高水碘地区孕妇碘营养及其甲状腺功能的研究

发布时间：2018-07-26 12:25

【摘要】： 目的：探讨高水碘地区孕妇妊娠各期甲状腺功能的特征。方法：在高水碘地区选天津市静海县妇幼保健院(饮水碘大于200μg/L)和适碘地区选天津市和平区妇幼保健院(饮水碘10μg/L,碘盐普及率90%,居民尿碘中位数100μg/L)作为调查点。在妇幼保健院门诊,选取妊娠早、中、晚期孕妇各50名,非孕妇女50名,采集血样用化学发光法检测甲状腺功能。同时收集日问随意一次尿样、家中饮用水样和食用盐样,尿碘测定采用砷铈催化分光光度法,水碘测定采用快速定量检测试剂盒,盐碘测定采用硫代硫酸钠滴定法。结果：(1)孕妇与非孕妇女甲状腺功能的差异在不同地区存在相同点和不同点(2)甲状腺抗体阴性孕妇中,高水碘地区孕早期妇女血清TT4、TT3、FT4低于适碘地区(111.97nmol/L vs 140.46 nmol/L,Z=3.56,P0.01；1.86 nmol/L vs 2.26 nmol/L,Z=2.35,P0.05；14.13 pmol/L vs 16.32 pmol/L,Z=5.14,P0.01)；孕中期妇女血清FT4、FT3低于适碘地区(11.98 pmol/L vs 14.30 pmol/L,Z=5.75, P0.01；4.04 pmol/L vs 4.32 pmol/L,Z=2.76,P 0.01)；孕晚期妇女血清TT3.TSH高于适碘地区(2.88 nmol／L vs 2.70 nmol／L,Z=一2.27,P0.05；2.37 mU/L vs 1.75 mU/L,Z=-2.70,P0.01).(3)高水碘地区孕妇家中饮水碘和孕妇尿碘高于适碘地区(205.57μg/L vs8.22μg/L,Z=-14.71,P10.01；305.91μg/L vs 191.86μg/L,Z=-5.30,P0.01),家电盐碘低于适碘地区(26.5mg/kg vs 31.7 mg/kg, Z=5.86,P0.01).以上差异有统计学显著性(41)在健康且没有邦状腺病史的被调查孕妇中,妊娠各期甲状腺抗体的阳性率在高水碘和适碘地区之间没有显著差异(孕早期10.20% vs 10.64%；孕中期14%vs 9.52%；孕晚期4% vs 7.69% P0.05)。(5)孕妇的FT4与饮水碘、尿碘、尿碘／肌酐和TSH呈负相关关系,非孕妇女的FT4与饮水碘、尿碘／肌酐和TSH呈负相关关系。结论：高水碘地区孕妇妊娠各期甲状腺功能不同于适碘地区,对高水碘地区孕妇应加强孕期(特别是孕早、中期)甲状腺功能监测。
[Abstract]:Objective: to study the thyroid function of pregnant women in high water iodine area. Methods: women's and children's health care centers (drinking iodine > 200 渭 g / L) in Jinghai County, Tianjin, and MCH Health Care Hospital (10 渭 g / L) in Heping District of Tianjin (drinking water iodine 10 渭 g / L, iodized salt penetration rate 90, median urinary iodine 100 渭 g / L) were selected as investigation points in high water iodine area. In the outpatient clinic of MCH, 50 pregnant women and 50 non-pregnant women were selected for early, middle and late pregnancy respectively. Blood samples were collected to detect thyroid function by chemiluminescence method. At the same time, random daily urine samples, domestic drinking water samples and edible salt samples were collected. Urinary iodine was determined by arsenic and cerium catalytic spectrophotometry, water iodine was determined by rapid quantitative detection kit, salt iodine was determined by sodium thiosulfate titration. Results: (1) there were similarities and differences in thyroid function between pregnant and non-pregnant women. (2) among the pregnant women with negative thyroid antibody, the level of TT4TT3FT-4 was lower than that of iodine deficient women (111.97nmol/L vs 140.46 nmol / L), P 0.011.86 nmol/L vs 2.26 nmol / L ~ (2.35) nmol 路L ~ (-1) (P = 0.05). Serum FT _ 4 FT _ 3 of women in the second trimester of pregnancy was lower than that in the regions with iodine deficiency (11.98 pmol/L vs 14.30 mmol / L, P 0.01L / L 4.04 pmol/L vs 4.32 mmol / L ~ (2.76) pmol/L vs 2.32 mmol / L ~ (2.76) pmol/L, P ~ (0.01), and the level of serum FT _ (4) FT _ (3) was higher in the second trimester of pregnancy (2.88 nmol/L vs 2.70 nmol 路L ~ (-1) Z = 2.27 nmol 路L ~ (-1) P ~ (0.05). 2.37 mU/L vs 1.75 MU / L Z-2.70). (3) iodine in drinking water and urine iodine of pregnant women in high water iodine area was higher than that in normal iodine area (205.57 渭 g / L vs8.22 渭 g / L vs 191.86 渭 g / L Z-5.30 渭 g / L, 26.5mg/kg vs 31.7 mg / kg, Z5.86 渭 g / L, P0.01). The positive rate of thyroid antibody in pregnant women with no history of state gland was not significantly different between the areas with high iodine and iodine (10.20% vs 10.64 in the first trimester), 14%vs 9.52 in the second trimester of pregnancy, and the positive rate of thyroid antibody in the pregnant women with no history of state gland disease was significantly higher than that of the normal pregnant women (10.20% vs 10.64 in the first trimester). There was a negative correlation between FT4 and iodine, urinary iodine / creatinine and TSH in pregnant women in the third trimester (P0.05). (5 vs 7.69%, P 0.05). The FT4 in non-pregnant women was negatively correlated with iodine in drinking water, urinary iodine / creatinine and TSH. Conclusion: the thyroid function of pregnant women in high water iodine area is different from that in iodine deficient area. The monitoring of thyroid function should be strengthened during pregnancy, especially in the first and second trimester of pregnancy.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R188

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