江苏高碘和适碘地区孕妇甲状腺疾病流行病学调查

发布时间：2018-04-21 18:41

本文选题：高碘 + 适碘　；参考：《南京医科大学》2014年博士论文

【摘要】：第一部分江苏高碘和适碘地区孕妇不同孕期的甲状腺疾病患病特征调查背景妊娠合并甲状腺疾病在临床上十分常见,妊娠本身可影响甲状腺疾病的发展,未得到控制的甲状腺疾病亦可影响正常的妊娠结局。由于甲状腺激素保证是胎儿神经系统发育的重要激素,故在妊娠期发生甲状腺功能改变或亚临床甲状腺功能异常,不仅会导致不良妊娠结局,亦可影响后代智力发育和认知功能,甚至引起后代代谢性疾病发病风险增高,如糖尿病等。目的为了了解高碘和适碘地区孕妇甲状腺疾病患病情况,本课题组自2008年8月至2010年3月在江苏省徐州市丰县和凌城两地对不同妊娠期的孕妇进行了甲状腺疾病的筛查。对象和方法本研究的对象来自高碘区丰县妇幼保健院和适碘区凌城中心医院进行早期妊娠确认的当地孕妇,共纳入396名17-40岁的早孕女性,进行问卷调查、体格检查、留取血样进行甲状腺功能及自身抗体测定,相关数据录入Epidata数据库,利用STATA10.0软件进行统计学分析。结果两地孕妇年龄无差别,各孕期测得的高血压发生率和体重均无显著差异,妊娠早期轻度呕吐反应情况亦相似,两地孕妇的一般资料具有同质性。高碘地区孕妇妊娠早期的FT3、FT4、TT4显著低于适碘地区,TSH显著高于适碘地区,孕中期高碘地区孕妇的TT4显著低于适碘地区,其余甲状腺功能相关指标在两地孕妇中无差异。两地孕妇的FT3、FT4随孕周增加而下降。在整个孕期中,两地孕妇甲状腺疾病总体患病率为62.44%(246/394),疾病种类包括甲状腺机能亢进症(甲亢),甲状腺机能减退症(甲减),亚临床甲亢,亚临床甲减,第T4血症和TPOAb阳性。其中,高碘地区孕妇各类甲状腺疾病的患病率为67.45%(201/298),而适碘地区为46.88%(45/96),χ,2为13.106,P值为0.000,提示高碘地区孕妇甲状腺疾病患病率显著高于适碘地区,主要体现在孕早期。在妊娠早期和中期,各类甲状腺疾病患病率在两地孕妇中无差别,孕晚期适碘地区孕妇甲减患病率显著高于高碘地区。江苏省高碘地区孕妇妊娠早期甲状腺功能参考范围为FT33.29-5.99pmol/L, FT414.09-21.62pmol/L, TT468.97-197.03nmol/L, TSH0.12-2.40μIU/ml。用正常人群参考范围作为诊断标准时,在诊断甲减、亚临床甲减和低T4血症时敏感性均显著低于妊娠特异性参考范围,在妊娠早期体现特别显著。以TT4代替FT4作为诊断低T4血症的指标时,其诊断敏感性偏低。结论高碘地区孕妇甲状腺疾病总体患病率显著高于适碘地区,妊娠早期高碘地区孕妇甲状腺疾病的患病率高于适碘地区,但差异无统计学差异。用正常人群甲状腺功能参考范围诊断妊娠甲状腺疾病会遗漏大部分甲状腺功能不足的孕妇,特别是妊娠早期。TT4诊断低T4血症的效能低于FT4。第二部分南京地区孕期特异性甲状腺功能正常参考值范围的研究目的确立南京地区女性孕期特异性甲状腺功能正常参考值范围,比较新旧参考值范围下孕期各甲状腺功能异常患病情况的差异。方法选取2012年7月至11月孕检的育龄期妇女,其中,孕早期288例、孕中期255例、孕晚期262例,另设非妊娠育龄女性282例为对照组,受试者签署知情同意书,填写调查问卷表,留取受试者清晨血、尿标本,利用化学发光法测甲状腺功能(TSH、FT3、FT4、TT3、TT4, TPO-Ab),砷铈催化法定量测量尿碘,四类人群分别抽取其中TPOAb阴性,碘营养正常,既往无甲状腺疾病个人史、家族史,无雌激素、甲状腺激素、抗甲状腺药物等用药史,无严重肝功能、肾功能、心功能异常病的受试者各132例、124例、127例和125例,算得甲状腺功能各指标2.5%-97.5%可信区间,比较新旧参考值范围下孕期各甲状腺功能异常患病情况差异。结果南京地区孕期特异性甲状腺功能正常参考值范围为：孕早期,TSH：0.02-3.78mIU/1, FT4:13.93-26.49pmol/1, TT4:103.39-319.43nmol/1;孕中期,TSH:0.47-3.89mIU/1, FT4:12.33-19.33pmol/1, TT4:92.28-234.88nmol/1;孕晚期：TSH:0.55-4.91mIU/1, FT4:11.38-19.21pmol/1, TT4:83.54-258.12nmol/1；对照组:TSH:0.76-4.88mIU/1, FT4:13.04-22.18pmol/1, TT4:75.70-175.76nmol/1,使用ATA推荐的孕期TSH参考范围,南京地区亚临床甲状腺功能减退症检出率为12.42%,甲状腺功能减退症检出率为0.50%,亚临床甲状腺功能亢进症检出率为0.99%,甲状腺功能亢进症检出率为1.61%,低T4血症检出率为0.99%,TPO-Ab阳性检出率为11.80%；以本研究所得新标准为正常范围,上述各类型甲状腺功能异常的检出率则分别变为1.99%、0.25%、1.61%、0.37%、8.81%,相比之下,亚临床甲状腺功能减退、甲状腺功能亢进症检出率较下降,而低T4血症检出率则升高。结论孕期特异性甲状腺功能正常参考值范围较ATA推荐标准存在差异,各地区实验室需建立独立的孕期特异性甲状腺功能正常参考值范围。
[Abstract]:Part one
Prevalence of thyroid diseases in pregnant women with iodine deficiency and iodine deficiency in Jiangsu
Background pregnancy with thyroid disease is very common clinically. Pregnancy itself can affect the development of thyroid diseases. Uncontrolled thyroid diseases can also affect normal pregnancy outcomes. Thyroid function changes or subclinical armour may occur during pregnancy due to thyroid hormone assurance as an important hormone in the development of the fetal nervous system. Abnormal glandular function can not only lead to bad pregnancy outcome, but also affect the intellectual development and cognitive function of offspring, and even increase the risk of metabolic diseases in future generations, such as diabetes.
Objective in order to understand the prevalence of thyroid diseases in pregnant women in high iodine and iodized areas, the subjects were screened from August 2008 to March 2010 in Fengxian County and Lingcheng, Xuzhou, Jiangsu, on the thyroid diseases of pregnant women in different pregnancy periods.
