摘要
目的探讨高水碘地区改换低碘饮用水后对孕妇碘营养状况和甲状腺功能的影响。方法采用横断面调查,在水源性高水碘地区山东省淄博市高青县,以2019-2021年于山东省高青县人民医院产科门诊进行产检的孕妇为调查对象;参照《水源性高碘地区和高碘病区的划分标准》(GB/T 19380-2016),以孕妇饮用水水碘>100μg/L为高水碘组,≤100μg/L为非高水碘组。采集孕妇基本信息、空腹血样、一次随意尿样、24 h尿样及饮用水水样,并对孕妇进行甲状腺B超检查。采用电感耦合等离子体质谱法检测尿碘(UI)浓度(UIC)、饮用水水碘浓度(WIC),并计算24 h尿碘排泄量(UIE)和孕妇每日碘摄入量(TII);全自动化学发光免疫检测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(TgAb)水平;去蛋白终点微孔板法测定尿肌酐(CR),计算UI/CR。结果共纳入孕妇797名,UIC为150.2(88.1,281.3)μg/L,碘营养总体处于适宜水平。其中,非高水碘组孕妇584名,UIC为120.9(74.9,191.5)μg/L,处于碘缺乏水平;高水碘组孕妇213名,UIC为321.1(201.9,569.1)μg/L,处于碘超适宜水平;两组孕妇WIC、UIC、UIE、TII、UI/CR比较,差异均有统计学意义(Z=21.63、13.34、15.14、15.14、11.81,均P<0.001)。按不同孕期分层后,非高水碘组孕妇WIC、TSH和高水碘组孕妇UI/CR不同孕期间比较,差异均有统计学意义(H=59.13、7.30、13.60,均P<0.05)。共检测744名孕妇甲状腺功能,检出TSH>2.5 mU/L 128例、低甲状腺素血症15例、亚临床甲状腺功能减退症19例,检出率分别为17.2%、2.0%、2.6%;高水碘组和非高水碘组孕妇TSH、TPOAb水平及TSH>2.5 mU/L孕妇比例比较,差异均有统计学意义(Z=3.04、-2.17,χ^(2)=6.94,P=0.002、0.030、0.008)。检查孕妇甲状腺720例,检出甲状腺肿大30例、甲状腺结节150例,检出率分别为4.2%、20.8%;高水碘组和非高水碘组孕妇甲状腺容积中位数分别为8.92、8.60 ml,均处于正常值范围,组间比较差异无统计学意义(Z=-0.75,P=0.455)。结论改换低碘水后,目前高青县孕妇总体碘营养处于适宜水平,且水碘降低有效减少当地孕妇TSH异常的风险。但非高水碘组孕妇处于碘缺乏水平,高水碘组孕妇处于碘超适宜水平,该地区孕妇碘营养水平变异较大,造成了当地孕妇总体处于碘适宜水平的"假象"。
Objective To investigate the impact of switching to low iodine drinking water in areas with high water iodine levels on the iodine nutritional status and thyroid function of pregnant women.Methods A cross sectional survey was conducted in Gaoqing County,Zibo City,Shandong Province.Pregnant women who underwent prenatal examinations at the Obstetrics Clinic of Gaoqing County People's Hospital from 2019 to 2021 were selected as the survey subjects.With reference to the Criteria for the Classification of Water Source High Iodine Areas and High Iodine Disease Areas(GB/T 19380-2016),pregnant women with drinking water iodine>100μg/L were considered as the high water iodine group and≤100μg/L was the non-high water iodine group.Basic information,one random urine sample,fasting blood sample,24-hour urine sample and drinking water sample of pregnant women were collected,and thyroid ultrasound examination was performed on pregnant women.Urinary iodine(UI)concentration(UIC)and drinking water iodine concentration(WIC)were measured by inductively coupled plasma mass spectrometry,and 24-hour urinary iodine excretion(UIE)and daily iodine intake(TII)of pregnant women were calculated.Serum thyroid hormone(TSH),free triodothyronine(FT:),free thyroxine(FTa),thyroid peroxidase antibody(TPOAb)and anti-thyroid autoantibodies(TgAb)were determined by automatic chemiluminescence immunoassay.Creatinine(CR)was determined using deproteinized endpoint microplate method and UI/CR was calculate.Results A total of 797 pregnant women were included,and the UIC was 150.2(88.1,281.3)μg/L,the iodine nutrition was generally at an appropriate level.Among them,584 pregnant women in the non-high water iodine group had a UIC of 120.9(74.9,191.5)μg/L,which was at the iodine deficiency level;213 pregnant women in the high water iodine group had a UIC of 321.1(201.9,569.1)μg/L,which was at the iodine super-appropriate level;the differences in WIC,UIC,UIE,TII,and UI/CR between the two groups were statistically significant(Z=21.63,13.34,15.14,15.14,11.81,P<0.001).After stratification by different gestational periods,the differences were statistically significant when comparing WIC and TSH in pregnant women in the non-high water iodine group and UI/CR in pregnant women in the high water iodine group by gestational period(H=59.13,7.30,13.60,P<0.05).A total of 744 pregnant women were tested for thyroid function,and 128 cases of TSH>2.5 mU/L,15 cases of hypothyroxemia,and 19 cases of subclinical hypothyroidism were detected,with detection rates of 17.2%,2.0%,and 2.6%,respectively.The differences were statistically significant when comparing TSH and TPOAb levels and the proportion of pregnant women with TSH>2.5 mU/L in the high water iodine and non-high water iodine groups(Z=3.04,-2.17,χ^(2)=6.94,P=0.002,0.030,0.008).The thyroid glands of pregnant women were examined in 720 cases,and 30 cases of goiter and 150 cases of thyroid nodules were detected,with detection rates of 4.2%and 20.8%,respectively.The median thyroid volume was 8.92 ml in the high water iodine group and 8.60 ml in the non-high water iodine group,which were both within the normal range,with no statistically significant difference between the groups(Z=-0.75,P=0.455).Conclusions After changing to low iodine water,the overall iodine nutrition of pregnant women in Gaoqing County is now at an appropriate level,and the reduction of water iodine effectively reduces the risk of TSH abnormalities in local pregnant women.However,pregnant women in the non-high water iodine group are iodine deficiency,and pregnant women in the high water iodine group are at iodine super-appropriate,and the iodine nutrition level of pregnant women in this area is highly variable,which causes the"illusion"that the overall iodine level of local pregnant women is suitable.
作者
张可心
程元贵
武文
张鼎言
蒋雯
王晓明
董淑瑶
张万起
Zhang Kexin;Cheng Yuangui;Wu Wen;Zhang Dingyan;Jiang Wen;Wang Xiaoming;Dong Shuyao;Zhang Wanqi(Department of Nutrition and Food Hygiene,School of Public Health,Tianjin Medical University,Tianjin 300070,China;Gaoqing County People1s Hospital,Gaoqing 256300,China;Shandong Institute for Endemic Disease Control,Jinan 250014,China;Key Laboratory of Environmental Nutrition and Public Health,Tianjin International Cooperative Research Center for Environmental Nutrition and Public Health,Tianjin 300000,China;Department of Endocrinology and Metabolism,Afiliated Hospital of Tianjin Medical University,Tianjin 300000,China)
出处
《中华地方病学杂志》
CAS
北大核心
2023年第6期447-452,共6页
Chinese Journal of Endemiology
关键词
碘
尿
饮水
孕妇
碘营养状况
甲状腺功能
Iodine
Urine
Drinking water
Pregnant women
Iodine nutrition status
Thyroid function
