Wang Guocheng, Jin Feng, Xie Limin, Zhang Xiaofen, Zhang Yawei, Ni Xin, Li Wei, Zhang Guojun
Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, China.
Department of Genetics and Reproductive Medicine, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Capital Medical University, Beijing, China.
Lab Med. 2023 Sep 5;54(5):449-456. doi: 10.1093/labmed/lmac150.
Thyroid-stimulating hormone (TSH) levels are associated with serum lipid concentrations in the general nonpregnant population. Here, we aimed to establish trimester-specific reference intervals and to explore the associations of their variations within the specific reference intervals during pregnancy.
Trimester-specific reference intervals were established according to the Clinical and Laboratory Standard Institute EP28-A3c guidelines using a direct sampling method based on a large prospective cohort. After making one-to-one matches, correlation analyses between TSH and lipid index levels, especially within the reference intervals, were conducted.
A total of 1648 pregnant women for TSH and 2045 subjects for lipids were recruited to establish the trimester-specific reference intervals. The upper reference limit (90% confidence interval) of TSH for pregnant women in the first trimester is 3.95 (3.66-4.29) mIU/L, which is very close to the default value (4.0 mIU/L) recommended by the American Thyroid Association in 2017. Apart from triglyceride and high-density lipoprotein cholesterol, TSH levels were positively associated with the serum concentrations of total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), and remnant cholesterol (RC) either in the entire range or within the specific reference intervals. Of note, the positive correlations between TSH and non-HDL-C and RC were, albeit similarly weak (r < 0.25), relatively more robust (P < .001).
In this study, we showed positive correlations between TSH and lipid components within trimester-specific reference intervals, highlighting the need for the integrated management of pregnant women over age 35 and with nonoptimal lipid status in China.
在一般非妊娠人群中，促甲状腺激素（TSH）水平与血清脂质浓度相关。在此，我们旨在建立孕早期、中期和晚期特定的参考区间，并探讨孕期特定参考区间内其变化的相关性。
根据临床和实验室标准协会EP28 - A3c指南，采用直接抽样法，基于一个大型前瞻性队列建立孕早期、中期和晚期特定的参考区间。进行一对一匹配后，对TSH与脂质指数水平进行相关性分析，特别是在参考区间内。
共招募了1648名检测TSH的孕妇和2045名检测脂质的受试者来建立孕早期、中期和晚期特定的参考区间。孕早期孕妇TSH的参考上限（90%置信区间）为3.95（3.66 - 4.29）mIU/L，这与美国甲状腺协会2017年推荐的默认值（4.0 mIU/L）非常接近。除甘油三酯和高密度脂蛋白胆固醇外，在整个范围内或特定参考区间内，TSH水平与总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇（non - HDL - C）和残余胆固醇（RC）的血清浓度呈正相关。值得注意的是，TSH与non - HDL - C和RC之间的正相关性虽然同样较弱（r < 0.25），但相对更显著（P <.001）。
在本研究中，我们显示了在孕早期、中期和晚期特定参考区间内TSH与脂质成分之间存在正相关，强调了对中国35岁以上且脂质状态不理想的孕妇进行综合管理的必要性。
