摘要目的 建立杭州市孕早期妇女甲状腺相关指标正常参考值范围,分析盐碘含量新标准实施后杭州市孕早期妇女甲状腺疾病筛查结果,为开展孕早期妇女甲状腺功能监测提供参考.方法 采用分层随机抽样方法,在杭州市各调查点抽取孕早期(孕0~13周)妇女共计582名作为研究对象,进行问卷调查及血清甲状腺功能的检测.促甲状腺激素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)及甲状腺球蛋白抗体(TgAb)的测定采用化学发光法.根据美国临床生化研究院(NACB)的标准,从中严格筛选出359名孕早期妇女,建立TSH、FT4参考值范围,参考值范围采用95%可信区间(95%CI)确定.用新建立的参考值对参加调查的582名孕早期妇女进行甲状腺功能分析.结果 杭州市孕早期妇女TSH参考值为0.048~3.354 mU/L, FT4参考值为(13.023 ± 3.316)pmol/L,FT4的第10百分位数(P10)为11.030 pmol/L.孕早期妇女甲状腺功能异常率为14.4%(84/582),其中临床甲状腺功能减退症(甲减)、亚临床甲状腺功能减退症(亚甲减)、亚临床甲状腺功能亢进症(亚甲亢)及低甲状腺素血症的检出率分别为0.2%(1/582)、3.4%(20/582)、1.9%(11/582)、8.9% (52/582);甲状腺亢进症(甲亢)检出率为0,TPOAb、TgAb阳性检出率分别为10.8%(63/582)、11.7%(68/582).城乡间孕早期妇女低甲状腺素血症的异常率(11.4%、6.3%)及TPOAb阳性率(13.5%、8.1%)比较差异均有统计学意义(χ2=4.708、4.309,P均 <0.05).结论 建立了杭州市孕早期妇女甲状腺激素正常参考值范围,发现盐碘含量新标准实施后杭州市孕早期妇女甲状腺疾病检出率较高,开展孕早期妇女的甲状腺功能监测(或筛查)势在必行.

abstractsObjective To establish a normal reference range of thyroid-related indicators of early pregnant women in Hangzhou,and investigate the prevalence of thyroid disease among them after the implementation of a new standard of salt iodine content, in order to provide reference for monitoring of thyroid disease in pregnant women.Methods A total of 582 women in early pregnancy(0 - 13 weeks of gestation) in Hangzhou were selected via the stratified random sampling method as the subjects of the study and for detection of serology thyroid function. The levels of serum thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody (TgAb) were measured by chemiluminescence method. According to the standard American Academy of Clinical Biochemistry (NACB), 359 women in early pregnancy were strictly screened to establish the normal reference value of TSH, FT4, and the reference range using the 95% confidence interval (95%CI). At the same time, the newly establish reference interval was used to evaluate the thyroid function of 582 early pregnant women. Results The reference interval of TSH in early pregnant women of Hangzhou was 0.048 -3.354 mU/L.The reference interval of FT4was(13.023 ± 3.316) pmol/L, and the tenth percentile of FT4was 11.030 pmol/L. Eighty-four persons' thyroid function was abnormal in 582 and the rate of abnormal was 14.4% (84/582), in which the rates of abnormal in clinical hypothyroidism, subclinical hypothyroidism, subclinical hyperthyroidism and hypothyroxinemia were 0.2% (1/582), 3.4% (20/582), 1.9% (11/582) and 8.9% (52/582), respectively. The case with clinical hyperthyroidism was not detected. The positive rate of TPOAb and TgAb were 10.8% (63/582) and 11.7%(68/582). The abnormal rate of hypothyroxinemia and the positive rate of TPOAb in early pregnant women in the city(11.4%,13.5%)were significantly higher than that in the rural areas(6.3%,8.1%,χ2=4.708,4.309, P < 0.05). Conclusions The normal reference value of thyroid hormones in early pregnant women in Hangzhou is established, and it is found that the incidence of thyroid disease is higher in pregnant women in Hangzhou after the implementation of the new standard of salt iodine content, therefore, it is imperative to carry out monitoring (or screening)of thyroid function in early pregnant women.