不同孕期妇女尿碘水平与甲状腺功能相关性研究

目的研究全民食盐加碘后杭州市孕妇在不同孕期碘营养和甲状腺功能状况,为今后实施孕妇甲状腺功能监测的必要性和可能性提供依据。方法随机抽取杭州市5个调查点395人进行尿碘、水碘、盐碘、促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(FT4)实验室检测,采用酸消化砷-铈接触法测定尿碘、水碘,采用硫代硫酸钠直接滴定法测定盐碘,化学发光法测定TSH、FT3、FT4水平。统计学处理采用SPSS13.0统计软件,率的比较用χ2检验,P0.05为差异有统计学意义。结果①孕早、中、晚期妇女的尿碘中位数分别为170.3,170.2,162.4μg/L,均显著低于对照组(251.9μg/L,均P0.05);②孕中期妇女中FT4低于下限值者占8.7%,FT3低于下限值者占9.6%;孕晚期妇女中FT4低于下限值者占22.7%,FT3低于下限值者占17.5%;③孕晚期甲状腺激素指标异常的妇女尿碘值300μg/L者(36.6%)明显高于正常组(8.8%)(χ2=12.54,P=0.002)。结论①从群体的角度来看,杭州市孕妇的碘营养处于适宜水平;②建议在孕妇中开展尿碘监测,对于尿碘值150μg/L或300μg/L的孕妇要进行甲状腺功能的筛查。

Correlations of urinary iodine level and thyroid function in pregnant women

Objective To investigate the correlations of iodine nutrition status and thyroid function in pregnant women.Methods Three hundred and ninety-tive persons were randomly selected for laboratory testing to evaluate correlative index of iodine nutrition status and thyroid function after the application of universal salt iodization.The levels of iodine in urinary and tap water samples were measured by a spectrophotometer method.The concentration of salt iodine was measured by the method of iodometric titration with sodium subsulfite.The levels of thyroid-stimulating hormone（TSH）,free triiodothyronine（FT3）and free thyroxine（FT4）were tested by a chemistry radiation method.Results The median value of urinary iodine was 170.3 μg/L,170.2 μg/L,162.4 μg/L respectively in the women with the 1st,2nd and 3rd timester of pregnancy,which were all significantly lower than that in non-pregnant women（ 251.9 μg/L,all P〈0.05）.The lower level of FT4 and FT3 were observed in 8.7%（9/104）and 9.6%（10/104）of women with the 2nd trimester of pregnancy,and in 22.7%（22/97）and 17.5%（17/97）of women with the 3rd trimester of pregnancy,respectively.During the 3rd trimester of pregnancy,36.6%（15/41）of women with thyroid function abnormalities had urinary iodine level higher than 300 μg/L,which was significantly higher than that in those with normal thyroid function（P〈0.05）.Conclusion The pregnant women have good nutritional status of iodine in Hangzhou.The results suggested the importance of thyroid function evaluation for pregnant women with urinary iodine levels lower than 150 μg/L or higher than 300 μg/L.