鲁西南地区孕晚期孕妇的碘营养状态及其对孕妇心电活动的影响

The iodine nutritional status of pregnant women in the third trimester in the Southwest of Shandong Province and its impact on their cardiac electrical activity

目的了解鲁西南地区孕晚期孕妇的碘营养状态,分析其对孕妇心电活动的影响,为孕期科学补碘提供依据。方法2021年1月至2022年6月,采用整群随机抽样方法行横断面调查,根据纳入排除标准,在鲁西南3个地市的3所三级医院分别选取孕晚期孕妇200例,设为孕晚组(n=600);分别选取非孕期女性100例,设为对照组(n=300)。采用砷铈催化分光光度法检测受试者的尿碘含量,依据尿碘中位数(MUIC)将孕晚组孕妇再分组:碘缺乏亚组(G1亚组,MUIC<150μg/L),碘过量亚组(G2亚组,MUIC≥500μg/L),碘适量亚组(G3亚组,150μg/L≤MUIC<500μg/L)。采用化学发光免疫分析法检测受试者的血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)水平。使用12导联体表心电图机检测受试者的心电指标。结果鲁西南3个地市间孕晚组孕妇、对照组非孕期女性尿碘水平比较差异均无统计学意义(H=3.63、3.27,均P>0.05)。孕晚组中,G1、G2、G3亚组孕妇构成比分别为27.67%(166/600)、6.83%(41/600)、65.50%(393/600),各亚组和对照组间孕妇尿碘水平比较差异有统计学意义(H=11.56,P<0.001)。G2亚组血清FT3、FT4水平均低于G1和G3亚组(均P<0.001),但3个亚组血清TSH水平比较,差异均无统计学意义(均P>0.05)。G1、G2、G3亚组和对照组ECG正常率分别为38.55%(64/166)、41.46%(17/41)、92.37%(363/393)、95.33%(286/300),各组间比较差异有统计学意义(χ^(2)=461.25,P<0.001),G1、G2亚组ECG正常率均低于对照组(均P<0.001)。孕晚组的异常ECG以短P-R间期、ST-T改变最为多见。结论鲁西南地区孕晚期孕妇碘缺乏、碘过量等碘营养状态异常发生率较高,由此所致的短P-R间期、ST-T改变等心律失常较为多见,应加强孕期碘营养状态和ECG的监测,及时调整补碘等干预策略。

Objective To study the iodine nutritional status of pregnant women in the third trimester in the Southwest of Shandong Province,analyze its impact on their cardiac electrical activity,and provide a basis for scientific supplementation of iodine during pregnancy.Methods From January 2021 to June 2022,a cross-sectional survey was conducted using cluster random sampling method.According to the inclusion and exclusion criteria,200 pregnant women in the third trimester were selected from 3 tertiary hospitals in three cities in the Southwest of Shandong Province,and were divided into the third trimester group(n=600),and 100 non-pregnant women were selected as the control group(n=300).The urinary iodine content was detected by arsenic-cerium catalytic spectrophotometry,and the pregnant women in the third trimester group were subdivided into iodine deficiency subgroup[G1 subgroup,median urinary iodine(MUIC)<150μg/L]based on the MUIC,iodine excess subgroup(G2 subgroup,MUIC≥500μg/L)and moderate iodine subgroup(G3 subgroup,150μg/L≤MUIC<500μg/L).Chemiluminescence immunoassay was used to measure the serum levels of thyroid-stimulating hormone(TSH),free thyroxine(FT4)and free triiodothyronine(FT3).The cardiac electrical indexes were detected by a 12-lead surface electrocardiogram(ECG)machine.Results There was no statistically significant difference in urinary iodine levels between pregnant women in the third trimester group and non-pregnant women in the control group among the 3 tertiary hospitals in the Southwest of Shandong Province(H=3.63,3.27,P>0.05).In the third trimester group,the proportion of pregnant women in the G1,G2 and G3 subgroups was 27.67%(166/600),6.83%(41/600)and 65.50%(393/600),respectively.There was a statistically significant difference in urinary iodine levels between the subgroups and the control group(H=11.56,P<0.001).The serum FT3 and FT4 levels in the G2 subgroup were lower than those in the G1 and G3 subgroups(P<0.001),but there was no statistically significant difference in serum TSH levels among the three subgroups(P>0.05).The normal rates of ECG in the G1,G2,G3 subgroups,and the control group were 38.55%(64/166),41.46%(17/41),92.37%(363/393),and 95.33%(286/300),respectively.The difference between the groups were statistically significant(χ^(2)=461.25,P<0.001),the normal rate of ECG in the G1 and G2 subgroups was lower than that in the control group(P<0.001).Short P-R intervals and ST-T changes were the most common abnormal ECG in the third trimester group.Conclusions The incidence of iodine deficiency,iodine excess,and other abnormal iodine nutritional status in pregnant women in the third trimester of the Southwest of Shandong Province is relatively high.Short P-R intervals,ST-T changes,and other arrhythmia caused by this are more common.It is necessary to strengthen monitoring of iodine nutritional status and ECG during pregnancy,and adjust intervention strategies such as iodine supplementation in a timely manner.