碘过量对孕妇及新生儿甲状腺功能的影响
发布时间：2018-09-07 07:06
【摘要】：目的1.了解高水碘地区河北省沧州市海兴县及适碘地区天津市妊娠晚期孕妇的碘营养状况。2.掌握两地区孕妇及新生儿的甲状腺功能及甲状腺自身免疫功能。3.探讨过量碘摄入与甲状腺功能、甲状腺自身免疫功能的关系,为高碘防治工作提供理论依据。4.探讨不同碘水平摄入对新生儿生长发育的影响。 方法1.根据水源性高碘地区划定标准及沧州市疾病预防控制中心的水碘监测数据,选择海兴县为高碘地区,并以地理位置毗邻、基本消除碘缺乏的天津市为适碘地区。2.分别在海兴县医院和天津市中心妇产科医院收集18～45岁的待产孕妇,纳入标准为无内分泌疾病及其他自身免疫性疾病、无心脏病及家族遗传病等、在当地居住5年以上,饮食习惯无特殊、孕期未使用碘剂。3.记录入选对象的基本资料,签订知情同意书。4.采集孕妇中段尿样、静脉血及其新生儿脐带血,采用砷-铈催化分光光度法测定孕妇尿碘水平,化学免疫发光法测定血清FT3、FT4和sTSH水平,放射免疫法测定TPOAb和TGAb水平。 结果1.高碘地区210名孕妇和适碘地区174名孕妇的尿碘中位数分别为1240.70μg/L和217.06μg/L,分别属于碘过量和碘营养适宜状态。2.高碘地区孕妇和新生儿的血清FT3、sTSH水平高于适碘地区孕妇和新生儿,FT4水平低于适碘地区孕妇和新生儿(P0.05)。3.高碘地区孕妇甲状腺疾病总患病率尤其是亚甲减患病率高于适碘地区孕妇(P0.05)；高碘地区新生儿血清sTSH水平分布与适碘地区新生儿相比,偏向高值分布(P0.05)。4.两地孕妇和新生儿的甲状腺自身抗体阳性率差异均无统计学意义(P0.05)。5.高碘地区患有甲状腺疾病尤其是亚甲减的孕妇,其自身及新生儿的甲状腺自身抗体阳性率与甲状腺功能正常者相比有升高趋势,但差异无统计学意义(P0.05),所产新生儿的血清sTSH偏向高值分布(P0.05)。6.同一地区不同甲状腺自身免疫功能孕妇及新生儿的血清甲状腺激素水平差异无统计学意义(P0.05)；相同甲状腺自身免疫状态者,高碘地区孕妇甲状腺疾病尤其是亚甲减患病率及新生儿血清FT3和sTSH水平均高于适碘地区、新生儿FT4水平低于适碘地区、抗体阳性孕妇血清FT3和sTSH水平高于适碘地区、FT4水平低于适碘地区、新生儿sTSH 5mIU/L比率低于适碘地区、sTSH10mIU/L比率高于适碘地区相应人群(P0.05)。7.同一地区孕妇尿碘水平分别与其新生儿的TGAb和TPOAb阳性率呈正相关(P0.05)。8.高水碘是孕妇甲状腺功能异常的危险因素,OR值为26.535(P0.05)；高水碘和妊娠结局异常是新生儿甲状腺功能异常(sTSH10mlU/L)的危险因素,OR值分别为10.738和3.179(P0.05)。9.高碘地区新生儿的出生体重和双顶径均大于适碘地区新生儿(P0.05),而股骨径小于适碘地区新生儿(P0.05)。高碘地区无甲状腺疾病的孕妇所产新生儿的双顶径大于患有甲状腺疾病尤其是亚甲减孕妇(P0.05)。 结论1.高碘地区被调查孕妇中大部分处于碘过量状态,提示应尽快改治水源,保证适宜的碘摄入量。2.过量碘摄入能增加孕妇患甲状腺疾病尤其是亚甲减的风险,并影响新生儿的甲状腺功能,使其TSH水平升高。3.孕妇碘过量合并甲状腺自身抗体阳性时对新生儿甲状腺功能影响较大。4.孕妇和新生儿的甲状腺自身抗体阳性率有随孕妇尿碘水平的增高而升高的趋势,应监测相关指标。5.应关注患有甲减或亚甲减孕妇所产新生儿的甲状腺功能及生长发育情况,高碘对新生儿生长发育的影响有待进一步研究。
[Abstract]:Objective 1. To understand the iodine nutritional status of pregnant women in late pregnancy in Haixing County of Cangzhou City and in Tianjin City where iodine is suitable. 2. To master thyroid function and thyroid autoimmune function of pregnant women and newborns in the two areas. 3. To explore the relationship between excessive iodine intake and thyroid function and thyroid autoimmune function, so as to provide a worker for prevention and treatment of iodine excess. To provide a theoretical basis for.4. to explore the effects of different iodine levels on the growth and development of newborns.
