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目的探讨北京市平谷地区妊娠特异性甲状腺功能参考范围在评估妊娠期妇女甲状腺功能中的作用。方法采集2011年6月至2012年12月在北京市平谷区医院正常产检的951例妊娠≤20周妇女的血清,应用直接化学发光法测定血清TSH、FT4和TPOAb。分别以平谷地区妊娠特异性和非妊娠人群甲状腺功能参考范围及指南参考标准,筛查妊娠甲状腺功能异常的患病率。结果采用妊娠特异性甲状腺功能的参考范围,临床甲状腺功能减退(简称甲减)、亚临床甲减和低甲状腺素(T4)血症患病率(例)分别为0.74%(7)、5.05%(48)、2.10%(20);采用非妊娠人群的参考范围,患病率分别为0.53%(5)、1.79%(17)、1.58%(15);以指南的标准,患病率分别为0.84%(8)、11.04%(105)、2.00%(19),三种诊断标准获得的临床甲减、亚临床甲减和低甲状腺素(T4)血症的总患病率分别为:7.89%(75)、3.89%(37)、13.88%(132),两两比较差异均有统计学意义(P<0.001);采用非妊娠人群的参考范围作为标准,临床甲减、亚临床甲减和低T4血症的漏诊率分别为0.21%、3.25%、0.52%,总漏诊率为3.98%;采用指南的标准,临床甲减及亚临床甲减的过度诊断率分别为0.10%、5.99%,总过度诊断率为6.09%。结论采用妊娠特异性甲状腺功能指标的参考范围诊断妊娠期甲状腺功能异常,可以明显降低漏诊率及过度诊断率。
Objective To explore the role of pregnancy-specific thyroid function reference range in assessing thyroid function in pregnant women in Pinggu district of Beijing. Methods Serum TSH, FT4 and TPOAb were measured by direct chemiluminescence assay in 951 pregnant women ≤20 weeks of gestation from June 2011 to December 2012 in Pinggu District Hospital of Beijing. The prevalence of thyroid dysfunction in pregnant women was screened by the reference range of thyroid function in pregnancy-specific and non-pregnant population in Pinggu area and the reference standard of guideline respectively. Results The reference range of pregnancy-specific thyroid function was 0.74% (7), 5.05% (hypothyroidism), subclinical hypothyroidism (Hypothyroidism) and T4 hypothyroidism (48) and 2.10% (20). The prevalence rates of non-pregnant population were 0.53% (5), 1.79% (17) and 1.58% (15) respectively. According to the guidelines, The prevalences of clinical hypothyroidism, subclinical hypothyroidism and hyponatremia were all 0.84% (8), 11.04% (105), 2.00% (19) 7.89% (75), 3.89% (37), 13.88% (132) respectively. There was significant difference between every two groups (P <0.001). The reference range of non-pregnant population was used as standard, clinical hypothyroidism, The rates of missed diagnosis and hypothyroidism were 0.21%, 3.25% and 0.52% respectively, and the total misdiagnosis rate was 3.98%. According to the guidelines, the overdiagnosis rates of clinical hypothyroidism and subclinical hypothyroidism were 0.10% and 5.99 %, The total overdiagnosis rate was 6.09%. Conclusion Using the reference range of pregnancy-specific thyroid function index to diagnose thyroid dysfunction during pregnancy can significantly reduce the rate of missed diagnosis and over-diagnosis.