摘要
目的 调查杭州市妊娠早期妇女甲状腺疾病患病情况,进一步探讨妊娠早期妇女开展甲状腺功能筛查的必要性.方法 将至各调查点进行检查的妊娠早期（妊娠0～13周）1 165例妇女作为研究对象,收集其家庭食用盐、空腹晨尿及静脉血,分别采用硫代硫酸钠直接滴定法测定食用盐碘含量,酸消化砷-铈接触法测定尿碘,化学发光法测定血清促甲状腺激素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）.结果 杭州市妊娠早期妇女尿碘中位数为135.2μg/L,仅有26.7％的人处于碘适宜水平,城市和农村之间尿碘中位数及频率分布差异无统计学意义（P＞0.05）;TPOAb阴性的妊娠早期妇女TSH、FT4异常率分别6.8％ （71/1 039）、8.9％（92/1 039）,且农村妊娠早期妇女的TSH、FT4的异常率均高于城市（P=0.035和P=0.001）;杭州市妊娠早期妇女临床甲状腺功能减退症（临床甲减）、亚临床甲减及低甲状腺素血症的患病率分别为0.3％（3/1 165）、2.0％（23/1 165）、4.8％（56/1 165）,且农村妊娠早期妇女的低甲状腺素血症的患病率明显高于城市（6.1％对3.5％,P=0.040）;TPOAb阳性率为9.9％（114/1 153）,TPOAb阳性妊娠早期妇女TSH易发生异常,其高于参考值上限的比例（6.1％）明显高于阴性组（1.7％）,发生亚临床甲减的危险性是阴性组的3.34倍（95％ CI 1.29～8.65）.结论 经济欠发达的农村及TPOAb阳性的妊娠早期妇女更易出现甲状腺功能异常,应重点对这部分人群开展甲状腺功能及碘营养的筛查及监测.
Objective To investigate the prevalence of thyroid disease in early pregnancy women of Hangzhou,and further to discuss the necessity of screening thyroid function in early pregnant women.Methods From March to October 2013,1 165 cases of women in the center of community health service （or health） for routine prenatal care during early pregnancy were used as research subjects.Household salt,fasting morning urine and serum samples were collected.The salt iodine level was measured by direct titration of sodium thiosulfate.The urinary iodine level was measured by arsenic-cerium contact process method.The levels of serum TSH,FT4,and thyroid peroxidase antibody （TPOAb） were measured by chemiluminescence method.Results The median of urinary iodine of the early pregnancy women was 135.2 μg/L,and only 26.7% of early pregnancy women＇s iodine-nutrition status were optimal.These were no significant difference in median urinary iodine as well as the frequency distribution between urban and suburban（P〉0.05）.The abnormal rates of TSH and FT4 in early pregnancy women with negative TPOAb were 6.8% （71/1 039） and 8.9% （92/1 039）,and the abnormal rates of TSH and FT4 in suburban areas were higher than those in urban areas（P=0.035,P =0.001）.The prevalences of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia in early pregnant women of Hangzhou were 0.3% （3/1 165）,2.0% （23/1 165）,and 4.8% （56/1 165） respectively,and the prevalence of hypothyroxinemia in suburban areas was significantly higher than that in urban areas （6.1% vs 3.5%,P =0.040）.The positive rate of TPOAb was 9.9% （114/1 153）.The early pregnant women with positive TPOAb have an increased risk of thyroid dysfunction,the ratio of TSH over the reference values was significantly higher than that in the negative group and more prone to subclinical hypothyroidism （OR =3.34,95% CI 1.29-8.65）.Conclusion The early pregnant women in rural areas or with positive TPOAb have an increased risk of abnormal thyroid function,thyroid function and iodine nutrition screening or monitoring should be highlighted.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2014年第7期553-557,共5页
Chinese Journal of Endocrinology and Metabolism
关键词
妊娠早期
碘营养
甲状腺功能
Early pregnancy
Iodine nutrition
Thyroid function
