2020年湖北省孕妇碘营养与甲状腺功能调查

Investigation on iodine nutrition and thyroid function of pregnant women in Hubei Province in 2020

目的了解湖北省孕妇碘营养水平和甲状腺功能状态。方法2020年按《全国碘缺乏病监测方案(2016版)》要求,采用横断面调查方法,在湖北省2个山区县和2个平原区,每个县(区)划分为东、西、南、北、中5个片区,每个片区抽取1个乡镇(街道),每个乡镇(街道)抽取20名孕妇作为调查对象,检测尿碘含量和甲状腺功能指标[血清游离三碘甲腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、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],分析甲状腺功能异常率及自身特异性抗体阳性率,并进行甲状腺功能指标相关性分析(Spearman法)。结果共纳入孕妇321人,其中孕早、中、晚期分别为43、114、164人;尿碘中位数为164.80μg/L。血清FT_(3)、FT_(4)、TSH、TPOAb、TgAb中位数分别为4.10、12.83 pmol/L,1.85 mU/L,15.84、13.35 U/ml,不同孕期血清FT_(3)、FT_(4)、TSH水平比较,差异均有统计学意义(均P<0.05)。孕早期FT_(3)与TSH、TPOAb水平均呈负相关(r=-0.46、-0.33,均P<0.05),TSH与TPOAb水平呈正相关(r=0.33,P=0.032);孕中期FT_(4)与TgAb水平呈正相关(r=0.21,P=0.032);孕晚期FT_(3)与TPOAb水平呈负相关(r=-0.19,P=0.017);整个孕期FT_(3)与FT_(4)水平、TPOAb与TgAb水平均呈正相关(均P<0.05);尿碘含量与甲状腺功能指标均无相关性(均P>0.05)。甲状腺功能总异常率为7.79%(25/321),孕早、中、晚期分别为16.28%(7/43)、5.26%(6/114)、7.32%(12/164),组间比较差异无统计学意义(χ^(2)=4.83,P=0.097)。低甲状腺素血症、甲状腺功能减退、亚临床甲状腺功能减退、甲状腺功能亢进、亚临床甲状腺功能亢进检出率分别为4.36%(14/321)、0.31%(1/321)、2.49%(8/321)、0.31%(1/321)、0.31%(1/321)。自身特异性抗体总阳性检出率为10.28%(33/321),其中TPOAb阳性检出率为9.97%(32/321),TgAb阳性检出率为5.30%(17/321)。结论湖北省孕妇碘营养处于适宜水平,甲状腺功能异常率及甲状腺自身特异性抗体阳性率较低。应持续动态监测孕妇碘营养及甲状腺功能指标,加强孕期碘缺乏危害的健康宣传,尽量减少因碘缺乏所导致的母婴健康损害。

Objective To investigate the iodine nutrition level and thyroid function status of pregnant women in Hubei Province.Methods According to the requirements of"the National Iodine Deficiency Disorders Monitoring Program(2016 Edition)",in 2020,using a cross-sectional survey method,two mountainous counties and two plain areas in Hubei Province were divided into five districts:east,west,south,north,and central.One township(street)was selected from each district,and 20 pregnant women were selected from each township(street)as survey subjects.Urine iodine content and thyroid function indicators[serum free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid-stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb)]were tested.Abnormal thyroid function rate and antibody positive rate were analyzed,and correlation analysis of thyroid function indicators was conducted(Spearman method).Results A total of 321 pregnant women were included,including 43,114,and 164 in early,middle,and late pregnancy,respectively;The median urinary iodine was 164.80μg/L.The median serum FT_(3),FT_(4),TSH,TPOAb,TgAb levels were 4.10,12.83 pmol/L,1.85 mU/L,15.84 and 13.35 U/ml,respectively.There were statistically significant differences in FT_(3),FT_(4),and TSH levels among different trimesters(P<0.05).According to Spearman's correlation analysis,FT_(3)in early stage of pregnancy was negatively correlated with TSH and TPOAb levels(r=-0.46,-0.33,P<0.05),while TSH was positively correlated with TPOAb level(r=0.33,P=0.032);there was a positive correlation between FT_(4)and TgAb levels in middle stage of pregnancy(r=0.21,P=0.032);there was a negative correlation between FT_(3)and TPOAb levels in late stage of pregnancy(r=-0.19,P=0.017);FT_(3)and FT_(4),TPOAb and TgAb levels were positively correlated throughout pregnancy(P<0.05).There was no correlation between urinary iodine content and thyroid function indicators(P>0.05).The total abnormal rate of thyroid function was 7.79%(25/321),with 16.28%(7/43),5.26%(6/114),and 7.32%(12/164)in early,middle,and late pregnancy,respectively.There was no statistically significant difference in the abnormal rate of thyroid function among different pregnancy periods(χ^(2)=4.83,P=0.097).The detection rates of hypothyroxinemia,hypothyroidism,subclinical hypothyroidism,hyperthyroidism,and subclinical hyperthyroidism were 4.36%(14/321),0.31%(1/321),2.49%(8/321),0.31%(1/321),and 0.31%(1/321),respectively.The positive detection rate of autospecific antibodies was 10.28%(33/321),with a TPOAb positive detection rate of 9.97%(32/321)and a TgAb positive detection rate of 5.30%(17/321).Conclusions The iodine nutrition level of pregnant women in Hubei Province is at a suitable level,and the rates of abnormal thyroid function and thyroid autospecific antibody positive are relatively low.It is necessary to continuously monitor the iodine nutrition and thyroid function indexes of pregnant women,strengthen health education on the hazards of iodine deficiency during pregnancy,and minimize the harm to maternal and infant health caused by iodine deficiency.