Object and methods: the subjects of this study were from the local pregnant women of Fengxian County maternal and child health care hospital of high iodine district and Lingcheng Central Hospital for early pregnancy confirmation. A total of 396 women aged 17-40 years of early pregnancy were included in the study. A questionnaire survey, physical examination, blood samples were taken to determine the thyroid function and autoantibodies. The related data were recorded in the Epidata database. STATA10.0 software was used for statistical analysis.
Results there was no difference in age between the two pregnant women. There was no significant difference in the incidence of high blood pressure and weight during pregnancy. The mild vomiting reaction in early pregnancy was similar. The general data of pregnant women in both places were homogeneity. The FT3, FT4 and TT4 in the early pregnancy of pregnant women in high iodine region were significantly lower than those in the area of iodine, and the TSH was significantly higher than that in the area of iodide, high iodine in the middle of pregnancy. The TT4 of pregnant women in the region was significantly lower than that in the area of iodine. The other thyroid function related indexes were not different among the two pregnant women. The FT3 and FT4 decreased with the increase of gestational age in both pregnant women. In the whole pregnancy, the overall prevalence rate of thyroid disease was 62.44% (246/394) in two pregnant women, and the type of disease included hyperthyroidism (hyperthyroidism) and thyroid function. Hypothyroidism (hypothyroidism), subclinical hyperthyroidism, subclinical hypothyroidism, subclinical hypothyroidism, T4 and TPOAb positive. Among them, the prevalence of thyroid diseases in pregnant women in high iodine areas was 67.45% (201/298), while iodine was 46.88% (45/96), Chi, 2, 13.106 and 0, indicating that the prevalence of thyroid disease in pregnant women in high iodine areas was significantly higher than that in the area of iodine. In the early and mid trimester of pregnancy, there was no difference in the prevalence of all kinds of thyroid diseases among the two pregnant women. The incidence of hypothyroidism in pregnant women in the late pregnant areas was significantly higher than that in the high iodine areas. The thyroid function reference range of pregnant women in high iodine areas in Jiangsu province was FT33.29-5.99pmol/L, FT414.09-21.62pmol/L, TT468.97-197.03nmol/L, TS. The sensitivity of H0.12-2.40 mu IU/ml. to the diagnosis of hypothyroidism, subclinical hypothyroidism and hypothyroidism in the diagnosis of hypothyroidism, subclinical hypothyroidism and hypothyroidism was significantly lower than that of pregnancy specific reference, especially in the early pregnancy. The sensitivity of TT4 to the diagnosis of low T4 was lower than that of FT4 as an indicator of FT4 for the diagnosis of hypothyroidism.
