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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

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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/OL]. 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/OL]. 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.

[1]
Moreno-Reyes R, Glinoer D, Van Oyen H, et al. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study [J]. J Clin Endocrinol Metab, 2013, 98(9): 3694-3701.
[2]
滕卫平. 对妊娠早期TSH参考范围上限值的新认识 [J]. 中华内分泌代谢杂志, 2014, 30(12): 1039-1040.
[3]
Baloch Z, Carayon P, Conte Devoix B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease [J]. Thyroid, 2003, 13(1): 123-126.
[4]
中华医学会内分泌学分会, 中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南 [J]. 中华内分泌代谢杂志, 2012, 28(5): 354-371.
[5]
张晓梅, 姚宝婷, 王丹阳, 等. 妊娠期甲状腺功能动态变化:自我纵向序列研究 [J]. 中华内分泌代谢杂志, 2014, 30(12): 1053-1057.
[6]
Yu B, Wang QW, Huang RP, et al. Establishment of self-sequential longitudinal reference intervals of maternal thyroid function during pregnancy [J]. Exp Biol Med(Maywood), 2010, 235(10): 1212-1215.
[7]
Lee RH, Spencer CA, Mestman JH, et al. Free T4 immunoassays are flawed during pregnancy [J]. Am J Obstet Gynecol, 2009, 200(3): 260.e1-260.e6.
[8]
Soldin OP, Tractenberg RE, Hollowell JG, et al. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency [J]. Thyroid, 2004, 14(12): 1084-1090.
[9]
Mehran L, Amouzegar A, Delshad H, et al. Trimester-specific reference ranges for thyroid hormones in Iranian pregnant women [J]. J Thyroid Res, 2013, 2013: 651517.
[10]
Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid [J]. Clin Chem, 2005, 51(8): 1480-1486.
[11]
Dashe JS, Casey BM, Wells CE, et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges [J]. Obstet Gynecol, 2005, 106(4): 753-757.
[12]
罗军, 韩密, 宋梦帆, 等, 两种免疫试剂检测妊娠期甲状腺功能结果的比较 [J]. 中华围产医学杂志, 2012, 15(7): 404-410.
[13]
许诗珺, 范建霞, 杨帅, 等. 不同促甲状腺激素和游离甲状腺素检测试剂对妊娠期甲状腺功能检测结果的影响 [J]. 中华围产医学杂志, 2015, 18(2): 81-86.
[14]
马冬红, 陆汉魁, 高云朝, 等. 六种TSH检测方法的对比研究 [J]. 标记免疫分析与临床, 2010, 17(2): 102-106.
[15]
Boucai L, Surks MI. Reference limits of serum TSH and free T4 are significantly influenced by race and age in an urban outpatient medical practice [J]. Clin Endocrinol(Oxf), 2009, 70(5): 788-793.
[16]
Surks MI, Boucai L. Age- and race-based serum thyrotropin reference limits [J]. J Clin Endocrinol Metab, 2010, 95(2): 496-502.
[17]
Boucai L, Hollowell JG, Surks MI. An approach for development of age-, gender-, and ethnicity specific thyrotmpin reference limits [J]. Thyroid, 2011, 21(1): 5-11.
[18]
Samollow PB, Perez G, Kammerer CM, et al. Genetic and environmental influences on thyroid hormone variation in Mexican Americans [J]. J Clin Endocrinol Metab, 2004, 89(7): 3276-3284.
[19]
Horvath A, Faucz F, Finkielsain GP, et al. Haplotype analysis of the promoter region of phosphodiesterase type 8B(PDE8B) in correlation with inactivating PDE8B mutation and the serum thyroid-stimulatinghormone levels [J]. Thyroid, 2010, 20(4): 363-367.
[20]
占明, 赵双霞, 顾朝晖, 等. PDE8B基因多态性与中国汉族人群高促甲状腺素血症易感性的关联分析 [J]. 中华医学杂志, 2012, 92(12): 801-805.
[21]
李晨嫣, 关海霞, 滕晓春, 等. 碘充足地区血清TSH正常值范围及其影响因素的流行病学研究 [J]. 中华内分泌代谢杂志, 2011, 27(6): 458-462.
[22]
姜雅秋, 李宁娜, 刘秀, 等. 慢性碘过量对Wistar大鼠甲状腺功能及垂体促甲状腺素β表达的影响 [J]. 中国医科大学学报, 2012, 41(12): 1083-1087.
[23]
阎玉芹, 董作亮, 董玲, 等. 碘营养不足对孕期妇女甲状腺功能影响的研究 [J]. 中国地方病学杂志, 2007, 26(20): 381-384.
[24]
Glinoer D1, De Nayer P, Delange F, et al. A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects [J]. J Clin Endocrinol Metab, 1995, 80(1): 258-269.
[25]
Liesenkotter KP, Göpel W, Bogner U, et al. Earliest prevention of endemic goiter by iodine supplementation during pregnancy [J]. Eur J Endocrinol, 1996, 134(4): 443-448.
[26]
蔡可英, 杨昱, 王晓东, 等. 江苏高碘和适碘地区孕妇甲状腺疾病患病率的调查 [J]. 中华内分泌代谢杂志, 2012, 28(6): 475-479.
[27]
李玉姝, 赵冬, 单忠艳, 等, 不同碘摄入量地区甲状腺自身抗体的流行病学五年随访研究 [J]. 中华内分泌代谢杂志, 2006, 22(6): 518-522.
[28]
Teng W, Shan Z, Patil-Sisdia K, et al. Hypothyroidism in pregnancy [J].Lancet Diabetes Endocrinol, 2013, 1(3): 228-237.
[29]
Li CY, Shah ZY, Mao JY, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? [J].J Clin Endocrinol Metab, 2014, 99(1): 73-79.
[30]
李晨嫣, 单忠艳,毛金媛, 等. 评估妊娠早期甲状腺功能:中国妊娠妇女妊娠早期TSH参考上限的合理制定 [J]. 中华内分泌代谢杂志, 2014, 30(12): 1047-1052.
[31]
Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function [J]. N Engl J Med, 2012, 366(6): 493-501.
[32]
Brent GA. The debate over thyroid-function screening in preguancy [J]. N Engl J Med, 2012, 366(6): 562-563.
[33]
薛海波, 李元宾, 滕卫平, 等. 妊娠早期母亲亚临床甲状腺功能减退症对其后代脑发育影响的前瞻性研究 [J]. 中华内分泌代谢杂志, 2010, 26(11): 916-920.
[34]
Liu H, Shan Z, Li C, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study [J]. Thyroid, 2014, 24(11): 1642-1649.
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