淄博市不同孕期女性尿碘水平及甲状腺功能状况调查

发布时间：2018-08-21 08:29

【摘要】：目的:研究淄博市孕期女性碘营养状况、不同妊娠阶段甲状腺功能变化及妊娠期甲状腺疾病种类分布,制定淄博地区孕期女性特异的血清甲状腺功能指标参考值,为孕期实施碘营养监测及甲状腺功能筛查提供理论依据。方法:选取2013年3月至2014年2月在淄博市妇幼保健院门诊行产检的1268例孕妇。采用化学发光法测定妊娠早、中、晚期孕妇的血清促甲状腺素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(即TPOAb)。采用酸消化砷一铈接触法测定尿碘水平。结果:1268例孕妇中,孕早、中、晚期尿碘中位数分别为100.3、110.5、105.2,孕早期尿碘水平最低,孕中期尿碘中位数高于孕晚期。孕期FT4参考值范围设定:孕早期12.50~25.10pmmol/L,孕中期12.10~23.10pmmol/L,孕晚期11.20~20.16pmmol/L;孕期TSH参考值范围设定:孕早期0.15~3.20m IU/L,孕中期0.40~3.90m IU/L,孕晚期0.50~4.12m IU/L。正常尿碘组、低尿碘组及高尿碘组的FT4、TSH均在正常范围,高尿碘组、低尿碘组的FT4均低于正常尿碘组(P0.05),3组的TSH值比较差异均无统计学意义(P0.05)。1268例孕妇中,甲状腺功能异常者368例(29.02%),孕早期的甲状腺功能异常发生率高于孕中期及孕晚期,甲状腺功能异常以亚临床型甲减为主,其次为单纯TPOAb阳性。结论:淄博市孕期女性碘营养缺乏严重,需定期监测尿碘水平。随着孕周的增加,FT4值逐渐下降,而TSH值则呈上升趋势;尿碘异常早期可引起FT4的改变,对TSH影响不大。建议在妊娠早期对有甲状腺疾病危险因素的女性积极筛查甲状腺功能。
[Abstract]:Objective: to study the iodine nutrition status of pregnant women, the changes of thyroid function and the distribution of thyroid diseases during pregnancy in Zibo city, and to establish the reference value of serum thyroid function index for pregnant women in Zibo city. To provide theoretical basis for iodine nutrition monitoring and thyroid function screening during pregnancy. Methods: 1268 pregnant women in Zibo Maternal and Child Health Hospital from March 2013 to February 2014 were selected. Determination of serum thyrotropin (TSH), free thyroxine (FT4) and thyroid peroxidase antibody (TPOAb).) in pregnant women of early, middle and late pregnancy by chemiluminescence assay Urinary iodine level was determined by acid digestion arsenic-cerium contact method. Results among 1268 pregnant women, the median of urinary iodine in early, middle and late pregnancy was 100.3110.5105.2, respectively. The level of urinary iodine in the first trimester of pregnancy was the lowest, and the median of urinary iodine in the second trimester was higher than that in the third trimester. The reference range of FT4 during pregnancy was 12.50 卤25.10 mmol / L, 12.1010 卤23.10 mmol / L, 11.20 卤20.16 mmol / L in the second trimester, 0.153.20 m / L in early pregnancy, 0.403.90 m / L in middle pregnancy, 0.50 卤4.12 m / L in third trimester. The FT4 of normal urine iodine group, low urine iodine group and high urine iodine group were all in normal range. The FT4 of high urinary iodine group and low urine iodine group were lower than that of normal urine iodine group (P0.05). There was no significant difference in TSH value among 1268 pregnant women (P0.05). 368 cases (29.02%) had abnormal thyroid function. The incidence of thyroid dysfunction in the early pregnancy was higher than that in the second and third trimester. Subclinical hypothyroidism was the main type of thyroid dysfunction, followed by simple TPOAb positive. Conclusion: iodine deficiency of pregnant women in Zibo city is serious, and urine iodine level should be monitored regularly. With the increase of gestational age, FT _ 4 value decreased gradually, while the TSH value showed an upward trend, and early urinary iodine abnormality caused the change of FT4, but had little effect on TSH. It is recommended that women with thyroid disease risk factors be actively screened for thyroid function in early pregnancy.
【作者单位】：淄博市妇幼保健院产科;淄博市中心医院整形外科;
【分类号】：R715.3

【参考文献】