Conclusion the overall prevalence rate of thyroid diseases in pregnant women in high iodine areas is significantly higher than that in the area of iodine. The prevalence of thyroid diseases in pregnant women with high iodine in early pregnancy is higher than that in the area of iodine - suitable, but there is no difference in the difference. In women, especially in early pregnancy, the efficacy of.TT4 in diagnosing low T4 is lower than that in FT4..
The second part
Study on the reference range of specific thyroid function during pregnancy in Nanjing area
Objective to establish the normal range of normal thyroid function reference values for women during pregnancy in Nanjing, and to compare the differences of the abnormal thyroid function in the pregnant period of the new and old reference values.
Methods the women of childbearing age from July 2012 to November were selected, including 288 cases of early pregnancy, 255 cases in the middle of pregnancy, 262 cases in the late pregnancy, and 282 cases of non pregnant women of childbearing age as the control group. The subjects signed the informed consent book, filled out the questionnaire, left the subjects in the morning blood, urine specimens, and measured the thyroid function by chemiluminescence (TSH, FT3, FT4, TT). 3, TT4, TPO-Ab), the arsenic cerium catalysis method was used to measure urine iodine quantitatively. The four groups were divided into 132 cases, 132 cases, 124 cases, 127 cases and 125 of the subjects without serious liver function, renal function, and heart function disorder. The 2.5%-97.5% confidence interval of each index of thyroid function was calculated, and the difference of thyroid function abnormality during pregnancy was compared between the old and new reference values.
Results the normal reference value of normal thyroid function during pregnancy in Nanjing was: early pregnancy, TSH:0.02-3.78mIU/1, FT4:13.93-26.49pmol/1, TT4:103.39-319.43nmol/1; mid trimester, TSH:0.47-3.89mIU/1, FT4:12.33-19.33pmol/1, TT4:92.28-234.88nmol/1; TSH:0.55-4.91mIU/1, FT4:11.38-19.21pmol/1, TT4:83.54-258. in the late pregnancy. 12nmol/1; the control group: TSH:0.76-4.88mIU/1, FT4:13.04-22.18pmol/1, TT4:75.70-175.76nmol/1, using the TSH reference range recommended by ATA, the detection rate of subclinical hypothyroidism in Nanjing region was 12.42%, the detection rate of hypothyroidism was 0.50%, the detection rate of hyperthyroidism was 0.99%, thyroid function was 0.99%. The detection rate of hyperthyroidism was 1.61%, the detection rate of hypothyroidemia was 0.99%, and the positive rate of TPO-Ab was 11.80%. The new standard of this study was normal, and the detection rates of all types of thyroid dysfunction were 1.99%, 0.25%, 1.61%, 0.37%, 8.81% respectively, compared with subclinical hypothyroidism and detection of hyperthyroidism. The rate of T4 was decreased, while the low detection rate of hypoemia was increased.
Conclusion there is a difference in the range of normal reference value of normal thyroid function during pregnancy compared with that of the ATA recommended standard, and the regional laboratory needs to establish an independent normal range of reference values for specific thyroid function during pregnancy.

【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R714.256

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