促甲状腺激素释放激素兴奋试验在碘缺乏病监测中的临床意义

A study on clinical significance of thyrotropin-releasing-hormone stimulation test in iodine deficiency disease monitoring.

目的 探讨促甲状腺激素释放激素 (TRH)兴奋试验 (TRH- ST)在碘缺乏病 (IDD)防治监测中的临床意义。方法 研究全民食盐加碘前后安徽大别山、巢湖缺碘病区和碘营养不足地区合肥市儿童 TRH兴奋试验的曲线变化特征及其与尿碘 (UI)的相关性 ,并和其它甲状腺功能指标进行比较。结果 加碘后大别山和巢湖地区儿童 TRH- ST反应曲线增高 ,合肥地区加碘前后 TRH- ST反应曲线无明显变化。相关分析显示 :UI与 TRH- ST中 30 ,6 0 m in TSH值及兴奋绝对值和 FT4均呈显著正相关关系。当 UI在 2 0 0～ 5 0 0 μg/ L 范围内 ,TRH- ST与 UI的相关性进一步增强。结论 TRH- ST在 IDD病区加碘前后变化明显 ,且比其它血清学指标更敏感。对于儿童垂体 -甲状腺轴功能状态的反应 ,考核安全的 U I范围 。

Objective Study on clinical significance of Thyrotropin-Releasing-Hormone Stimulation Test (TRH-ST) in IDD monitoring.Methods Reaction curve changes of TRH-ST and correlation between urinary iodine with TRH-ST,FT 3,FT 4,TSH,Tg were carried out from iodine-deficient disease areas in Dabie mountain,Chaohu and iodine-nutritional deficiency area in Hefei before and after one year's implementation of universal salt iodization.Results After universl iodization of one year,the reaction curve of TRH-ST in Dabei mountain and Chaohu were significantly increased with the increasing of median urinary iodine,but the reaction curve of TRH-ST in Hefei had no change.In analyses of correlation between urinary iodine level and fold or absolute TRH response,basal TSH,FT 4,the urinary iodine levels were significant positively related to TSH(30,60)min.The correlation between UI and TSH 60,TSH60'-TSH0' was the best compated with FT 4.The correlation between UI and TRH-ST became even stronger when the median UI was among 200~500μg/L.Conclusions There was a significant change of TRH-ST in the IDD areas by universal salt iodization.TRH-ST be more sensitive,as an indicator,than any other serum indicators in mitoring of IDD.It would be more valuable in showing states of Pituitary-thyroid axis function,judging safety range of UI and protecting the injury of high or low iodine.