摘要
目的:探讨妊娠早期孕妇血清碘和铁水平与甲状腺功能及甲状腺过氧化物酶抗体(TPOAb)之间的关系,为指导妊娠早期个体化补碘补铁提供科学依据。方法:选取来本院初次产检建卡的单胎妊娠孕妇共404名,收集孕妇一般资料并检测血清中血清铁蛋白(SF)、血红蛋白(Hb)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、TPOAb和尿肌酐(UCr)水平及尿碘浓度(UIC)。孕妇根据不同碘营养水平分为碘缺乏组(UIC/UCr<150μg·g^(-1))、碘充足组(150μg·g^(-1)≤UIC/UCr<250μg·g^(-1))和碘超足量/碘过量组(UIC/UCr≥250μg·g^(-1)),根据不同铁营养水平分为铁缺乏组(SF<20μg·L^(-1))、铁充足组(20μg·L^(-1)≤SF≤150μg·L^(-1))和铁过量组(SF>150μg·L^(-1)),分别比较各组孕妇的甲状腺功能和血清TPOAb阳性率以及亚临床甲状腺功能减退(甲减)和亚临床甲状腺功能亢进(甲亢)的患病率。结果:404名孕妇血清中TSH水平中位数(四分位数)1.15 mIU·L^(-1)(0.62 mIU·L^(-1),1.63 mIU·L^(-1)),FT4水平中位数(四分位数)12.96 pmol·L^(-1)(12.06 pmol·L^(-1),13.96 pmol·L^(-1)),UIC/UCr和SF水平中位数(四分位数)分别为158.66μg·g^(-1)(106.93μg·g^(-1),239.41μg·g^(-1))和60.93μg·L^(-1)(33.86μg·L^(-1),89.61μg·L^(-1))。碘缺乏组和碘超足量/碘过量组孕妇血清中TSH水平明显高于碘充足组(P<0.05),碘超足量/碘过量组孕妇TPOAb阳性率高于碘缺乏组和碘充足组(P<0.05),3组孕妇血清中FT4水平比较差异无统计学意义(P>0.05);铁缺乏组孕妇血清中TSH水平和TPOAb阳性率高于铁充足组和铁过量组(P<0.05),铁缺乏组孕妇血清中FT4水平低于铁过量组(P<0.05)。碘缺乏组和碘超足量/碘过量组孕妇亚临床甲减患病率高于碘充足组(P<0.05);铁缺乏组孕妇亚临床甲减患病率高于铁充足组和铁过量组(P<0.05),铁过量组孕妇亚临床甲亢患病率高于铁缺乏组和铁充足组(P<0.05)。相关性分析,孕妇UIC/UCr比值与TSH和FT4水平无相关性(P>0.05);SF水平与TSH水平呈负相关关系(r=-0.148,P<0.05),SF水平与FT4水平呈正相关关系(r=0.150,P<0.05)。结论:妊娠早期孕妇碘和铁营养水平与甲状腺功能及甲状腺自身免疫有关,应及时评估妊娠早期孕妇碘和铁的营养状况,个体化补碘补铁,同时应避免碘和铁过量。
Objective:To explore the relationships between the serum iodine and iron levels and the thyroid function and thyroid peroxidase antibodies(TPOAb)in the pregnant women during the early pregnancy,and to provide a scientific basis for guiding the individualized iodine and iron supplementation.Methods:A total of 404 pregnant women during early pregnancy in our hospital were enrolled.The general information of patients was collected;the levels of serum ferritin(SF),haemoglobin(Hb),free thyroxine(FT4),thyroid-stimulating hormone(TSH),TPOAb,urinary creatinine(UCr)and urinary iodine concentration(UIC)were measured in the pregnant women.The pregnant women were divided into iodine deficiency group(UIC/UCr<150μg·g^(-1)),idodine adequate group(150μg·g^(-1)≤UIC/UCr<250μg·g^(-1))and more-than-adequate/excessive iodine group(UIC/UCr≥250μg·g^(-1))according to the different idodine levels.The pregnant women were divided into iron deficiency group(SF<20μg·L^(-1)),iron adequate group(20μg·L^(-1)≤SF<150μg·L^(-1))and iron excess group(SF≥150μg·L^(-1))according the different iron levels.The thyroid function,the serum TPOAb positive rates and the prevalence of subclinical hypothyroidism and subclinical hyperthyroidism of the pregnant women in various groups were compared.Results:The median of TSH,FT4,UIC/UCr and SF of 404 pregnant women were 1.15 mIU·L^(-1)(0.62 mIU·L^(-1),1.63 mIU·L^(-1)),12.96 pmol·L^(-1)(12.06 pmol·L^(-1),13.96 pmol·L^(-1)),158.66μg·g^(-1)(106.93μg·L^(-1),239.41μg·L^(-1))and 60.93 mg·L^(-1)(33.86μg·L^(-1),89.61μg·L^(-1)).The serum TSH levels of pregnant women in iodine deficiency group and more-than-adequate/excessive iodine group were higher than that in iodine adequate group(P<0.05).The TPOAb positive rate in more-than-adequate/excessive iodine group was higher than those in iodine deficiency group and iodine adequate group(P<0.05);the FT4 levels had no significant differences among various groups(P>0.05).The serum TSH levels and the TPOAb positive rate of pregnant women in iron deficiency group were higher than those in iron adequate group and iron excess group(P<0.05).The FT4 level of pregnant women in iron deficiency group was lower than that in iron excess group(P<0.05).The prevalence of subclinical hypothyroidism in the pregnant women in iodine deficiency group and more-than-adequate/excessive iodine group was higher than that in iodine adequate group(P<0.05).However,the prevalence of subclinical hypothyroidism in the pregnant women in iron deficiency group was higher than those in iron adequate group and iron excess group(P<0.05),and the prevalence of subclinical hyperthyroidism in iron excess group was higher than those in iron deficiency group and iron adequate group(P<0.05).The further correlation analysis results revealed that the UIU/UCr ratio had no correlations with the TSH and FT4 levels of the pregnant women(P>0.05);the SF level was negatively correlated with the TSH level(r=-0.148,P<0.05),and positively correlated with the TSH level(r=-0.150,P<0.05).Conclusion:The nutritional levels of iron and iodine of the pregnant women in early pregnancy is related to thyroid function and thyroid autoimmunity,and the nutritional condition of iron and iodine should be assessed promptly,the individualized supplement of iodine and iron should be done,at the same time,the excessive iodine supplement should be avoided.
作者
从相国
陈欣欣
吴英
曹梦蝶
李淑湘
陈蕾
沈琼
CONG Xiangguo;CHEN Xinxin;WU Ying;CAO Mengdie;LI Shuxiang;CHEN Lei;SHEN Qiong(Department of Endocrinology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China;Department of Medical Laboratory,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China)
出处
《吉林大学学报(医学版)》
CAS
CSCD
北大核心
2022年第4期988-994,共7页
Journal of Jilin University:Medicine Edition
基金
国家自然科学基金项目(81900714)
江苏省苏州市卫健委科技项目(LCZX202009)
江苏省苏州市卫健委科教兴卫青年科技项目(KJXW2021029)。