孕期甲状腺功能障碍的TSH和FT4参考间隔建议和患病率:当前诊断方法的量化
Joris A J Osinga1,2, Arash Derakhshan1,2, Ulla Feldt-Rasmussen3,4
1Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
The Journal of clinical endocrinology and metabolism
|September 23, 2023
概括
在怀孕期间使用甲状腺激素的替代参考间隔导致严重的过度诊断和不足诊断. 这凸显了在怀孕期间识别甲状腺功能障碍时需要更好的策略.
科学领域:
- 内分泌学 在内分泌学.
- 生殖医学 生殖医学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 怀孕指南建议针对甲状腺刺激激素 (TSH) 和自由甲状腺素 (FT4) 的人口和三个月的特定参考间隔 (RIs).
- 缺乏这些特定的RI迫使临床医生使用替代诊断策略.
- 这项研究量化了当前建议的诊断影响.
研究的目的:
- 评估怀孕期间甲状腺激素的替代参考间隔 (RI) 方法的诊断准确性.
- 量化使用非特异性RI用于甲状腺功能测试的后果.
主要方法:
- 分析了来自甲状腺和怀孕联盟18个队伍的52,496名参与者的数据.
- 与替代方法比较三个月特定的RIs:固定的TSH上限 (4.0 mU/L),TSH减去方法 (0.5 mU/L) 和非怀孕的RIs.
- 对莱沃西治疗指示的敏感性和错误发现率 (FDR) 的评估.
主要成果:
- 与季度特定的RI相比,替代RI方法的灵敏度低 (0.63-0.82),FDR高 (0.11-0.35).
- 治疗指示的第一季度检测具有相似的灵敏度和FDR,跨越固定的限制,减去和非怀孕方法.
- FT4 RI方法影响了明显的甲状腺功能障碍和甲状腺功能障碍的检测,而TSH RI方法影响了亚临床甲状腺功能障碍的诊断.
结论:
- 目前用于确定妊娠中TSH和FT4RI的替代方法导致了大量的过度诊断和不足诊断.
- 迫切需要改进的策略来准确地识别孕妇甲状腺功能障碍.
- 优化RI选择对于在怀孕期间适当的甲状腺疾病管理至关重要.
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