摘要目的 探讨浙江省正常孕妇及哺乳期妇女的甲状腺激素参考范围.方法 2010年6-9月在浙江省13个县区调查了1 079名妇女,根据调查表和甲状腺B超检查结果,筛选出338名孕妇、322名哺乳期妇女和139名非妊娠期妇女(对照)作为调查对象,采用砷铈催化分光光度测定法和化学发光免疫法进行尿碘与甲状腺功能[游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、三碘甲腺原氨酸(T3)、甲状腺素(T4)、促甲状腺激素(TSH)]的测定.分析孕妇、哺乳期妇女甲状腺激素95％医学参考区间.结果 孕妇、哺乳期妇女及非妊娠期妇女尿碘中位数均处于适宜水平(150～ 249 μμg/L).哺乳期妇女FT3指标水平高于孕妇、非妊娠期妇女(Z哺-孕=3.98,Z哺-非=2.46,P均＜0.05);哺乳期妇女FT4指标水平高于孕妇、非妊娠期妇女(Z哺-孕=2.68,Z哺-非=2.25,P均＜ 0.05);哺乳期妇女T3指标水平高于孕妇、非妊娠期妇女(Z哺-孕=3.51,Z哺-非=2.41,哺乳期妇女T4指标水平最高,孕妇次之,非妊娠期妇女最低(Z哺-非=2.30,Z哺-孕=4.90,Z孕-非=1.57,P均＜0.05);哺乳期妇女、非妊娠期妇女TSH指标水平均高于孕妇(Z哺-Z哺=2.81,Z孕-非=1.68,P均＜0.05);孕妇的FT3指标95％医学参考区间为3.37～6.53 pmol/L,FT4为10.68～20.85 pmol/L,T3为1.40～2.79 nmol/L,T4为72.72～166.41 nmol/L,TSH为0.15 ～ 4.44 mU/L;哺乳期妇女FT3指标95％医学参考区间为3.39～6.44 pmol/L,FT4为10.81～20.33 pmol/L,T3为1A4～2.77 nmol/L,T4为71.94～164.61 nmol/L,TSH为0.25～4.47 mU/L.结论 孕妇、哺乳期妇女的甲状腺激素水平与非妊娠期妇女相差较大,所以建立孕妇、哺乳期妇女的甲状腺激素参考值范围具有临床意义.

abstractsObjective To set up the reference ranges of thyroid hormones for pregnant and lactating woman in Zhejiang.Methods A total of 338 pregnancy,322 lactating women and 139 non-pregnant women (as a control) were selected from 1 079 women in 13 survey sites of Zhejiang as survey subjects,through the questionnaire survey and thyroid B-ultrasound tests from June 2010 to September 2010.The level of urinary iodine was measured by spectrophotometer,and the thyroid hormone [free triiodothyronine (FT3),free (unbound) thyroxin (FT4),triiodothyronine (T3),tetraiodothyronine (T4),thyroid stimulating hormone (TSH)] was measured by automated chemiluminescence immunoassay.Analysis of thyroid hormone 95％ in pregnant women and lactating women.Results The median urinary iodine of all women investigated were in optimal urine levels (150-249 μg/L),which indicated they were in iodine sufficient status.The FT3 index of lactating women was higher than that of pregnant women and non pregnant women (Zlactating-pregnant =3.98,Zlactating-pregnant =2.46,all P ＜ 0.05);the FT4 index level of lactating women was higher than that of pregnant women and non pregnant women (Zlactating-pregnant =2.68,Zlactating-non-pregnant =2.25,all P ＜ 0.05);the T3 index level of lactating women was higher than that of pregnant women and non pregnant women (Zlactating-pregnant =3.51,Zlactating-non pregnant =2.41,all P ＜ 0.05);levels of T4 in lactating women was the highest (Zlactating-pregnant =2.30,Zlactating-pregnant =4.90,Zlactating-non pregnant =1.57,all P ＜ 0.05);TSH index of lactating women and non pregnant women were higher than that of pregnant women (Zlactating-pregnant =2.81,Zlactating-non pregnant =1.68,all P ＜ 0.05).And in pregnant,the 95％ medical reference interval of FT3 was 3.37-6.53 pmol/L,FT4 was 10.68-20.85 pmol/L,T3 was 1.40-2.79 nmol/L,T4 was 72.72-166.41 nmol/L,and TSH was 0.15-4.44 mU/L;in lactating woman,FT3 was 3.39-6.44 pmol/L,FT4 was 10.81-20.33 pmol/L,T3 was 1.44-2.77 nmol/L,T4 was 71.94-164.61 nmol/L,and TSH was 0.25-4.47 mU/L.Conclusion The thyroid hormone levels of pregnant and lactating women are different from those of non-pregnant women,therefore establishing reference data of thyroid hormones for pregnant and lactating women may be a very important step for clinical practice.