Institute of Endocrinology, and Key Laboratory of Hormone and Development of China Ministry of Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China.
Clin Endocrinol (Oxf). 2011 Feb;74(2):262-9. doi: 10.1111/j.1365-2265.2010.03910.x.
The importance of diagnosis and treatment of thyroid dysfunction during pregnancy has been widely recognized. We therefore established trimester- and method-specific reference intervals for thyroid testing in pregnant women according to the NACB recommended criteria. Several factors can affect the setting of reference intervals, in particular manufacturer's methodology, euthyroid definition and iodine status.
Cross-sectional dataset analysis.
Five hundred and five normal pregnant women at different stages of gestation were rigorously selected for setting reference intervals. All were healthy, iodine sufficient, euthyroid and negative for both serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb).
Thyrotrophin (TSH), total and free thyroxine (TT4 and FT4), total and free triiodothyronine (TT3 and FT3) and anti-TPOAb and anti-TgAb were measured using the Bayer ADVIA Centaur system. Iodine content in drinking water, salt and urine was determined by national standard methods. The 2·5th and 97·5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester.
All participants had long-term consumption of iodized salt and median urinary iodine of 150-200 μg/l during each three trimester. The reference intervals for the first, second and third trimesters were, respectively, TSH 0·03-4·51, 0·05-4·50 and 0·47-4·54 mIU/l and FT4 11·8-21·0, 10·6-17·6 and 9·2-16·7 pmol/l. The manufacturer's method, euthyroid definition and iodine status may influence TSH and FT4 reference intervals. Alterations in thyroid hormone concentrations during pregnancy differed at different stage of gestation and to those of a nonpregnant state.
The trimester- and method-based reference intervals for thyroid tests during pregnancy are clinically appropriate. Some variables should be controlled when establishing reference intervals.
甲状腺功能障碍的诊断和治疗在怀孕期间的重要性已得到广泛认可。因此，我们根据 NACB 推荐的标准，为孕妇的甲状腺检测建立了基于三孕期和方法的参考区间。有几个因素会影响参考区间的设定，特别是制造商的方法、甲状腺功能正常的定义和碘状态。
横断面数据集分析。
我们严格选择了 505 名处于不同妊娠阶段的正常孕妇来设定参考区间。所有孕妇均健康、碘充足、甲状腺功能正常，血清甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）均为阴性。
使用 Bayer ADVIA Centaur 系统测量促甲状腺激素（TSH）、总甲状腺素（TT4 和 FT4）、总三碘甲状腺原氨酸（TT3 和 FT3）以及抗 TPOAb 和抗 TgAb。采用国家标准方法测定饮用水、盐和尿中的碘含量。计算每个三孕期的 2.5%和 97.5%百分位数作为甲状腺激素水平的参考区间。
所有参与者在每个三孕期均长期食用碘盐，尿碘中位数为 150-200μg/l。第 1、2 和第 3 孕期的参考区间分别为 TSH 0.03-4.51、0.05-4.50 和 0.47-4.54 mIU/l，FT4 11.8-21.0、10.6-17.6 和 9.2-16.7 pmol/l。制造商的方法、甲状腺功能正常的定义和碘状态可能会影响 TSH 和 FT4 的参考区间。怀孕期间甲状腺激素浓度的变化在不同的妊娠阶段与非妊娠状态不同。
基于三孕期和方法的妊娠期间甲状腺检测参考区间具有临床意义。在建立参考区间时，应控制一些变量。
