摘要
目的分析妊娠期妇女甲状腺功能与碘营养水平及甲状腺自身抗体的关系。方法于2016年选取天津市不同水碘地区,抽取当地孕妇作为研究对象,采集其一次性尿样25 ml测定尿碘,采集静脉非抗凝血3 ml测定血清甲状腺激素及甲状腺自身抗体。采用化学发光免疫分析法测定孕妇甲状腺功能指标[血清游离三碘甲状腺原氨酸(FT_(3))、血清游离甲状腺素(FT_(4))、血清促甲状腺激素(TSH)]及甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)水平,根据TSH、FT_(4)水平将孕妇分为正常组和亚临床甲状腺功能减退症(简称亚甲减)组。应用尿中碘的砷铈催化分光光度法检测孕妇尿碘水平。分析两组孕妇尿碘水平与甲状腺功能指标的相关性,运用单因素及多因素logistic回归分析亚甲减发生的影响因素。结果甲状腺功能正常组有798名孕妇,亚甲减组有28名孕妇,亚甲减检出率为3.39%(28/826)。正常组与亚甲减组分别有43.73%(349/798)、46.43%(13/28)的孕妇尿碘水平<150μg/L;尿碘水平与血清TSH水平无相关性(r=0.038,P>0.05),与血清FT_(4)水平呈正相关(r=0.077,P<0.05)。正常组与亚甲减组血清TPOAb、TgAb水平比较差异均有统计学意义(Z=-3.986、-3.411,P均<0.05)。经logistic回归分析,TPOAb阳性为亚甲减发生的危险因素(OR=3.428,95%CI:1.131~10.388)。结论孕前或孕早期应将尿碘及甲状腺自身抗体筛查作为常规检查项目,及时纠正碘缺乏,同时避免盲目过量补碘,降低孕妇亚甲减的发生,以减少对亲子的不利影响。
Objective To analyze the relationship between thyroid function,iodine nutrition level and thyroid autoantibodies in pregnant women.Methods In 2016,pregnant women were selected from different water iodine areas in Tianjin.A disposable urine sample of 25 ml was collected to determine urine iodine,and 3 ml of intravenous non-anticoagulated blood was collected to determine serum thyroid hormones and thyroid autoantibodies.Chemiluminescence immunoassay was used to determine the thyroid function indexes[free triiodothyronine(FT3),free thyroxine(FT4),thyroid-stimulating hormone(TSH)],thyroid peroxidase antibody(TPOAb)and thyroglobulin antibody(TgAb)levels in pregnant women.According to serum TSH and FT4 levels,pregnant women were divided into the euthyroidism group and subclinical hypothyroidism group(referred to as hypothyroidism).Urine iodine arsenic-cerium catalytic spectrophotometry was used to detect the urine iodine level of pregnant women.The correlation between urinary iodine levels and thyroid function indexes of the two groups of pregnant women was analyzed,and single factor and multivariate logistic regression were used to analyze the influencing factors of hypothyroidism.Results There were 798 pregnant women in the euthyroidism group and 28 pregnant women in the hypothyroidism group.The hypothyroidism detection rate was 3.39%(28/826).In the euthyroidism group and hypothyroidism group,43.73%(349/798)and 46.43%(13/28)of pregnant women had urine iodine levels<150μg/L,respectively.There was no correlation between urine iodine level and serum TSH(r=0.038,P>0.05),and a positive correlation with serum FT4(r=0.077,P<0.05).The differences between the euthyroidism group and the hypothyroidism group in the median(interquartile range)of TPOAb and TgAb were statistically significant(Z=-3.986,-3.411,P<0.05).After logistic regression analysis,TPOAb was a risk factor for hypothyroidism(OR=3.428,95%CI:1.131-10.388).Conclusions Urine iodine and thyroid autoantibodies should be screened as routine examination items before or during pregnancy.Correct iodine deficiency in time,avoid blindly excessive iodine supplement,and reduce the occurrence of subclinical hypothyroidism in pregnant women,so as to reduce the adverse effects on mothers and their offspring.
作者
侯常春
李芳
刘绍英
钱明
刘忠慧
Hou Changchun;Li Fang;Liu Shaoying;Qian Ming;Liu Zhonghui(Institute of Environment and Health,Tianjin Center for Disease Control and Prevention,Tianjin 300011,China;Tianjin Jinghai District Center for Disease Control and Prevention,Tianjin 301600,China;Medical Psychology Department,Tianjin Medical University,Tianjin 300070,China)
出处
《中华地方病学杂志》
CAS
北大核心
2021年第3期215-219,共5页
Chinese Journal of Endemiology
基金
天津市卫生局科技基金重点项目(2014KR11)。
