Shan Z Y, Chen Y Y, Teng W P, Yu X H, Li C Y, Zhou W W, Gao B, Zhou J R, Ding B, Ma Y, Wu Y, Liu Q, Xu H, Liu W, Li J, Wang W W, Li Y B, Fan C L, Wang H, Guo R, Zhang H M
Department of Endocrinology and Metabolism, First Affiliated Hospital, China Medical University, Shenyang, Liaoning Province, China.
Eur J Clin Invest. 2009 Jan;39(1):37-42. doi: 10.1111/j.1365-2362.2008.02055.x.
Maternal thyroid hormone deficiency is the most common disorder of thyroid function during pregnancy and can influence the outcome for mother and foetus. The purpose of this study was to investigate the prevalence of thyroid hormone deficiency during the first half of pregnancy in iodine sufficient areas of China.
Four thousand eight hundred pregnant women from 10 hospitals during the first 20 weeks of gestation were enrolled in this study. All sera obtained from pregnant women were measured for thyrotropin, free thyroxine and thyroid peroxidase antibody. Screening for thyroid hormone deficiency was performed on pregnant women using gestational age-specific reference intervals or non-pregnant population reference intervals.
With gestational age-specific reference intervals as the criterion, the prevalence of subclinical hypothyroidism at 4, 8, 12,16 and 20 weeks of gestation was 4.59%, 6.15%, 4.68%, 4.53% and 5.96%, respectively, and the prevalence of hypothyroxinaemia was 3.69%, 1.11%, 2.92%, 1.29% and 2.29%, respectively. Different prevalence was obtained when non-pregnant population reference intervals was used as the criterion. If non-pregnant population reference intervals were used, the percentage of potentially misclassified cases of subclinical hypothyroidism were 0.18%, 2.85%, 4.1%, 3.24%, and 3.21%, respectively, and 3.45%, 0.66%, 2.34%, 1.29%, and 1.83%, respectively, in potentially misclassified cases of hypothyroxinaemia.
The percentage of potentially misclassified cases of subclinical hypothyroidism and hypothyroxinaemia in pregnant women decreased by using the gestational age-specific reference intervals as a diagnostic criteria during the first half of pregnancy.
孕期母体甲状腺激素缺乏是孕期最常见的甲状腺功能紊乱疾病，会影响母婴结局。本研究旨在调查中国碘充足地区妊娠前半期甲状腺激素缺乏的患病率。
本研究纳入了来自10家医院的4800名妊娠20周内的孕妇。检测所有孕妇血清中的促甲状腺激素、游离甲状腺素和甲状腺过氧化物酶抗体。采用特定孕周参考区间或非妊娠人群参考区间对孕妇进行甲状腺激素缺乏筛查。
以特定孕周参考区间为标准，妊娠4、8、12、16和20周时亚临床甲状腺功能减退的患病率分别为4.59%、6.15%、4.68%、4.53%和5.96%，低甲状腺素血症的患病率分别为3.69%、1.11%、2.92%、1.29%和2.29%。以非妊娠人群参考区间为标准时，患病率有所不同。若采用非妊娠人群参考区间，亚临床甲状腺功能减退潜在误诊病例的百分比分别为0.18%、2.85%、4.1%、3.24%和3.21%，低甲状腺素血症潜在误诊病例的百分比分别为3.45%、0.66%、2.34%、1.29%和1.83%。
在妊娠前半期，以特定孕周参考区间作为诊断标准，孕妇亚临床甲状腺功能减退和低甲状腺素血症的潜在误诊病例百分比降低。
