妊娠期血清甲状腺激素水平与缺铁性贫血相关性

Correlation between serum thyroid hormone levels and iron deficiency anemia during pregnancy

目的甲状腺激素水平及功能异常会影响机体铁代谢,增加贫血发生率,本研究旨在探究血清甲状腺激素水平与妊娠期铁代谢及缺铁性贫血的相关性。方法选择2018-10-10-2019-10-30在郑州人民医院产科产检的缺铁性贫血孕妇150例为贫血组和健康非贫血孕妇100名为对照组。检测两组孕妇铁代谢指标:血清铁(serum iron,SI)、血清铁蛋白(serum ferritin,SF)、总铁结合力(total iron binding capacity,TIBC)和转铁蛋白(serum transferrin,STF);检测三碘甲状腺原氨酸(triiodothyronine,T3)、四碘甲状腺原氨酸(tetraiodothyronine,T4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free tetraiodothyronine,FT4)和促甲状腺激素(thyroid stimulating hormone,TSH)水平,比较两组及不同程度贫血组间甲状腺激素水平的差异。结果贫血组T3水平为(1.16±0.25)nmol/L,低于对照组的(1.38±0.27)nmol/L,t=6.592,P<0.001;T4水平为(89.16±17.45)nmol/L,低于对照组的(99.56±16.93)nmol/L,t=4.672,P<0.001;FT3水平为(3.57±0.44)pmol/L,低于对照组的(3.84±0.41)pmol/L,t=4.853,P<0.001;FT4水平为(8.68±1.31)pmol/L,低于对照组的(9.44±1.26)pmol/L,t=4.575,P<0.001;TSH水平为(2.87±1.14)mIU/L,高于对照组的(2.07±1.06)mIU/L,t=5.642,P<0.001。重度贫血组T3水平为(1.07±0.25)nmol/L,低于轻度组的(1.23±0.24)nmol/L和中度贫血组的(1.17±0.24)nmol/L,F=5.090,P=0.017;FT3水平为(3.44±0.44)pmol/L,低于轻度组的(3.68±0.46)pmol/L和中度贫血组的(3.61±0.41)pmol/L,F=3.825,P=0.024;FT4水平为(8.26±1.31)pmol/L,低于轻度组的(9.03±1.28)pmol/L和中度贫血组的(8.79±1.26)pmol/L,F=4.390,P=0.014;而TSH水平为(3.09±1.14)mIU/L,高于轻度组的(2.48±1.10)mIU/L和中度贫血组的(2.97±1.13)mIU/L,F=3.551,P=0.031。Logistic回归分析结果显示,T3<1.39nmol/L、FT3<97.70nmol/L、FT4<8.81pmol/L和TSH>2.33mIU/L是妊娠期缺铁性贫血的独立危险因素。结论孕妇甲状腺激素水平与妊娠期缺铁性贫血密切相关,甲状腺激素异常可能是妊娠期缺铁性贫血发生的潜在危险因素。

OBJECTIVE Abnormal thyroid hormone levels and functions can affect iron metabolism and increase the incidence of anemia.This study aimed to explore the relationship between serum thyroid hormones and iron metabolism during pregnancy and iron deficiency anemia.METHODS A total of 150 pregnant women with iron deficiency anemia who underwent obstetric examination in Zhengzhou People’s Hospital from October 10,2018 to October 30,2019 were collected as anemia group and 100 healthy non-anemic pregnant women as control group.Serum iron(SI),serum ferritin(SF),total iron binding capacity(TIBC),and serum transferrin(STF)were tested in two groups of pregnant women.The levels of triiodothyronine(T3),tetraiodothyronine(T4),free triiodothyronine(FT3),free triiodothyronine(FT4),and thyroid stimulating hormone(TSH)were detected,the differences of thyroid hormone levels between the two groups and the different anemia groups were comparied.RESULTS The T3 level of the anemia group was(1.16±0.25)nmol/L,which was lower than that of the control group(1.38±0.27)nmol/L,t=6.592,P<0.001.The T4 level was(89.16±17.45)nmol/L,which was lower the control group(99.56±16.93)nmol/L,t=4.672,P<0.001.The FT3 level was(3.57±0.44)pmol/L,lower than the control group(3.84±0.41)pmol/L,t=4.853,P<0.001.FT4 level was(8.68±1.31)pmol/L,lower than the control group(9.44±1.26)pmol/L,t=4.575,P<0.001.TSH level was(2.87±1.14)mIU/L,higher than the control group(2.07±1.06)mIU/L,t=4.642,P<0.001.The T3 level in the severe anemia group was(1.07±0.25)nmol/L,which was lower than the mild group(1.23±0.24)nmol/L and the moderate anemia group(1.17±0.24)nmol/L,F=5.090,P=0.017.The FT3 level was(3.44±0.44)pmol/L,which was lower than the mild group(3.68±0.46)pmol/L and the moderate anemia group(3.61±0.41)pmol/L,F=3.825,P=0.024.FT4 level was(8.26±1.31)pmol/L,lower than mild group(9.03±1.28)pmol/L and moderate anemia group(8.79±1.26)pmol/L,F=4.390,P=0.014.While TSH level was(3.09 ±1.14)mIU/L,higher than the mild group(2.48±1.10)mIU/L and moderate anemia group(2.97±1.13)mIU/L,F=3.551,P=0.031.Logistic regression analysis showed that T3<1.39 nmol/L,FT3<97.70 nmol/L,FT4<8.81 pmol/L and TSH>2.33 mIU/L were independent risk factors for iron deficiency anemia during pregnancy.CONCLUSIONS Thyroid hormone levels in pregnant women are closely related to iron deficiency anemia during pregnancy.Abnormal thyroid hormones may be a potential risk factor for iron deficiency anemia during pregnancy.