Objective To establish the gestational age-specific reference ranges for thyroid-related indicators(FT4,FT3,TSH)in Wenzhou, and to compare the incidence rates of subclinical hypothyroidism during pregnancy via different diagnostic reference ranges.Methods From Jan. 2015 to Jun. 2016,pregnant women who had antenatal care and delivered in the Second Affiliated Hospital of Wenzhou Medical University were collected. Among them,768 pregnant women with single fetus who conformed to the National Academy of Clinical Biochemistry criteria,without adverse pregnancy outcomes and obstetric complications were recruited. The thyroid tests including FT4,FT3,TSH,TPOAb,and the pregnancy outcomes were followed up. Data were analyzed to establish the gestational age-specific reference intervals for thyroid function in Wenzhou.Results The gestational age-specific reference ranges for thyroid-related indicators of pregnant women in Wenzhou were as follows:in the first trimester:FT40.70~1.58ng/dl,FT32.57~3.77pg/ml,TSH 0.11~3.99mU/L. In the second trimester: FT40.62~1.48ng/dl,FT32.33~3.59pg/ml,TSH 0.13~4.11mU/L. In the third trimester:FT40.73~1.33ng/dl,FT31.91~3.22pg/ml,TSH 0.42~4.74mU/L. The incidence rates of subclinical hypothyroidism during the three trimester diagnosed by the reference intervals of our study were 2.80%,2.24%,2.34%,respectively,which was higher than the incidence rates diagnosed by the kits' standard and lower than the incidence rates diagnosed by the guidelines of 2011 ATA.Conclusion The gestational age-specific reference ranges for thyroid-related indicators in Wenzhou are different from the kits' reference range and the 2011 ATA recommended standard,the first trimester TSH is very close to 4 mU/L. which is recommended by 2017 ATA guidelines. The establishment of the gestational age-specific reference ranges for thyroid-related indicators in Wenzhou,can reduce the risk of over diagnosis and missed diagnosis of subclinical hypothyroidism during pregnancy.%目的 建立温州地区妊娠月份特异性血清甲状腺功能FT4、FT3、TSH参考值范围,探讨不同促甲状腺激素(TSH)标准诊断的妊娠亚临床甲状腺功能减退症(亚临床甲减)的患病率.方法 收集2015年1月至2016年7月就诊的妊娠期妇女,检测甲状腺功能,随访妊娠结局.符合美国临床生化研究院推荐标准的孕妇纳入研究共768例,T1期284例,T2期356例,T3期128例.对其统计分析,建立温州地区妊娠月份特异性FT4、FT3、TSH的参考值范围.结果本研究得到温州地区妊娠月份特异性甲状腺参考范围:T1期:FT40.70~1.58 ng/dl,FT32.57~3.77pg/ml,TSH 0.11~3.99mU/L T2期:FT40.62~1.48ng/dl,FT32.33~3.59 pg/ml,TSH 0.13~4.11mU/L T3期:FT40.73~1.33ng/dl,FT31.91~3.22pg/ml,TSH 0.42~4.74mU/L.根据本研究制定的温州地区妊娠月份特异性甲状腺功能参考值范围,诊断妊娠TI、T2、T3期亚临床甲减的患病率分别为2.80%、2.24%、2.34%,高于应用试剂盒标准诊断亚临床甲减的患病率,低于应用2011年美国甲状腺学会(ATA)标准诊断亚临床甲减的患病率.结论 温州地区妊娠期妇女血清甲状腺功能水平与试剂盒的参考范围及2011年ATA指南推荐标准存在差异,妊娠早期TSH水平接近2017年ATA指南标准推荐的4mU/L.利用不同参考值范围,诊断妊娠期亚临床甲减,其发生率存在差异,建立温州地区妊娠月份特异性甲状腺功能参考值范围,可减少亚临床甲减的过度诊断或漏诊.
展开▼
