Wei Q, Zhang L, Liu X X, Pu X M, Xu Y
Key Laboratory of Birth Defects and Women Children's Diseases, Ministry of Education, Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu 610041, China.
Zhonghua Fu Chan Ke Za Zhi. 2018 May 25;53(5):299-303. doi: 10.3760/cma.j.issn.0529-567x.2018.05.003.
To explore the reference intervals of thyrotropin (TSH) and free thyroxine (FT(4)) in normal pregnant women. Prospective and longitudinal sequential collection of the cases were performed. A total of 155 singleton pregnant women who had regular prenatal examination and delivery in West China Second Hospital of Sichuan University from January 2015 to December 2015 were included as the research group. Blood samples were sequentially collected from the pregnant women at the first (9-13(+6) weeks) , the second (24-27(+6) weeks) , the third (32-36 weeks) trimesters, respectively. Another 155 non-pregnant women were selected as the control group simultaneously, in an effort to establish a range of reference intervals of thyroid index in each period of pregnancy. Meanwhile, neonatal plantar blood were also collected on special filter paper and TSH levels were measured. (1) TSH reference intervals [percentile 2.5-percentile 97.5 ((2.5)-(97.5)) ] were 0.08-3.29 mU/L, 0.59-4.22 mU/L and 0.81-4.33 mU/L in three trimesters respectively. FT(4) reference intervals were 11.88-20.06 pmol/L, 9.89-15.80 pmol/L and 9.22-15.77 pmol/L in three trimesters respectively. (2) The median serum TSH in the first trimester (1.35 mU/L) was lower than that in the second trimester (2.15 mU/L) , the third trimester (2.19 mU/L) , and the control group (2.19 mU/L) . The differences were all statistically significant (0.05) . There was no significant difference in median serum TSH between the second trimester and the third trimester, the second trimester and the control group, and the third trimester versus the control group. (3) The median serum FT(4) in the first trimester (15.16 pmol/L) was higher than that in the second trimester (12.39 pmol/L) and the third trimester (12.26 pmol/L) . The differences were both statistically significant (0.05) . The median FT(4) in the second trimester and the third trimester was lower than that in the control group (15.64 pmol/L) , and the differences were both statistically significant (0.05) . (4) In the first trimester, the median serum total triiodothyronine (TT(3)) level (2.32 nmol/L) was higher than that in the control group (1.56 nmol/L) , total thyroxine (TT(4)) level (154.60 nmol/L) was also higher than that in the control group (98.25 nmol/L) , and free triiodothyronine (FT(3)) level (4.70 pmol/L) was lower than that in the control group (4.84 pmol/L) , the differences were all statistically significant (0.05) . (5) The TSH levels of all neonatus were normal [ (2.1±1.3) mU/L]. The thyroid hormone levels between pregnant women and non-pregnant women are significantly different. Moreover, the reference intervals are vary with pregnancy period. It is important to establish the specific reference intervals of thyroid hormones in the first, second and third trimester of pregnancy specific to local region or unit.
探讨正常孕妇促甲状腺激素(TSH)和游离甲状腺素(FT4)的参考区间。对病例进行前瞻性纵向序列收集。选取2015年1月至2015年12月在四川大学华西第二医院进行定期产前检查并分娩的155名单胎孕妇作为研究组。分别在孕早期(9 - 13⁺⁶周)、孕中期(24 - 27⁺⁶周)、孕晚期(32 - 36周)依次采集孕妇血样。同时选取155名非孕妇作为对照组,以建立孕期各阶段甲状腺指标的参考区间范围。此外,还在特殊滤纸上采集新生儿足底血并检测TSH水平。(1)三个孕期TSH参考区间[第2.5百分位数 - 第97.5百分位数(2.5 - 97.5)]分别为0.08 - 3.29 mU/L、0.59 - 4.22 mU/L和0.81 - 4.33 mU/L。FT4参考区间分别为11.88 - 20.06 pmol/L、9.89 - 15.80 pmol/L和9.22 - 15.77 pmol/L。(2)孕早期血清TSH中位数(1.35 mU/L)低于孕中期(2.15 mU/L)、孕晚期(2.19 mU/L)及对照组(2.19 mU/L)。差异均有统计学意义(P < 0.05)。孕中期与孕晚期、孕中期与对照组、孕晚期与对照组血清TSH中位数比较差异无统计学意义。(3)孕早期血清FT4中位数(15.16 pmol/L)高于孕中期(12.39 pmol/L)和孕晚期(12.26 pmol/L)。差异均有统计学意义(P < 0.05)。孕中期和孕晚期FT4中位数低于对照组(15.64 pmol/L),差异均有统计学意义(P < 0.05)。(4)孕早期血清总三碘甲状腺原氨酸(TT3)水平中位数(2.32 nmol/L)高于对照组(1.56 nmol/L),总甲状腺素(TT4)水平中位数(154.60 nmol/L)也高于对照组(98.25 nmol/L),游离三碘甲状腺原氨酸(FT3)水平中位数(4.70 pmol/L)低于对照组(4.84 pmol/L),差异均有统计学意义(P < 0.05)。(5)所有新生儿TSH水平均正常[({2.1} ± 1.3)mU/L]。孕妇与非孕妇的甲状腺激素水平存在显著差异。而且,参考区间随孕期不同而变化。建立当地或单位孕期早、中、晚期甲状腺激素的特定参考区间很重要。