Methods 1. According to the demarcation standard of water-borne iodine excess area and the monitoring data of water iodine from Cangzhou Center for Disease Control and Prevention, Haixing County was selected as the high iodine area, and Tianjin, which is adjacent to Haixing County and basically eliminates iodine deficiency, was selected as the suitable iodine area. 2. Pregnancies aged 18-45 were collected from Haixing County Hospital and Tianjin Central Obstetrics and Gynecology Hospital respectively. Maternal inclusion criteria are no endocrine diseases and other autoimmune diseases, no heart disease and family hereditary diseases, living in the local for more than five years, no special dietary habits, no iodine during pregnancy. 3. Record the basic information of the selected subjects, sign informed consent. 4. Collection of urine samples of pregnant women, venous blood and umbilical cord blood of their newborns, using The urinary iodine level of pregnant women was determined by arsenic-cerium catalytic spectrophotometry, the serum FT3, FT4 and sTSH levels were determined by chemiluminescence method, and the levels of TPOAb and TGAb were determined by radioimmunoassay.
The median urinary iodine levels of 210 pregnant women in iodine excess area and 174 pregnant women in suitable iodine area were 1240.70 ug/L and 217.06 ug/L respectively, which were suitable for iodine excess and iodine nutrition. The prevalence of thyroid diseases, especially hypothyroidism, was higher in pregnant women with high iodine than in pregnant women with suitable iodine (P 0.05). The distribution of serum sTSH in pregnant women with high iodine was higher than that in neonates with suitable iodine (P 0.05). 4. There was no significant difference in the positive rate of thyroid autoantibodies between pregnant women and neonates with high iodine. The positive rate of thyroid autoantibodies in pregnant women with thyroid diseases especially hypothyroidism in Iodine-Excess areas was higher than that in normal thyroid function, but there was no significant difference (P 0.05). The serum sTSH of neonates in the same area tended to be higher (P 0.05). 6. There was no significant difference in serum thyroid hormone levels between pregnant women and neonates with immune function (P 0.05); the prevalence of thyroid diseases, especially hypothyroidism, and the levels of FT3 and sTSH in neonates in iodine-rich areas were higher than those in iodine-tolerant areas, and the levels of FT4 in neonates were lower than those in iodine-tolerant areas. The levels of FT3 and sTSH in maternal serum were higher than those in iodine-adapted areas, FT4 was lower than those in iodine-adapted areas, the ratio of sTSH 5 MIU/L in newborns was lower than that in iodine-adapted areas, and the ratio of sTSH 10 mIU/L was higher than that in iodine-adapted areas (P 0.05). 7. The urinary iodine levels of pregnant women in the same area were positively correlated with the positive rates of TGAb and TPOAb in newborns (P 0. The OR value was 26.535 (P 0.05), high water iodine and abnormal pregnancy outcome were the risk factors of thyroid dysfunction (sTSH 10 ml U/L), and the OR value was 10.738 and 3.179 (P 0.05). 9. The birth weight and biparietal diameter of neonates in high iodine area were higher than those in suitable iodine area (P 0.05), while the femoral diameter was smaller than that in suitable iodine area (P 0.05). Neonates (P 0.05). The biparietal diameter of newborns born to pregnant women without thyroid disease in high iodine area was larger than that of pregnant women with thyroid disease, especially hypothyroidism (P 0.05).
Conclusion 1. Most of the pregnant women in iodine excess areas were in iodine excess state, suggesting that the water source should be changed as soon as possible to ensure the appropriate iodine intake. 2. Excessive iodine intake can increase the risk of thyroid disease, especially hypothyroidism, and affect the thyroid function of the newborn, so that TSH level increased. 3. Pregnant women with iodine excess combined with thyroid self-control. The positive rate of thyroid autoantibodies in pregnant women and newborns increased with the increase of urinary iodine level of pregnant women. The related indicators should be monitored. 5. The thyroid function and growth of newborns born to pregnant women with hypothyroidism or hypothyroidism should be paid attention to. The effect of growth and development needs further study.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R151
本文编号：2227555
[Abstract]:Objective 1. To understand the iodine nutritional status of pregnant women in late pregnancy in Haixing County of Cangzhou City and in Tianjin City where iodine is suitable. 2. To master thyroid function and thyroid autoimmune function of pregnant women and newborns in the two areas. 3. To explore the relationship between excessive iodine intake and thyroid function and thyroid autoimmune function, so as to provide a worker for prevention and treatment of iodine excess. To provide a theoretical basis for.4. to explore the effects of different iodine levels on the growth and development of newborns.
