妊娠早期孕妇母体碘营养与甲状腺功能异常的初步研究

Preliminary Study on Maternal Iodine Nutrition and Thyroid Dysfunction during Early Pregnancy

目的研究妊娠早期妇女碘营养及甲状腺功能。方法将于我院产科门诊进行常规产前检查的521例妊娠早期妇女作为研究对象,收集其空腹晨尿及静脉血,利用砷铈催化分光光度法测定尿标本中碘含量,利用电化学发光法测定促甲状腺激素及游离甲状腺素。结果本院妊娠早期妇女甲状腺功能指标促甲状腺激素的参考值范围为0.44~3.78 mIU/L,游离甲状腺素的参考值范围为12.61~20.07 pmol/L。521例妊娠早期妇女甲减患病率为2.5%,亚甲减患病率为9.2%,甲亢患病率为1.2%,亚甲亢患病率为4.2%,低甲状腺素血症患病率为1.0%,甲状腺过氧化物酶抗体阳性率为10.56%;妊娠早期妇女尿碘中位数为159.27μg/L,尿碘水平异常的个体甲状腺功能异常患病率高于碘适量水平个体(分别为20.5%和6.9%,P<0.05)。碘适量水平的过氧化物酶抗体阳性个体总甲状腺功能异常患病率高于阴性的个体(分别为57.1%和6.9%,P<0.05)。尿碘中位数与促甲状腺激素相关系数为-0.021。结论建议在妊娠早期对孕妇加强健康宣传教育,鼓励增加含碘膳食,对盐摄入量偏低的孕妇必要时可增加碘补充剂,同时进行尿碘监测,及时纠正碘营养情况,做到个体化指导。尿碘浓度<150μg/L及≥250μg/L的孕妇应进行甲状腺功能筛查。

Objective To assess maternal iodine nutrition and thyroid function during early pregnancy. Methods From August 2011 to October 2012,521 cases of women who were in our hospital obstetric clinic for routine prenatal care during early pregnancy as research sub- jects, fasting morning urine and serum samples were collected. Utilize arsenic cerium catalytic spectrophotometric determination of iodine con- tent in unne specimens method for the determination of thyroid stimulating hormone （qSH） and free thyroxine in blood specimens. Results Trimester-specific reference ranges during early pregnancy of the hospital：TSH 0.44-3.78 mlU/L,FT4 12.61- 20.07 pmol/L. Our hospital 521 eases of early pregnancy women,the prevalence of hypothyroidism, subclinical hypothyroidism,hypeahy- roidism, subclinical hyperthyroidism and hypothyroxinemia was 2.5%, 9.2%, 1.2%, 4.2% and 1.0%, respectively. Positive rate for thyroid per- oxidase antibody （TPOAb） was 10.56%. The median urinary iodine concentration in early pregnant women is 159.27 txg/L. Thyroid dysfunc- tion prevalence of individuals with abnormal urinary iodine level is higher than those with iodine appropriate level （20.5% vs 6.9%,P 〈 0.05 ）. Prevalence of thyroid dysfunction is higher in TPOAb-positive individuals （57.1% vs 6.9%, P 〈 0.05 ）. Correlation eoet^cient of me- dian urinary iodine concentration and TSH is -0.021. Conclusion It is recommended to strengthen health education and promotion for pregnant women in early pregnancy, and encourage to increase iodine dietary. If necessary, pregnant women with low salt intake should re- ceive iodine supplements daily, simultaneously monitor for urinary iodine, to rectify iodine nutritional situation in time, and give individualized guidance. For early pregnant women with urinary iodine concentrations of between 150 μg/L and 250μg/L, screening of thyroid function should be carried out.