目的: 初步建立漳州地区妊娠期妇女血清甲状腺激素水平的参考范围并进行分析,为妊娠妇女孕期检查及后续研究提供依据。方法: 筛选2019年12月~2021年5月到漳州市医院产检正常的孕妇983例作为研究对象,其中孕早期269例,孕中期400例,孕晚期314例,同时留取健康体检非孕期妇女血清标本368例作为非孕期对照组,用化学发光免疫学方法分别测定甲状腺激素FT3、FT4及TSH的含量,统计分析其变化情况及正常参考值范围。 结果: 随着孕期的发展,孕妇血清FT3、FT4呈逐渐下降的趋势,其中FT3和FT4孕早期分别与非孕期对照组无明显区别,而孕中期和孕晚期均明显低于非孕期对照组(P＜0.05),且孕期三组之间两两分别比较,差异均有统计学意义(P＜0.05)。TSH在孕早期、孕中期时显著降低,孕早期最低,之后随着孕期的发展逐渐升高,孕晚期接近于非孕期对照组(P＞0.05)。非孕期对照组、孕早、中、晚期妊娠组血清FT3的参考值范围分别为3.96~6.16、4.08~6.20、3.51~5.86、3.57~5.53 pmol/L,FT4的参考值范围分别为 8.15~13.59、8.04~13.34、6.46~11.60、6.16~10.66 pmol/L,TSH的参考值范围分别为0.58~4.73、0.33~4.18、0.33~3.96、0.47~4.06 mIU/L。结论: 妊娠期孕妇血清甲状腺激素水平有所变化,本研究初步建立漳州地区不同妊娠期特异性甲状腺激素水平参考值范围,以供正常妊娠常规筛查及后续研究。

Objective: To establish and analyze the reference range of serum thyroid hormone levels in pregnant women in Zhangzhou, and to provide basis for pregnancy examination and subsequent research. Methods: A total of 983 pregnant women with normal antenatal examination in Zhangzhou Hospital from December 2019 to May 2021 were selected as the research objects, including 269 cases in the early pregnancy, 400 cases in the middle pregnancy and 314 cases in the late pregnancy. At the same time, 368 serum samples of healthy non-pregnant women were taken as the non-pregnant control group. The contents of FT3, FT4 and TSH were determined by chemiluminescence immunoassay, and the changes and the range of normal reference values were statistically analyzed. Results: With the development of pregnancy, the serum FT3 and FT4 of pregnant women showed a gradual downward trend. There was no significant difference in FT3 and FT4 levels between the early pregnancy and the non-pregnant control group, respectively, while the middle pregnancy and late pregnancy were significantly lower than those of the non-pregnant control group (P＜0.05), and the differences among the three groups during pregnancy were statistically significant (P＜0.05). The level of TSH was significantly decreased in the early and middle pregnancy, and was the lowest in the early pregnancy. After that, it gradually increased with the development of pregnancy, and was close to the non-pregnant control group in the late pregnancy (P>0.05). In non-pregnant control group, early pregnancy group, middle pregnancy group and late pregnancy group, the reference ranges of serum FT3 were 3.96-6.16, 4.08-6.20, 3.51-5.86, 3.57-5.53 pmol/L, respectively; the reference ranges of serum FT4 were 8.15-13.59, 8.04-13.34, 6.46-11.60, 6.16-10.66 pmol/L, respectively; the reference values of TSH were 0.58-4.73 mIU/L, 0.33-4.18 mIU/L, 0.33-3.96 mIU/L and 0.47-4.06 mIU/L, respectively. Conclusion: The serum thyroid hormone levels of pregnant women in pregnancy have changed, and the reference ranges of specific thyroid hormone levels in different pregnancy periods in this region are preliminarily established for routine screening of normal pregnancy and subsequent studies.