口服碘油丸对妊娠期妇女甲状腺功能的影响

Effect of oral iodized oil pills on thyroid function of pregnant women

目的评价口服碘油丸对新疆维吾尔自治区(新疆)妊娠期妇女碘营养及其甲状腺功能的影响。方法2017年5-7月,分别自妊娠期妇女未服用过碘油丸的新疆伊犁州、每年口服碘油丸1次的阿克苏地区和每年口服碘油丸2次的喀什地区各抽取1个县作为调查点;每个调查县抽取妊娠期妇女100名(孕早、中、晚期分布均衡),收集一般资料并采集尿液和血液样本,进行尿碘和血清甲状腺功能指标[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb)]检测。结果共调查妊娠期妇女308名,最终纳入分析289名,平均年龄为25岁;身体质量指数(BMI)为(22.69±3.07)kg/m^(2);职业分布以农民为主,占93.77%(271/289);学历以初中及以下居多,占71.97%(208/289)。喀什地区孕早、中、晚期妇女的尿碘中位数分别为712.87、604.50和656.23μg/L,均处于碘过量状态;伊犁州和阿克苏地区孕早期妇女的碘营养水平均处于碘超足量状态,孕中、晚期妇女的碘营养水平均处于碘适宜状态。不同地区间孕早、中、晚期妇女尿碘中位数比较差异均有统计学意义(Z=53.02、49.60、44.66,P均<0.001);且喀什地区各孕期妇女尿碘中位数均明显高于伊犁州和阿克苏地区(P均<0.05)。不同地区间孕早期妇女FT_(3),孕中期妇女FT_(4)、TSH水平比较,差异均有统计学意义(F=4.59、10.92,Z=8.61,P<0.05或<0.001)。其中,喀什地区孕早期妇女FT_(3)水平低于伊犁州(P<0.05);孕中期妇女FT_(4)水平高于伊犁州,TSH水平低于伊犁州(P均<0.05)。不同地区间孕早、中、晚期妇女TgAb阳性率、TPOAb阳性率及双抗体阳性率比较,差异均无统计学意义(P均>0.05)。伊犁州、阿克苏地区、喀什地区孕早期妇女低甲状腺素血症的检出率分别为13.9%(5/36)、3.2%(1/31)和0(0/33),地区间比较差异有统计学意义(P=0.036);孕中期妇女亚临床甲状腺功能亢进症检出率依次为0(0/35)、0(0/40)、17.6%(6/34),地区间比较差异有统计学意义(P=0.001)。结论3个地区妊娠期妇女尿碘水平符合各自补碘策略下的碘营养分布,喀什地区妊娠期妇女在口服碘油丸后,目前呈现碘过量状态;同时,喀什地区妊娠期妇女血清FT_(3)、FT_(4)和TSH水平受到碘营养水平的影响。对妊娠期妇女实施强化补碘措施虽是科学有效的,但仍需进一步研究口服碘油丸的适宜度,保证妊娠期妇女处于碘营养适宜水平。

Objective To evaluate the effect of oral iodized oil pills on iodine nutrition and thyroid function of pregnant women in Xinjiang Uygur Autonomous Region(Xinjiang).Methods From May to July 2017,one county was selected from Ili Prefecture without taking iodized oil pills,Aksu Prefecture taking iodized oil pills once a year,and Kashgar Prefecture taking iodized oil pills twice a year in Xinjiang as survey sites,respectively;100 pregnant women(evenly distributed in early,middle and late pregnancy)were selected from each survey county,the general data,urine and blood samples were collected,and urinary iodine and thyroid function indicators[free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyrotropin(TSH),anti thyroglobulin antibody(TgAb),and anti thyroid peroxidase antibody(TPOAb)]were tested.Results A total of 308 pregnant women were investigated,and 289 were finally included in the analysis,with an average age of 25 years;the body mass index(BMI)was(22.69±3.07)kg/m^(2).The occupation distribution was mainly farmer,accounting for 93.77%(271/289);most of them had junior high school education or below,accounting for 71.97%(208/289).The median urinary iodine of early,middle and late pregnant women in Kashgar Prefecture was 712.87,604.50 and 656.23μg/L,respectively,which were in iodine excess state.The iodine nutrition level of early pregnant women in Ili Prefecture and Aksu Prefecture was in iodine super suitability state,and the iodine nutrition level of middle and late pregnant women was in the iodine suitability state.The difference of median urinary iodine in early,middle and late pregnancy women between different regions was statistically significant(Z=53.02,49.60,44.66,P<0.001).In addition,the urinary iodine of women in Kashgar Prefecture during each pregnancy period was significantly higher than that in Ili Prefecture and Aksu Prefecture(P<0.05).There were statistically significant differences in the levels of FT_(3) among women in early pregnancy,FT_(4) and TSH among women in middle pregnancy between different regions(F=4.59,10.92,Z=8.61,P<0.05 or<0.001).Among them,the level of FT_(3) in early pregnancy in Kashgar Prefecture was lower than that in Ili Prefecture(P<0.05);the level of FT_(4) in Kashgar Prefecture during middle pregnancy was higher than that in Ili Prefecture,and the level of TSH was lower than that in Ili Prefecture(P<0.05).There was no significant difference in TgAb positive rate,TPOAb positive rate and double antibody positive rate of early,middle and late pregnant women between different regions(P>0.05).The detection rates of hypothyroxinemia in early pregnant women in Ili Prefecture,Aksu Prefecture and Kashgar Prefecture were 13.9%(5/36),3.2%(1/31)and 0(0/33),respectively,and there was a statistically significant difference between different regions(P=0.036).The detection rates of subclinical hyperthyroidism in middle pregnant women were 0(0/35),0(0/40),17.6%(6/34),respectively,and there was a statistically significant difference between different regions(P=0.001).Conclusions The results of urinary iodine in the three regions are in line with the iodine nutrition distribution under their respective iodine supplement strategies.Pregnant women in Kashgar Prefecture present iodine excess status after taking iodized oil pills;at the same time,the serum FT_(3),FT_(4) and TSH levels of pregnant women in Kashgar Prefecture are affected by iodine nutrition levels.Although it is scientific and effective to implement the intensified iodine supplement measures for pregnant women,it is still necessary to further study the suitability of oral iodine oil pills to ensure that pregnant women are at an suitability iodine nutrition level.