中国已婚计划怀孕女性孕前TSH水平异常现况及影响因素

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摘要目的了解我国已婚计划怀孕女性孕前促甲状腺激素(TSH)水平异常现况,并探讨其影响因素。方法利用2013年1月1日—2013年12月31日全国参加国家免费孕前优生健康检查项目的已婚待孕女性孕前检查数据,分别以孕前检查服务机构自报TSH检测试剂盒参考值范围和2011年美国甲状腺学会(ATA)指南提出的妊娠早期TSH参考值范围为TSH水平异常判断标准依据,描述我国育龄女性孕前TSH水平异常的分布情况,并分析年龄、体质量指数(BMI)、妊娠史对孕前TSH水平的影响。结果 377 463例20～49岁已婚计划怀孕妇女孕前TSH中位数为1.73 mU/L,低于TSH参考值范围下限的检出率为2.5%,高于TSH参考值范围上限的检出率为3.3%,TSH＜0.1 mU/L的检出率为0.9%,TSH＞2.5 mU/L的检出率为26.6%。年龄、BMI、妊娠史对孕前TSH异常均有影响。结论基于ATA建议与TSH试剂盒参考值范围两种标准判定TSH异常分布差异较大,建议建立科学的备孕女性TSH异常判定标准,加强孕前甲状腺功能筛查,促进母婴健康。

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	李谦
	杨英
	彭左旗
	马旭

关键词 ：促甲状腺激素, 孕前保健, 妊娠史

Abstract：Objective To investigate the distribution of preconception thyroid stimulating hormone (TSH) in Chinese married women who prepare for pregnancy, and further discuss the factors associated with abnormal preconception TSH levels.Methods Preconception TSH data were drawn from the National Free Pre-pregnancy Checkups (NFPC) during January 2013 and December 2013. Two different reference ranges of TSH were used to judge abnormal preconception TSH level: the reference ranges of TSH test kits and the specific reference range in early pregnancy suggested by America Thyroid Association (ATA) in 2011. In addition, the impact of age, body mass index (BMI), and history of pregnancy on abnormal TSH level before pregnancy were further examined.Results A total of 377 463 women were included in the present study. The median of preconception TSH was 1.73 mU/L. The proportion of smaller than TSH reference range, greater than TSH reference range, smaller than 0.1 mU/L and greater than 2.5 mU/L was 2.5%, 3.3%, 0.9% and 26.6%, respectively. Moreover, age, BMI, and history of pregnancy were all factors associated with the likelihood of an abnormal preconception TSH level.Conclusion The prevalence of abnormal TSH in reproductive-aged women who planned to conceive was different between the range recommended by ATA and the range of the TSH detection kits. Hence, scientific standard TSH reference range specific to women preparing for pregnancy should be established and the screening for thyroid function should be strengthened.

Key words： Thyroid stimulating hormone Preconception health care History of pregnancy

基金资助:国家十二五科技支撑计划(2013BAI12B01),国家自然科学基金项目(81402757),中央级公益性科研院所基本科研业务费专项(2012GJSSJKC03)

通讯作者: 马旭(maxutougao@163.com)

引用本文:

李谦, 杨英, 彭左旗, 马旭. 中国已婚计划怀孕女性孕前TSH水平异常现况及影响因素[J]. 中国生育健康杂志, 2016, 27(3): 201-205.
LI Qian, YANG Ying, PENG Zuoqi, MA Xu. Abnormal TSH levels during the preconceptional period and associated factors in Chinese married women planning to become pregnant. Chinese Journal of Reproductive Health, 2016, 27(3): 201-205.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2016/V27/I3/201

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