2013年重庆地区计划妊娠妇女促甲状腺素水平检测和分析

Detection and analysis of thyroid-stimulating hormone in women under planned pregnancy in Chongqing

目的：筛查重庆市计划妊娠妇女甲状腺功能,指导优生优育。方法采用按比例多阶段分层整群随机抽样方法抽取11953名计划妊娠妇女进行问卷调查、体格检查并采集静脉血。结果调查对象促甲状腺素（TSH）中位数为2.04 mIU/ L,P25=1.36 mIU/ L,P75=2.99 mIU/ L,TSH 正常、高于上限和低于下限者占比分别为91.47%、6.20%和2.33%。渝东北地区 TSH 中位数及 TSH 高于上限者占比高于其他地区（P〈0.05）。随着文化程度升高,TSH 高于上限者、低于下限者占比有下降的趋势（P〈0.05）,随着体重指数的增加,TSH 高于上限者占比有升高的趋势（P〈0.05）。既往具有不良妊娠结局史的妇女 TSH 中位数、高于上限者占比高于对照组（P〈0.05）。高空腹血糖妇女 TSH 中位数低于血糖正常组（P〈0.05）,空腹血糖浓度和 TSH 呈负相关关系（P〈0.05）。结论重庆市计划妊娠妇女 TSH 异常率为8.53%,不同地区、文化程度、体重指数、血糖水平妇女 TSH 异常率不同；既往不良妊娠结局史与 TSH 水平升高有关,很有必要进行孕前甲状腺功能筛查。

Objective To screen thyroid function among planned pregnant women in Chongqing, to guide prenatal and postnatal care. Methods Proportional multi-stage stratified cluster random sampling method was adopted to enroll 11 953 planned pregnant women for questionnaire, physical examination, and serum samples collection. Results The median TSH was 2. 04 mIU/ L, P25 = 1. 36 mIU/ L,P75 = 2. 99 mIU/ L. TSH levels being normal, higher, and lower than the reference were 91. 47% , 6. 20% , and 2. 33% , respectively. In Northeast Chongqing, the proportions of median TSH level and TSH level above the upper limit were higher than those in other regions（P〈0. 05）. With improved education, proportions of TSH above the upper limit and below the lower limit declined（P〈0. 05）. With the increase in body mass index, the proportion of those whose TSH was above the upper limit showed elevated trend（P〈0. 05）. In women with history of adverse pregnancy outcomes, their median TSH was higher than that in the control group, and those, whose TSH level exceeded the upper limit, yield higher results than those in the control group（P〈0. 05）. In women with higher fasting blood glucose The median TSH level was lower than that in normal blood glucose group（ P〈0. 05）, with the fasting plasma glucose concentration and TSH negatively correlated（P〈0. 05）. Conclusion The abnormal rate of TSH level in planned pregnant women was 8. 53% in Chongqing. The abnormal rate varies by different regions, education levels, body mass indexes, and blood glucose levels. Previous history of adverse pregnancy outcomes was related to elevated TSH levels. It is necessary to take pre-pregnancy thyroid function screening investigation.