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目的制定妊娠早中期血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3),游离四碘甲腺原氨酸(FT4)的参考值范围,筛查上海市妊娠期妇女甲减和亚临床甲减的患病率。方法 2011年8月至2012年4月共10264例复旦附属妇产科医院产科门诊正规建卡的早中孕期单胎妊娠孕妇,晨8点至11点抽取5ml静脉血,分离血清后检测TSH、FT3、FT4、总T3(TT3)、总T4(TT4)、TPO-Ab。黄浦院区的甲状腺功能检测使用西门子化学发光仪,杨浦院区则使用雅培I2000化学发光仪,均使用配套的试剂盒采用直接化学发光技术的竞争免疫测定法进行检测。结果早孕期TSH参考值为0.04～3.61μIU/ml(雅培)、0.02～3.24μIU/ml(西门子),FT3参考值为3.60～5.81pmol/L(雅培)、3.58～5.41pmol/L(西门子),FT4参考值为12.32～21.66pmol/L(雅培)、11.85～21.26pmol/L(西门子)。中孕期TSH参考值为0.09～3.93μIU/ml(雅培)、0.09～4.57μIU/ml(西门子),FT3参考值为3.70～5.95pmol/L(雅培)、3.30～5.22pmol/L(西门子),FT4参考值为11.19～19.14 pmol/L(雅培)、10.68～17.65pmol/L(西门子)。亚临床甲减患病率2.8%,甲减患病率0.08%。结论上海地区早中孕期TSH参考值上限显著高于美国甲状腺协会推荐TSH参考值。
Objective To establish the reference value range of serum thyrotropin (TSH), free triiodothyronine (FT3) and free tetraiodothyronine (FT4) in the early and middle third trimester of pregnancy. To screen the hypothyroidism of pregnant women in Shanghai And the prevalence of subclinical hypothyroidism. Methods From August 2011 to April 2012, a total of 10264 pregnant women with single fetus in early pregnancy and middle pregnancy in 10264 cases of obstetrics and gynecology hospital obstetrics and gynecology hospital of Fudan University were enrolled in this study. 5ml of venous blood was drawn from 8:00 am to 11:00 am, FT3, FT4, total T3 (TT3), total T4 (TT4), TPO-Ab. The thyroid function test of Huangpu Hospital uses Siemens Chemiluminescence Instrument and the Yangpu Hospital Area uses Abbott I2000 Chemiluminescence Instrument, all of which are tested by direct competitive chemiluminescence immunoassay using the kit. Results The reference value of TSH in early pregnancy was 0.04 ~ 3.61μIU / ml (Abbott), 0.02 ~ 3.24μIU / ml (Siemens), FT3 reference value was 3.60 ~ 5.81pmol / L, 3.58 ~ 5.41pmol / , FT4 reference values of 12.32 ~ 21.66pmol / L (Abbott), 11.85 ~ 21.26pmol / L (Siemens). The TSH reference values in the second trimester were 0.09-3.93μIU / ml (Abbott), 0.09-4.57μIU / ml (Siemens), FT3 reference values were 3.70-5.95pmol / L (Abbott), 3.30-5.22pmol / L FT4 reference values were 11.19-19.14 pmol / L (Abbott) and 10.68-17.65 pmol / L (Siemens). Subclinical hypothyroidism prevalence 2.8%, hypothyroidism prevalence 0.08%. Conclusion The upper limit of TSH in early pregnancy in Shanghai is significantly higher than the recommended value of TSH recommended by the American Thyroid Association.