妊娠妇女尿碘与甲状腺功能异常的初步研究

目的研究妊娠早期妇女碘营养及甲状腺功能,为指导孕期妇女补碘提供依据。方法选取2013年6月至2014年1月在南方医科大学附属小榄医院产科门诊行常规产前检查的1 851例妊娠早期妇女作为研究对象,收集尿液和采集空腹静脉血,采用砷铈催化分光光度法测定尿标本中碘含量,利用化学发光法测定促甲状腺激素(TSH)、游离甲状腺素(FT4)和过氧化物酶抗体(TPOAb)。结果 1 851例妊娠早期孕妇尿碘中位数为129μg/L,其中60.72%的孕妇处于碘缺乏状态,28.09%的孕妇处于碘适量,2.32%的孕妇碘过量。本组孕妇甲状腺异常总患病率为29.39%,其中低甲状腺素血症、甲减、亚临床甲减、甲亢、亚临床甲亢、甲状腺TPOAb阳性的患病率分别为24.37%、0.70%、0.81%、0.92%、2.59%、11.02%。尿碘水平异常与碘足量水平的甲状腺功能异常总患病率分别为30.73%和25.96%,差异有统计学意义(χ2=4.095,P=0.043),而二者的甲状腺功能异常个体患病率差异无统计学意义(P0.05)。尿碘水平异常与尿碘足量水平孕妇的TPOAb阳性率分别为10.74%和11.73%,差异无统计学意义(P0.05)。结论妊娠早期妇女60%以上存在碘摄入不足,尿碘水平异常孕妇的甲状腺功能异常的总患病率明显高于碘足量水平孕妇。

Investigation of urine iodine and thyroid dysfunction in early pregnancy

Objective To study iodine nutrition and thyroid function in early pregnancy, and provide scientific basis for iodine supplementation for those women. Methods Totally 1 851 early pregnant women who visited the obstetric outpatient of Xiaolan hospital for regular checkup from June 2013 to January 2014 were enrolled in this study. Urine and fasting blood samples were collected and investigated.The urinary iodine level was measured by arsenic-cerium contact process method. The serum levels of TSH, FT4, and TPOAb were measured by chemiluminescence method. Results The urinary iodine median concentration in 1 851 early pregnant women was 129 μg / L. 60.72% of those women were iodine deficiency; 28.09% were iodine normal; 2.32% were iodine excess. The whole prevalence rate of thyroid disease was 29.39%. The prevalence rates of hypothyroxinemia, hypothyroidism, subclinical hypothyroidism, hyperthyroidism, subclinical hyperthyroidism, and positive of TPOAb were 24.37%, 0.70%, 0.81%, 0.92%, 2.59%, and 11.02%, respectively. The whole prevalence rates of thyroid disorders of iodine abnormal and iodine normal were 30.73% and 25.96%, respectively, showing significant difference（χ^2=4.095, P=0.043）. There was no difference between the individual prevalence rate of thyroid disorders. Positive rates of TPOAb of iodine abnormal and iodine normal were 10.74% and 11.73%, respectively, showing no significant difference.Conclusion Over 60% of those early pregnant women were in iodine deficency status. The whole prevalence rate of thyroid disease in iodine abnormal was obviously higher than that in iodine normal.