上海市浦东新区周浦和康桥地区孕妇碘营养状况及新生儿足跟血促甲状腺激素水平分析

Analysis of iodine nutritional status of pregnant women and level of neonatal heel blood thyroid stimulating hormone in Zhoupu and Kangqiao districts of Pudong New Area of Shanghai

目的 调查上海市浦东新区周浦和康桥地区（简称周康地区）孕妇的碘营养状况,新生儿足跟血促甲状腺激素（TSH）水平及其与母体孕期尿碘水平之间的关系.方法 于2009年4月至2010年11月,选择上海市周康地区孕早、中、晚期妇女各200例,哺乳期妇女193例,生育期非孕妇女（简称育龄期妇女）200例,同期新生儿200例作为观察对象.采集各期妇女随意1次尿样,用砷铈催化法检测尿碘,同时采集新生儿出生后72 h的足跟血,用时间分辨荧光免疫法（TRFIA）测定TSH.结果 600例孕妇的尿碘中位数为161.35 μg/L,其中孕晚期妇女尿碘中位数（126.35 μg/L）明显低于孕早、中期,哺乳期及育龄期妇女（178.80、180.50、167.90、163.40μg/L,P均＜0.05）；孕晚期妇女尿碘＜150 μg/L的比例[57.5％（115/200）]明显高于孕早、中期,哺乳期,育龄期妇女[39.0％（78/200）、39.5％（79/200）、16.6％（32/193）、23.0％（46/200）,P均＜0.05].孕早、中、晚期妇女尿碘≥300 μg/L的比例[9.0％（18/200）、8.0％（16/200）、5.0％ （10/200）]明显低于哺乳期、育龄期妇女[20.2％（39/193）、20.5％（41/200）,P均＜0.05].200例新生儿足跟血TSH水平为（2.92±1.83）mU/L,范围为0.01～9.76 mU/L,TSH＞5 mU/L的比例为11.0％（22/200）,超过世界卫生组织（WHO）碘营养适宜标准（＜3％）.结论 上海市浦东新区周康地区孕妇总体碘营养水平处在适宜范围,但孕晚期妇女存在轻度碘营养不足,而该区新生儿有碘营养缺乏的可能.应加强对孕妇碘营养的监测,科学补碘.

Objective To investigate the iodine nutritional status of pregnant women,newborn heel blood thyroid stimulating hormone（TSH） level and their relationship with urinary iodine（UI） level during pregnancy in Zhoupu and Kangqiao districts of Pudong New Area of Shanghai.Methods A total of 993 urinary samples（the first,second and third trimesters of pregnancy were 200 people,respectively）,breast feeding（193 people） and non-pregnant women （200 people） in Zhoupu and Kangqiao districts of Pudong New area were collected from Apr 2009 to Dec 2010.Two hundred copies of neonatal heel blood samples were collected.Median of UI was measured by arsenic-cerium catalysis.TSH in neonatal heel blood was analyzed 72 h after birth by time resolved fluoroisnmunoassay（TRFIA）.Results Median UI of all pregnant women was 161.35 μg/L,and that in third trimesters of pregnancy（ 126.35 μg/L） was lower than that of the first,the second,the breast feeding and non-pregnant women （178.80,180.50,167.90,163.40 μg/L,all P〈 0.05）.The percentage of UI level less than 150 μg/L in the third trimester[57.5%（115/200） ] was higher than that of the first[39.0%（78/200） ],the second[39.5%（79/200） ],the breast feeding [ 16.6% （32/193） ] and non-pregnant women [ 23.0% （46/200） ],respectively （all P 〈 0.05）.The percentage of UI level higher than 300 μg/L in the first [9.0%（18/200）],the second[8.0%（16/200） ] and the third trimester [ 5.0% （ 10/200 ） ] of pregnancy was lower than that of the breast feeding [ 20.2% （39/193） ] and nonpregnant [20.5%（41/200） ] women,respectively（all P 〈 0.05）.The level of neonatal heel blood TSH was（2.92 ± 1.83）mU/L,the range was 0.01 - 9.76 mU/L,11.0%（22/200） of the neonates heel blood TSH level（5 mU/L）exceeded the ratio of World Health Organization （WHO） standard （ 〈 3% ） suitable for iodine nutrition.Conclusions The overall level of iodine nutrition among pregnant women in Zhoupu and Kangqiao districts of Pudong New Area of Shanghai is in the appropriate range,but the pregnant women in the third trimester is in mild iodine deficiencies,and the neonates in these districts may be prone to iodine deficiency.Monitoring of iodine nutrition of pregnant women should be strengthened and iodine supplementation should be done scientifically.