天津医药

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两种参考值用于诊断妊娠期妇女甲状腺功能的比较研究

杨鹤超1,钱明1,2,丁文娟1,2,阎玉芹2,3,陈祖培2,Mehari Gebre-Medhin2,4   

  1. 1. 天津医科大学医学心理学教研室
    2.
    3. 天津医科大学内分泌研究所
    4. Uppsala University
  • 收稿日期:2010-11-30 修回日期:2011-01-11 出版日期:2011-04-15 发布日期:2011-04-15
  • 通讯作者: 杨鹤超

Study of comparing with two reference data for evaluation of maternal thyroid function during pregnancy

  • Received:2010-11-30 Revised:2011-01-11 Published:2011-04-15 Online:2011-04-15

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摘要： 摘要 目的：比较正常孕妇早中晚孕期甲状腺激素参考值范围（阎氏标准）和普通成人参考值范围（成人标准）在诊断妊娠妇女甲状腺功能异常中的差异和和可靠性。方法：选取不同妊娠期的孕妇共893例，以TSH和FT4为实验室诊断指标，采用阎氏和成人标准诊断，符合率和Kappa值为标准评价指标。结果：妊娠早中晚期妇女血清TSH含量中位数分别1.72，2.27，2.38 mIU/L；FT4含量均值分别为14.24，13.36，13.49 pmol/L。阎氏标准和成人标准诊断孕妇亚临床甲状腺功能减退（亚甲减）的患病率分别为10.5%和7.5%，差异主要出现在妊娠的早期（0～13周）和晚期（28～40周）；诊断单纯低游离甲状腺素血症（低FT4血症）的患病率分别为2.6%和11.0%，差异主要出现在妊娠的中期（14～27周）和晚期（28～40周）。结论：阎氏标准更符合妊娠期甲状腺激素生理变化规律，能减少采用成人标准诊断对孕妇亚甲减的漏诊和对低FT4血症误诊，有较高的临床应用价值。

关键词: 妊娠, 甲状腺, 亚临床甲状腺功能减退, 单纯低游离甲状腺素血症, 参考值

Abstract: Abstract Objective:　To evaluate the differences and reliability, we apply trimester-specific reference data created by Yan (Yan’s criteria) for diagnosis thyroid dysfunction of women during pregnancy, compared with population-based reference data (Adults’ criteria) . Methods: Totle samples we studied were 893 pregnant women during the three trimesters. The consistency of serum TSH and FT4 were detected. Both Yan’s and Adults’ criteria were applied to diagnosis thyroid dysfunction. Consistency rate and Kappa value were used to evaluate the validity and reliability of two types of criteria. Results: The medians of serum TSH concentration during pregnancy in the 1st, 2nd, 3rd trimesters were 1.72，2.27，2.38 mIU/L respectively; and the FT4 were 14.24, 13.36, 13.49 pmol/L. The prevalence of subclinical hypothyroidism diagnosed by Yan’s criteria during pregnancy is 10.5% compared with 7.5% by Adults’ criteria. The differences between them are mainly found in the 1st and 3rd trimesters. The revalence of hypothyroxinemia diagnosed by Yan’s criteria during pregnancy isse 2.6% compared with 11.0% by Adults’ criteria. The differences between them are found particularly in the 2nd and 3rd trimesters. Conclusion: Trimester-specific reference data of thyroid hormones established by Yan was confirmed to be more validity and reliability than population-based reference data during the three pregnant trimesters. The rates of missed diagnosis of subclinical hypothyroidism and misdiagnosis of hypothyroxinemia during pregnancy were decreased due to use of Yan’s criteria which was demonstrated more valuable in clinical practice.

Key words: pregnancy, thyroid, subclinical hypothyroidism, hypothyroxinemia, reference value