摘要
目的了解贵阳市观山湖区不同妊娠期孕妇碘营养状况和甲状腺激素变化规律及二者的关系，为开展孕妇碘营养监测和甲状腺功能筛查提供依据。方法2015年10月至2016年9月．在贵阳市第二人民医院及观山湖区碧海和金华园两个社区卫生服务中心，采用横断面调查方法抽取该区常住的不同孕期健康单胎初产妇341例，并采集血样、尿样。采用电化学发光法检测血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（取Ab），应用热消解法测定孕妇尿碘水平。结果妊娠早、中、晚期（T1、T2和T3期）孕妇尿碘中位数分别为191．8、198．9和214．5μg／L；随孕龄的增加FL水平[中位数（M）]先升后降（T1、T2、T3期分别为4．49、4．83、4．57pmol／L），T2期FT3水平显著高于T1期和T3期，差异均有统计学意义（P均〈0．05）；而FT4水平（M）随孕龄的增加呈下降趋势（T1、T2、T3期分别为16.32、14．65、13．22pmol／L），组间比较差异有统计学（H=67．517，P〈0．05）：各孕期TSH水平（M，T1、T2、T3期分别为2．05、2．01、2．39mU／L）组间比较差异无统计学意义（H=1．297，P〉0．05）。T2期TPOAb、TgAb滴度（M，9．60、19．02U／ml）显著低于T1期（M，18．92、24．75U／ml）和T3期（M，13-46、22．06U／ml），呈现“U”形分布，不同孕期抗体水平比较差异均有统计学意义（P均〈0．05）。孕妇TSH随尿碘水平增加呈升高趋势，碘超足量组（尿碘250—499μg／L）TSH水平（M，2．54mU／L）显著高于碘适量（尿碘150～249μg／L）和碘缺乏组（尿碘〈150μg／L，M，1．97、1．91mU／L），差异均有统计学意义（P均〈0．05）；而FT3、FT4、TPOAb、TgAb随尿碘水平变化均不明显。孕妇尿碘与其自身TSH水平之间呈显著正相关关系（rs=0．180，P〈0．01）。孕妇甲状腺功能异常发生率为29．33％（100／341），其中临床甲状腺功能减退（甲减）占0．88％（3／341），亚临床甲减占25．51％（87／341），低甲状腺素（T4）血症占1．76％（6／341），临床甲状腺功能亢进（甲亢）占0．59％（2／341），亚临床甲亢占0．59％（2／341）；TPOAb和（或）TgAb阳性率为12．61％（43／341），主要分布于T1、T2期；亚临床甲减的患病率随尿碘水平增加呈升高趋势，差异有统计学意义（x2=11．269，P〈0．05）。结论妊娠期孕妇碘营养状况与其自身TSH水平存在正相关关系，应当重视和开展孕妇尿碘监测，加强T1、T2期甲状腺功能和自身抗体的筛查。
Objective To investigate the relationship between iodine nutritional status and thyroid hormone levels, and to provide a guideline for monitoring iodine nutrition and thyroid function. Methods A crosssectional survey was performed by randomly selecting 341 samples （health pregnant women with a first child） from the Second People＇s Hospital of Guiyang, Bihai Community Medical Center and Jinhuayuan Community Center from October 2015 to September 2016. Levels of serum hormones and antibodies relative to throid of pregnant women in Guanshan Lake District of Guiyang at different pregnant times, which included throid stimulating hormone （TSH）, free three triiodothyronine （FT3）, free thyroxine （FT4）, thyroid peroxidase antibody （TPOAb）, and thyroglobulin antibody （TgAb）, were measured by the electrochemical luminescence method, and urinary iodine levels were measured by heat digestion. Results The median urinary iodine of pregnant women at early, middle and late stages （T1, T2 and T3 stages） were 191.8, 198.9 and 214.5 μg/L, respectively. FT3 increased first and then decreased during pregnancy. Levels of FT3 in the T2 stage were significantly higher than those in T1 and T3 stages （FTs medians at the three stages were 4.49, 4.83 and 4.57 pmol/L）, and the differences were statistically significant （P 〈 0.05）. FT4 levels decreased during pregnancy （FT4 medians at the three stages were 16.32, 14.65 and 13.22 pmol/L）, and the differences among the three groups were statistically significant （H = 67.517, P 〈 0.01）. Statistically significant differences were not found in the TSH levels among the three groups （TSH medians at the three stages were 2.05, 2.01 and 2.39 mU/L, H = 1.297, P 〉 0.05）. The medians of TPOAb and TgAb during T2 stage （9.60 and 19.02 U/ml） were significantly lower than those of other groups （18.92 and 24.75 U/ml at stage T1, and 13.46 and 22.06 U/ml at stage T3）, and the differences were statistically significant （P 〈 0.05）. TSH levels were consistent with urinary iodine levels. TSH levels in the excessive iodine group （urine iodine： 250 - 499 μg/L, 2.54 mU/L） were significantly higher than those in the adequate iodine group （urine iodine： 150 - 249 μg/L, 1.97 mU/L） and deficient iodine group （urine iodine： 〈 150 μg/L, 1.91 mU/L）, and the differences were statistically significant （P 〈 0.05）. No correlations were found between levels of FT3, FT4, TPOAb, TgAb and levels of the urinary iodine. There was a significant positive correlation between urinary iodine levels and TSH levels （rs = 0.180, P 〈 0.01）. The incidence of abnormal thyroid function in pregnant women was 29.33% （100/341）, which was composed of clinical hypothyroidism （accounting for 0.88%, 3/341）, subclinical hypothyroidism （accounting for 25.51%, 87/341）, low T4 level （accounting for 1.76%, 6/341）, clinical hyperthyroidism （accounting for 0.59%, 2/341）, subclinical hyperthyroidism （accounting for 0.59%, 2/341）, and TPOAb positive and TgAb positive （accounting for 12.61%, 43/341）. These abnormalities occurred mainly in the T1 and T3 stages. The prevalence of subclinical hypothyroidism increased with increasing of urinary iodine level, and the difference was statistically significant （X2 -＇- 11.269, P 〈 0.05）. Conclusion There is a positive correlation between pregnancy iodine nutritional status and its TSH level, so it is important to monitor the level of urinary iodine during pregnancy and to screen the thyroid function and antibodies in the early and middle time of pregnancy.
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2018年第1期54-58,共5页
Chinese Journal of Endemiology
基金
贵阳市卫生和计划生育委员会卫生科学技术计划项目（2015044）
关键词
妊娠
碘营养
甲状腺激素
Pregnancy
Iodine nutrition
Thyroid hormone
