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中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (17) : 2184 -2188. doi: 10.3877/cma.j.issn.1674-0785.2017.17.004

所属专题: 文献

综述

妊娠期亚临床甲状腺功能减退的合理诊断
陈凌志1, 刘启龙2, 谌红珊1, 续慧超1, 孙鹏1,(), 班博3   
  1. 1. 272000 济宁,济宁医学院附属医院营养科
    2. 272000 济宁,济宁医学院附属医院乳甲外科
    3. 272000 济宁,济宁医学院附属医院内分泌科
  • 收稿日期:2017-03-29 出版日期:2017-09-01
  • 通信作者: 孙鹏
  • 基金资助:
    济宁市科技发展计划项目(济科字[2016]56号-88); 济宁医学院附属医院"苗圃"科研计划项目(MP-2015-008)

Rational diagnosis of subclinical hypothyroidism during pregnancy

Lingzhi Chen1, Qilong Liu2, Hongshan Chen1, Huichao Xu1, Peng Sun1,(), Bo Ban3   

  1. 1. Department of Clinical Nutrition, Affiliated Hospital of Jining Medical University, Jining 272029, China
    2. Department of Breast and Thyroid Surgery, Affiliated Hospital of Jining Medical University, Jining 272029, China
    3. Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2017-03-29 Published:2017-09-01
  • Corresponding author: Peng Sun
  • About author:
    Corresponding author: Sun Peng, Email:
引用本文:

陈凌志, 刘启龙, 谌红珊, 续慧超, 孙鹏, 班博. 妊娠期亚临床甲状腺功能减退的合理诊断[J]. 中华临床医师杂志(电子版), 2017, 11(17): 2184-2188.

Lingzhi Chen, Qilong Liu, Hongshan Chen, Huichao Xu, Peng Sun, Bo Ban. Rational diagnosis of subclinical hypothyroidism during pregnancy[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(17): 2184-2188.

亚临床甲状腺功能减退(SCH)是妊娠期甲状腺常见疾病之一,美国甲状腺学会(ATA)制定的妊娠期甲状腺疾病的权威指南提出诊断SCH的2个标准,标准1:依据妊娠期特异的血清促甲状腺素(TSH)上限,标准2:根据血清TSH>2.5 mIU/L、游离甲状腺素(FT4)在正常范围。在中国如依据标准2诊断SCH,患病率高达27.8%,造成SCH的过度诊断和过度治疗。若想建立本单位或地区妊娠期特异性甲状腺功能指标参考值,需考虑影响因素除"正常"人群的筛选、采用的检测试剂及检测方法、种族、遗传、碘营养状态之外,还需关注采样方法(自身序贯或横断面)、妊娠早期具体孕周数。本文就妊娠特异性甲状腺功能指标参考值建立、影响因素以及SCH的合理诊断等方面所取得一些进展进行综述。

Subclinical hypothyroidism is one of the most common thyroid diseases during pregnancy, and the American Thyroid Association (ATA) guidelines proposed two diagnostic criteria for subclinical hypothyroidism during the first trimester of pregnancy: (1) pregnancy-specific TSH reference range; and (2) serum TSH>2.5 mIU/L with normal serum FT4. In China, the prevalence rate of subclinical hypothyroidism was as high as 27.8%, and the diagnosis based on criterion 2 may result in overdiagnosis and overtreatment. Establishing a hospital or region-specific thyroid function reference index during pregnancy needs considering many factors, including screening of normal people, detection reagents and methods, genetics, iodine nutritional status, race, sampling method (sequential or cross section), and the specific number of gestational weeks in early pregnancy. In this paper, we will review the progress in the establishment of the reference value of specific thyroid function index, the influencing factors, and the rational diagnosis of subclinical hypothyroidism.

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