新疆某三甲医院不同孕期妇女碘营养状态与甲状腺激素水平的关系

Relationship between iodine nutritional status and thyroid hormone level among pregnant women in different periods of gestation in a grade A class 3 hospital in Xinjiang

目的调查新疆某三甲医院孕妇碘营养水平及其与甲状腺激素水平的关系,为临床提供参考。方法选取2014年8月-2015年11月新疆维吾尔自治区人民医院门诊完善甲状腺功能及碘营养状态筛查的1 286例孕检者中资料完整及符合纳入标准的1 000例为研究对象,年龄(29.90±4.70)岁,回顾性分析甲状腺功能及抗体、尿碘等基本资料,采用砷铈催化分光光度法检测尿碘水平。结果研究对象尿碘中位数为170.40μg/L,其中碘缺乏占41.10%,碘适宜占35.80%,碘超量占23.10%,碘过量占3.80%。受试者在孕早、中、晚期尿碘中位数分别为180.35μg/L、165.90μg/L、170.80μg/L,三期尿碘水平差异没有统计学意义,但三期尿碘分布差异有统计学意义(P<0.05),并且碘缺乏的比例在孕早、中、晚期分别为37.00%、41.90%、42.60%,但变化趋势无统计学意义(P>0.05)。将研究对象按碘缺乏(<150μg/L)、碘适宜(150~249.99μg/L~)、碘超量及过量(≥250.00μg/L)分组后分析,受试者在不同碘营养状态下血清FT_4、FT_3、TSH水平差异均无统计学意义(均P>0.05)。将研究对象按孕早、中、晚期分组,受试者在不同孕期FT_4、FT_3、TSH水平有差异(P<0.05);在每个孕期进一步按碘营养水平分层后分析FT_4、FT_3、TSH水平,孕中期只有FT_3水平有差异(P<0.05),孕晚期只有TSH水平有差异(P<0.05)。结论研究对象在不同孕期均处于碘适宜状态,但仍有41%的孕妇存在碘缺乏。本次调查未发现不同孕期妇女碘营养状态与甲状腺激素水平明显相关。建议落实孕前及孕期科学合理补碘、并且在各孕期开展碘营养水平和甲状腺功能的监测。

Objective To investigate the relationship betwen iodine nutritional status and thyroid hormone level among pregnant women in a grade A class 3 hospital in Xinjiang,provide a reference for clinical treatment.Methods From August 2014 to November 2015,1 286 pregnant women receiving prenatal examination,thyroid function and iodine nutritional status screening in Outpatient Department of People＇s Hospital of Xinjiang Uyghur Autonomous Region were selected,and 1 000 pregnant women of them having intact data and meeting the inclusion criteria were selected as study object,they were aged（ 29.90±4.70） years old.The basic data（ throid function and antibody,urine iodine） was analyzed retrospectively.As-Ce catalysis spectrophotometry was used to detect urine iodine levels.Results The median of urine iodine was 170.4 μg/L,the proportions of pregnant women with iodine deficiency,sufficient iodine,excess iodine,and extremely excessive iodine accounted for 41.10%,35.80%,23.10%,and 3.80%,respectively.The medians of urine iodine during the first,the second,the third trimesters of pregnancy were 180.35 μg/L,165.90 μg/L,and 170.80 μg/L,respectively.There was no statistically significant difference in the level of urine iodine among different periods of gestation,but there were statistically significant differences in urine iodine distribution among different periods of gestation（ P 0.05）.The proportions of iodine deficiency during the first,the second,the third trimesters of pregnancy were 37.00%,41.90%,and 42.60%,respectively,but there was no statistically significant difference in change trend（ P〈0.05）.The pregnant women were divided into iodine deficiency group（ 150 μg/L）,sufficient iodine group（ 150-249.99 μg/L）,excess and extremely excessive iodine group（ ≥250.00 μg/L）,there was no statistically significant difference in the levels of serum free thyroxine（ FT_4）,free triiodothyronine（ FT_3）,and thyroid stimulating hormone（ TSH） among the three groups（ P〈0.05）.The pregnant women were divided into early pregnancy group,middle pregnancy group,and late pregnancy group,there were statistically significant differences in the levels of serum FT_4,FT_3,and TSH among the three groups（ P〈0.05）.The pregnant women in early pregnancy group,middle pregnancy group,and late pregnancy group were further divided into different subgroups according to iodine nutritional level,there was statistically significant difference in serum FT_3 level only in middle pregnancy group（ P〈0.05）,and there was statistically significant difference in serum TSH level only in late pregnancy group（ P〈0.05）.Conclusion The pregnant women had sufficient iodine in different periods of gestation,but iodine deficiency is found in 41% of the pregnant women.The survey did not find significant correlation between iodine nutritional status and thyroid hormone level in different periods of gestation.It is recommended that scientific and reasonable iodine supplementation should be implemented before and during pregnancy,and iodine nutritional level and thyroid function monitoring should be carried out in different periods of gestation.