Methods 1. According to the demarcation standard of water-borne iodine excess area and the monitoring data of water iodine from Cangzhou Center for Disease Control and Prevention, Haixing County was selected as the high iodine area, and Tianjin, which is adjacent to Haixing County and basically eliminates iodine deficiency, was selected as the suitable iodine area. 2. Pregnancies aged 18-45 were collected from Haixing County Hospital and Tianjin Central Obstetrics and Gynecology Hospital respectively. Maternal inclusion criteria are no endocrine diseases and other autoimmune diseases, no heart disease and family hereditary diseases, living in the local for more than five years, no special dietary habits, no iodine during pregnancy. 3. Record the basic information of the selected subjects, sign informed consent. 4. Collection of urine samples of pregnant women, venous blood and umbilical cord blood of their newborns, using The urinary iodine level of pregnant women was determined by arsenic-cerium catalytic spectrophotometry, the serum FT3, FT4 and sTSH levels were determined by chemiluminescence method, and the levels of TPOAb and TGAb were determined by radioimmunoassay.
The median urinary iodine levels of 210 pregnant women in iodine excess area and 174 pregnant women in suitable iodine area were 1240.70 ug/L and 217.06 ug/L respectively, which were suitable for iodine excess and iodine nutrition. The prevalence of thyroid diseases, especially hypothyroidism, was higher in pregnant women with high iodine than in pregnant women with suitable iodine (P 0.05). The distribution of serum sTSH in pregnant women with high iodine was higher than that in neonates with suitable iodine (P 0.05). 4. There was no significant difference in the positive rate of thyroid autoantibodies between pregnant women and neonates with high iodine. The positive rate of thyroid autoantibodies in pregnant women with thyroid diseases especially hypothyroidism in Iodine-Excess areas was higher than that in normal thyroid function, but there was no significant difference (P 0.05). The serum sTSH of neonates in the same area tended to be higher (P 0.05). 6. There was no significant difference in serum thyroid hormone levels between pregnant women and neonates with immune function (P 0.05); the prevalence of thyroid diseases, especially hypothyroidism, and the levels of FT3 and sTSH in neonates in iodine-rich areas were higher than those in iodine-tolerant areas, and the levels of FT4 in neonates were lower than those in iodine-tolerant areas. The levels of FT3 and sTSH in maternal serum were higher than those in iodine-adapted areas, FT4 was lower than those in iodine-adapted areas, the ratio of sTSH 5 MIU/L in newborns was lower than that in iodine-adapted areas, and the ratio of sTSH 10 mIU/L was higher than that in iodine-adapted areas (P 0.05). 7. The urinary iodine levels of pregnant women in the same area were positively correlated with the positive rates of TGAb and TPOAb in newborns (P 0. The OR value was 26.535 (P 0.05), high water iodine and abnormal pregnancy outcome were the risk factors of thyroid dysfunction (sTSH 10 ml U/L), and the OR value was 10.738 and 3.179 (P 0.05). 9. The birth weight and biparietal diameter of neonates in high iodine area were higher than those in suitable iodine area (P 0.05), while the femoral diameter was smaller than that in suitable iodine area (P 0.05). Neonates (P 0.05). The biparietal diameter of newborns born to pregnant women without thyroid disease in high iodine area was larger than that of pregnant women with thyroid disease, especially hypothyroidism (P 0.05).
Conclusion 1. Most of the pregnant women in iodine excess areas were in iodine excess state, suggesting that the water source should be changed as soon as possible to ensure the appropriate iodine intake. 2. Excessive iodine intake can increase the risk of thyroid disease, especially hypothyroidism, and affect the thyroid function of the newborn, so that TSH level increased. 3. Pregnant women with iodine excess combined with thyroid self-control. The positive rate of thyroid autoantibodies in pregnant women and newborns increased with the increase of urinary iodine level of pregnant women. The related indicators should be monitored. 5. The thyroid function and growth of newborns born to pregnant women with hypothyroidism or hypothyroidism should be paid attention to. The effect of growth and development needs further study.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R151
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