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中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (05) : 503 -510. doi: 10.3877/cma.j.issn.1673-5250.2017.05.002

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妊娠期甲状腺疾病及其相关诊断指标的参考值范围研究现状
王国成1, 麻伟博2, 孙红敏2, 冯国双3,†()   
  1. 1. 101300　北京市顺义区妇幼保健院，北京儿童医院顺义妇儿医院临床检验中心
    2. 101300　北京市顺义区妇幼保健院，北京儿童医院顺义妇儿医院妇产科
    3. 100045　首都医科大学附属北京儿童医院临床流行病学与循证医学中心
  • 收稿日期:2017-03-20 修回日期:2017-08-22 出版日期:2017-10-01
  • 通信作者: 冯国双

Research status of gestational thyroid diseases and reference ranges of related diagnostic indexes

Guocheng Wang1, Weibo Ma2, Hongmin Sun2, Guoshuang Feng3,†()   

  1. 1. Department of Clinical Laboratory
    2. Department of Gynecology and Obstetrics, Shunyi Women and Children′s Hospital of Beijing Children′s Hospital, Beijing 101300, China
    3. Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China
  • Received:2017-03-20 Revised:2017-08-22 Published:2017-10-01
  • Corresponding author: Guoshuang Feng
  • About author:
    Corresponding author: Feng Guoshuang, Email:
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王国成, 麻伟博, 孙红敏, 冯国双. 妊娠期甲状腺疾病及其相关诊断指标的参考值范围研究现状[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(05): 503-510.

Guocheng Wang, Weibo Ma, Hongmin Sun, Guoshuang Feng. Research status of gestational thyroid diseases and reference ranges of related diagnostic indexes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(05): 503-510.

妊娠期甲状腺疾病已迅速成为孕妇的常见疾病之一。究其原因，与妊娠前和妊娠期检查手段的增多、检查范围扩大及人群碘营养状态改变等有关。妊娠过程中，母体血清人绒毛膜促性腺激素(hCG)、雌激素水平上升，血容量增加和肾小球滤过功能增强等一系列生理变化，均对甲状腺功能，甲状腺激素合成、分泌、排泄产生重大影响。血清甲状腺激素水平异常、甲状腺功能紊乱，可导致不良妊娠结局，引起自然流产、早产，甚至死胎等。甲状腺激素在胎儿脑组织神经元迁移和髓鞘形成过程中不可或缺。妊娠期甲状腺素缺乏性疾病包括临床明显甲状腺功能减退(OH)、亚临床甲状腺功能减退(SCH)、单纯性低甲状腺素血症(IH)，这些均可导致子代神经系统发育缺陷、智力发育异常。妊娠期甲状腺疾病早期或亚临床甲状腺疾病时，临床症状、体征缺乏特异性表现，常与妊娠生理性表现重叠，而难以被临床诊断。因此，妊娠期甲状腺疾病相关实验室检查，成为早期诊断此类疾病的唯一手段。笔者拟就妊娠期疾病及其相关临床诊断指标的参考值范围的研究动态和争议进行阐述，以期为妊娠期甲状腺疾病的诊治工作提供参考。

关键词: 甲状腺疾病, 促甲状腺素, 诊断, 甲状腺素, 甲状腺功能试验, 子代, 孕妇

Gestational thyroid disease has rapidly emerged as one of the most common diseases during pregnancy. There are various of causes, including an increase in prenatal and pregnancy examinations strategies, enlarging of checkup scope and changes of iodine nutritional status in pregnant women. With the accumulation of serum human chorionic gonadotropin (hCG) and estrogen concentrations, blood volume and the strengthening glomerular filtration, the process of pregnancy could have substantial impacts on thyroid functions. The relation between thyroid disorders and adverse pregnancy outcomes has been demonstrated in a great deal of analyses and researches. Thyroxine deficient diseases in pregnant women, including overt hypothyroidism (OH), subclinical hypothyroidism (SCH) and isolated hypothyroidism (IH), do bring about neuropsychological dysplasia of the offspring due to the critical value of thyroid hormone in neuronal migration and myelin formation of fetal brain tissues. The clinical manifestations and signs of early and (or) subclinical gestational thyroid diseases are often overlaped with the physiological manifestations of pregnancy, so laboratory testing on thyroid functions always become the only means for the diagnosis of gestational thyroid diseases. We would review on the research status and controversial focus of gestational thyroid diseases and reference ranges of related diagnostic indexes, to provide references for the diagnosis and treatment of thyroid diseases pregnancy.

Key words: Thyroid disease, Thyrotropin, Diagnosis, Thyroxine, Thyroid function tests, Offspring, Pregnant women
图1 妊娠期血清hCG水平与血清TSH水平动态关系图
表1 中国孕妇血清TSH、FT4参考值范围(P2.5～P97.5)
诊断试剂生产公司 TSH (mIU/L) FT4 (pmol/L) 检测方法
早孕期 中孕期 晚孕期 早孕期 中孕期 晚孕期
美国DiagnosticProducts公司 0.13～3.93 0.26～3.50 0.42～3.85 12.00～23.34 11.20～21.46 9.80～18.20 化学发光免疫分析法
美国Abbott公司 0.03～3.60 0.27～3.80 0.28～5.07 11.49～18.84 9.74～17.15 9.63～18.33 化学发光免疫分析法
瑞士Roche公司 0.05～5.17 0.39～5.22 0.60～6.84 12.91～22.35 9.81～17.26 9.12～15.71 电化学发光免疫分析法
德国Bayer公司 0.03～4.51 0.05～4.50 0.47～4.54 11.80～21.00 10.60～17.60 9.20～16.70 化学发光免疫分析法
表2 中国孕妇血清FT4参考值范围的P5和P10(pmol/L)
诊断试剂生产公司 早孕期 中孕期 晚孕期 检测方法
P5 P10 P5 P10 P5 P10
美国DiagnosticProducts公司 13.46 14.30 11.66 12.21 10.40 11.10 化学发光免疫分析法
美国Abbott公司 12.95 13.18 10.44 11.03 10.38 10.92 化学发光免疫分析法
瑞士Roche公司 13.72 14.07 10.25 10.54 9.57 9.99 电化学发光免疫分析法
德国Bayer公司 12.10 12.70 10.80 11.70 9.60 10.30 化学发光免疫分析法
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