抚顺地区妇女妊娠期特异性甲状腺功能参考区间的建立与评价

Establishment and the evaluation of the specific reference ranges of the thyroid hormones for the pregnant women in the area with adequate iodine

关键词:  妊娠  甲状腺激素  促甲状腺激素  参考区间

Key words:  pregnancy  thyroid hormone  thyroid stimulating hormone  reference range

摘要:

目的　建立辽宁省抚顺地区妇女妊娠期特异性甲状腺功能检测指标的参考区间，比较与非妊娠妇女参考区间的差异，评估依据非妊娠人群参考区间造成的妊娠甲状腺疾病误诊、漏诊率，探讨妊娠期甲状腺疾病的正确诊断。方法　选取662例妊娠期女性，按照美国临床生化研究院的标准（National Academy of Clinical Biochemistry，NACB）筛选出妊娠早期、中期、晚期妇女各120例，采用DXI 800全自动化学发光免疫分析系统及配套试剂测定TSH、FT3、FT4水平，经数据分析建立甲状腺功能参考区间，并比较其与非妊娠妇女参考区间的差异，计算662例妊娠期女性按非妊娠人群参考区间判定的误诊率。结果　妊娠早期参考区间：TSH(0.08～21)mIU/L，FT3(51～67)pmol/L，FT4(7.17～124)pmol/L；妊娠中期TSH (0.46～64)mIU/L，FT3(18～13)pmol/L，FT4(20～10.71)pmol/L；妊娠晚期：TSH(0.32～33)mIU/L，FT3(05～36)pmol/L，FT4(25～120)pmol/L。使用非妊娠人群参考区间判定，妊娠早期将有12% TSH、6% FT3和9% FT4被误诊；妊娠中期误诊率分别为6%、10.6%和27.0%；妊娠晚期误诊率分别为2%、50.0%和20%。结论　应用非妊娠正常人群的参考区间判定妊娠妇女甲状腺功能，将会导致部分妊娠妇女被误诊，采用各实验室的设备与方法建立应用本地区妇女妊娠期甲状腺功能特异性参考区间会降低妊娠妇女甲状腺功能异常的误诊率。

Abstract:

Objective The specific reference ranges of thyroid function for the pregnant women in Fushun，the local area with adequate Iodine，was established，and the misdiagnosis rate and the missed diagnosis rate about thyroid disease was evaluated in order to obtain the correct diagnosis and treatment projects of thyroid disease during pregnancy.Methods We selected20 cases each from early pregnancy，the mid pregnancy and the late pregnancy according to the standard of the National Academy of Clinical Biochemistry (NACB）and analyzed the serum level of TSH，FT3 and FT4 with DXI 800 automatic Unical DXI800 Access Immunoassay system.After the specific reference ranges of the thyroid hormones for the pregnant women was established，we compared the different reference ranges to evaluate the error diagnosis with normal non-pregnancy.Results The reference ranges of TSH，FT3 and FT4 in the early pregnancy were 0.08-21 mIU/L.51-67 pmol/L and 7.17-124 pmol/L，respectively；those in the mid pregnancy were 0.46-64 mIU/L.18-13 pmol/L and.20-10.71 pmol/L，respectively；And those in the late pregnancy were 0.32-33 mIU/L.05-36 pmol/L and.25-120 pmol/L，respectively。The diagnosis with normal reference range would lead misjudge in about2% TSH、6% FT3 and.9% FT4 in the early pregnancy;.6%TSH、10.6%FT3、27.0%FT4 in the mid pregnancy; and.2%TSH、50%FT3、20%FT4 in the late pregnancy。Conclusions The diagnosis with normal reference range would lead misjudge in for pregnant women.So it is necessary for reducing misjudge to establish and use the specific reference ranges of pregnant women with our own methods and instruments in our own region.