孕妇尿碘监测的临床意义

Clinical significance of monitoring the urine iodine level in pregnant women

目的探讨孕妇尿碘监测的临床意义。方法对391例孕妇进行尿碘测定，分析孕期、妊娠合并症与尿碘的相关性，根据测定结果进行相应的碘营养健康教育。结果（1）391例孕妇尿碘值为（124．73±70．61）μg/L，严重缺碘率为37．85％，缺碘率为64．70％，碘适宜率仅为25．06％；（2）妊娠早、中、晚期尿碘值分别为（121．76±71．81）μg/L、（125．52±69．28）μg/L、（129．30±75．19）μg/L（t≤0．59，均P〉0．05），均值均低于WHO推荐适宜值（150～249μg/L），缺碘率分别为67．20％、63．23％、65．12％（x2=0．56，P〉0．05）；（3）甲状腺功能亢进合并妊娠的尿碘值[（85．76±53．09）μg/L]明显低于原发性甲状腺功能减退（甲减）合并妊娠、妊娠合并亚临床甲减及无合并症妊娠[分别为（133．65±73．41）μg/L、（136．50±79．19）μg/L、（119．34±66．43）μg/L]（t≥2．76，均P〈0．01），其缺碘率（87．88％）最高（x2=8．72，P〈0．05）；（4）77例孕妇碘营养干预后检测的尿碘值[（129．74±68．04）μg/L]较干预前[（107．01±74．36）μg/L]有明显的增高（t=1．98，P〈0．05），缺碘率由79．22％下降至63．64％（x2=4．58，P〈0．05）。结论妊娠尤其是有合并症的妊娠进行全程尿碘监测及碘营养干预对提高孕妇碘适宜率具有十分重要的意义。

Objective To study the clinical significance of monitoring the urine iodine level in pregnant women. Methods The urine iodine levels were detected in 391 cases of pregnant women. The relativity was analyzed among the pregnancy gestation, pregnancy complications and the urine iodine levels. The corresponding health educa- tion of iodine nutritional knowledge was conducted according to the results of the determination. Results （ 1 ） The urine iodine value was （124.73 ±70.61 ）μg/L in 391 pregnant women. The severe deficiency iodine rate, deficiency iodine rate and appropriate iodine rate of pregnant women were 37.85% , 64.70% and 25.06%, respectively. （2） There was no significant difference in values of urine iodine among the pregnant women during the first, second and third trimester of pregnancy[ （ 121.76 ± 71,81 ） μg/L, （ 125.52 ± 69.28 ） μg/L, （ 129.30 ± 75.19 ） μg/L ] （ t≤0.59, all P 〉 0.05 ）. The mean valUes were all lower than the appropriate values of WHO（ 150 - 249 μg/L）. The low iodine rates were 67.20%, 63.23 % and 65.12% , respectively. There was no significant difference among them （X2 = 0.56, P 〉 0. 05 ）. （ 3 ） The urine iodine value of the pregnant women complicated with hyperthyroidism [ （ 85. 76 ±53.09） μg/L] was significantly lower than that of primary hypothyroidism combined with pregnancy [ （133.65 ± 73.41 ） μg/L], pregnancy combined with subclinical hypothyroidism [ （ 136.50± 79. 19 ）μg/L ] and no pregnancy complication[ （ 119.34 ± 66.43 ） μg/L] （ t ≥ 2.76, P 〈 0.01 ）. The rate of iodine＇ deficiency （ 87.88% ） was highest （ X2 = 8.72, P 〈 0.05 ）. （4） The urine iodine value after iodine nutrition intervention was significantly higher than those before in 77 pregnant women[ （ 129.74 ± 68.04） μg/L vs. （ 107.01 ±74. 36） μg/L, t = 1.98, P 〈 0.05 ]. The iodine deficiency rate dropped from 79.22% to 63.64% （ X2 = 4.58, P 〈 0.05 ）. Conclusion In order to improve the appropriate iodine rate of pregnant women, it should be very important significance on monitoring the urine iodine level of pregnant women in particular with a complication of pregnancy and conducting iodine nutrition intervention in whole pregnancy gestation.