结局，在胎儿大脑发育中有重要作用，因此需要及时进行干预。胎儿10～12周会分泌甲状腺激素，在20周前会持续与母体进行甲状腺激素的交换[1]。有研究指出[2-3]，不同国家、种族、人群的参考值范围有一定差异，我国未给出具体的参考范围，推荐建立当地妊娠妇女甲状腺激素正常参考范围。因此建立正常妊娠早期妇女甲状腺参考范围十分重要，现报道如下。