妊娠早、中期妇女尿碘/尿肌酐比值与亚临床甲状腺功能减退症合并自身抗体阳性的相关性

Correlation Between Urinary Iodine/Creatinine Ratio and Subclinical Hypothyroidism with Positive Autoantibodies in Early and Middle Pregnancy

目的:探讨妊娠早、中期妇女尿碘/尿肌酐比值(UIC/UCr)与亚临床甲状腺功能减退症(SCH)合并自身抗体阳性的相关性。方法:回顾性选取2018年1月—2021年6月贵阳市第一人民医院进行孕检的妊娠早、中期SCH孕妇作为研究对象,依据甲状腺自身抗体检测结果,将其分为:妊娠早、中期甲状腺抗体阳性组;妊娠早、中期甲状腺抗体阴性组;另选取同时期进行检查的妊娠早、中期健康孕妇作为对照组,每组各100例,共计300例,观察甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、UIC/UCr、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)等指标。结果:妊娠早期三组孕妇一般临床资料比较,差异无统计学意义(P>0.05),妊娠中期三组孕妇收缩压(SBP)、舒张压(DBP)比较,差异有统计学意义(F=7.024、11.357,P<0.05);UIC/UCr分析显示,与其他组别比较,妊娠早、中期阳性组孕妇均值和百分位分布数值最低;甲状腺激素及抗体水平比较,除FT3和FT4外,妊娠早、中期阳性组孕妇UIC/UCr、TPOAb、TgAb和TSH水平与健康组和阴性组比较,差异有统计学意义(F=71.710、279.102、130.017、275.949、22.991、220.702、288.882、184.459,P<0.001);相关性分析结果显示,UIC/UCr与TSH、TgAb、TPOAb水平呈负相关;多元线性回归分析结果发现,UIC/UCr、TSH是TPOAb、TgAb的主要影响因素。结论:妊娠早、中期SCH合并自身抗体阳性孕妇,UIC/UCr显著偏低且与TPOAb、TgAb关系密切,建议在临床中加强UIC/UCr指标观察。

Objective:To investigate the correlation between urinary iodine/creatinine ratio(UIC/UCr)and subclinical hypothyroidism(SCH)with positive autoantibodies in early and middle pregnancy women.Methods:The pregnant women with SCH in the early and middle trimester of pregnancy who underwent pregnancy examination in Guiyang First People’s Hospital from January 2018 to June 2021 were retrospectively selected as the research objects.According to the thyroid autoantibody test results,the research objects were divided into thyroid antibody positive group in the early and middle trimester of pregnancy,and the thyroid antibody negative group in the early and middle trimester of pregnancy.In addition,healthy women in the early and middle trimester of pregnancy who were examined at the same time were selected as the control group,with 100 cases in each group.Thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),UIC/UCr,thyroid stimulating hormone(TSH)and Free triiodothyronine(FT3),serum free thyroxine(FT4)and other indicators were observed.Results:There was no significant difference in the general clinical data between the early pregnancy groups(P>0.05),but there was significant difference in SBP and DBP between the mid pregnancy groups(F=7.024,11.357;P<0.05).UIC/UCr analysis showed that,compared with other groups,the mean value and percentile distribution of the positive group in the early and middle trimester of pregnancy were the lowest.The comparison of thyroid hormone and antibody levels showed that except FT3 and FT4,the UIC/UCr,TPOAb,TGAb and TSH levels in the positive group in the early and middle trimester of pregnancy were significantly different from those in the healthy group and the negative group(F=71.710,279.102,130.017,275.949,22.991,220.702,288.882,184.459;P<0.001).Correlation analysis showed that UIC/UCr was negatively correlated with TSH,TGAb and TPOAb.Multiple linear regression analysis showed that UIC/UCr and TSH were the main influencing factors of TPOAb and TGAb.Conclusion:UIC/UCr is significantly lower in women with Sch and positive autoantibodies in the early and middle trimester of pregnancy,and is closely related to TPOAb and TGAb.It is suggested to strengthen the observation of UIC/UCr in clinical practice.