目的

探讨血清鸢尾素（Irisin）、促甲状腺激素（TSH）及同型半胱氨酸（Hcy）在妊娠期甲状腺功能减退症诊断中的应用价值。

方法

回顾性分析西安交通大学第一附属医院榆林医院2021 年9 月至2023 年9 月收治的100 例妊娠期甲状腺功能减退症患者作为甲减组，另选同期体检正常100 例孕妇作为对照组，统计两组患者临床资料，并检测两组血清Irisin、TSH 及Hcy 水平。Pearson相关分析血清Irisin、TSH、Hcy 水平及甲状腺功能指标水平的相关性，受试者操作特征（ROC）曲线分析三者对妊娠期甲状腺功能减退症的诊断价值。

结果

甲减组血清Irisin、TSH、Hcy、甲状腺过氧化物酶抗体（TPO-Ab）水平分别为（7.71±0.84）μg/L、（8.01±1.23）mU/L、（9.89±2.44）μmol/L、（388.45± 33.71）U/mL，高于对照组的（4.01±0.92）μg/L、（2.81±0.45）mU/L、（6.82±2.04）μmol/L、（18.56±4.01）U/mL（t=29.70，39.70，9.65，108.96；均P ＜0.01）。游离三碘甲状腺原氨酸（FT₃）、游离甲状腺激素（FT₄）水平分别为（3.31 ± 0.34）pmol/L、（9.89±1.88）pmol/L，低于对照组（3.92 ±0.28）pmol/L、（13.04± 0.65）pmol/L（t=13.85，15.84；均P ＜0.01）。Pearson 相关性分析显示：血清Irisin 与TSH 呈正相关（r=0.411，P ＜0.01），与FT₃、FT₄ 呈负相关（r=-0.368，-0.391；均P ＜0.01），与TPO-Ab 无明显相关性（r=0.201，P ＞0.05）。血清Hcy 与TSH、TPO-Ab 呈正相关（r=0.432，0.359；均P ＜0.01），与FT₃、FT₄ 呈负相关（r=-0.387，-0.374；均P ＜0.01）。ROC 结果显示，血清Irisin 诊断妊娠期甲减的曲线下面积（AUC）为0.755，敏感度、特异度均为76.00%；TSH 诊断妊娠期甲减的AUC 为0.675，敏感度、特异度分别为64.00%、66.00%；Hcy 诊断妊娠期甲减的AUC 为0.664，敏感度、特异度分别为60.00%、68.00%；三者联合诊断妊娠期甲减的AUC 为0.761，敏感度、特异度分别为71.00%、76.00%。

结论

妊娠期甲减患者血清Irisin、TSH 及Hcy 处于高水平状态，且血清Irisin、Hcy 均与TSH 呈正相关，与FT₃、FT₄ 呈负相关。血清Irisin 具有较高的诊断效能，三者联合使用可以提升诊断的准确性。

Objective

To investigate the application value of serum Irisin，thyroid-stimulating hormone （TSH） and homocysteine （Hcy） in diagnosing gestational hypothyroidism.

Methods

From September 2021 to September 2023，one hundred cases of hypothyroidism during pregnancy admitted to the First Affiliated Hospital of Xi′an Jiaotong University Yulin Hospital were classified into hypothyroidism group.During the same period，normal physical examinees （100 cases） were classified into control group.Clinical data of the 2 groups were collected，and serum Irisin，TSH and Hcy levels were detected.The correlations among serum Irisin，TSH，Hcy levels and thyroid function indexes were analyzed by Pearson correlation analysis.The diagnostic value of the 3 biomarkers on hypothyroidism in pregnancy was analyzed by receiver operating characteristic （ROC） curve.

Results

The levels of serum Irisin ［（7.71±0.84）μg/L，（4.01±0.92）μg/L］，TSH［（8.01±1.23）mU/L，（2.81±0.45）mU/L］，Hcy［（9.89±2.44）μmol/L，（6.82±2.04）μmol/L］ and thyroid peroxidase antibody （TPO-Ab） ［（388.45±33.71）U/mL，（18.56±4.01）U/mL］ in hypothyroidism group were higher than those in the control group （t= 29.70，39.70，9.65，108.96，all P ＜0.01）.While the levels of free triiodothyronine （FT₃） ［（3.31±0.34）pmol/L，（3.92±0.28）pmol/L］ and free thyroid hormone （FT₄） ［（9.89±1.88）pmol/L，（13.04±0.65）pmol/L］were lower than those in the control group （t=13.85，15.84，all P ＜0.01）.Pearson correlation analysis showed that serum Irisin was positively correlated with TSH （r=0.411，P ＜0.01），and negatively correlated with FT₃ and FT₄ （r=-0.368，-0.391，all P ＜0.01），but had no significant correlation with TPO-Ab （r=0.201，P ＞0.05）.Serum Hcy was positively correlated with TSH and TPO-Ab （r=0.432，0.359，all P ＜0.01），and negatively correlated with FT₃ and FT₄ （r=-0.387，-0.374，all P ＜0.01）.ROC results showed that the areas under the curve （AUC） of serum Irisin，TSH and Hcy in diagnosing gestational hypothyroidism were 0.755，0.675 and 0.664，and the sensitivity and specificity were 76.00%，64.00%，60.00%，and 76.00%，66.00%，68.00%，respectively.The AUC for the combined diagnosis was 0.761，and the sensitivity and specificity were 71.00% and 76.00%，respectively.

Conclusions

Serum Irisin，TSH and Hcy of patients with hypothyroidism during pregnancy are at high levels，and serum Irisin and Hcy are positively correlated with TSH，and negatively correlated with FT₃ and FT₄.Serum Irisin exhibits high diagnostic efficiency，and the combined use of the 3 biomarkers can enhance the accuracy of diagnosis.