高水碘地区孕妇甲状腺抗体阳性与新生儿TSH的关系调查

目的:探讨甲状腺抗体阳性孕妇的甲状腺功能变化及高水碘地区甲状腺抗体阳性孕妇与新生儿TSH水平之间的关系。方法:在高水碘地区选天津市静海县妇幼保健院(饮水水碘>200μg/L)和在适碘地区选天津市和平区妇幼保健院(饮水水碘<10μg/L,碘盐普及率>90%,居民尿碘中位数>100μg/L)作为调查现场。在妇幼保健院门诊选取资料完整的妊娠早、中、晚期孕妇各50例,研究对象均为健康、无甲状腺疾病史,年龄为20～40岁。检测血液样品的甲状腺功能指标(TSH、TT4、FT4、TT3、FT3、TG)。抽取高水碘地区115例被调查孕妇的新生儿,测定其足跟血的TSH。结果:①甲状腺抗体阳性孕妇TSH显著高于抗体阴性的孕妇,TG显著低于抗体阴性的孕妇。②甲状腺抗体阳性者新生儿TSH≥5μIU/ml的检出率高于抗体阴性者,但尚未达到统计学差异(3/10 vs 8/98,P=0.064)。结论:甲状腺抗体阳性孕妇可能存在亚临床甲减,其新生儿较易发生TSH升高,TG、TSH、甲状腺抗体等指标可作为孕妇甲状腺功能和胎儿甲状腺功能的监测指标。

Investigation on the relationship between positive thyroid antibody of pregnant women and thyroid stimulating hormone of neonates in high water iodine area

Objective:To explore the change of thyroid function of pregnant women with positive thyroid antibody and the relationship between positive thyroid antibody of pregnant women and thyroid stimulating hormone(TSH) of neonates in high water iodine area. Methods:Jinghai maternal and child health hospital in Tianjin in high water iodine area(iodine level in drinking water>200 μg/L) and maternal and child health hospital of Heping district in Tianjin in appropriate iodine area(iodine level in drinking water<10 μg/L,popularizing rate of iodized salt>90%,median of urine iodine>100 μg/L) were selected as investigation sites.50 pregnant women during the first trimester of pregnancy,50 pregnant women during the second trimester of pregnancy and 50 pregnant women during the third trimester of pregnancy were selected from outpatient department of the hospital with intact data,all the study objects were healthy,without the history of thyroid diseases,their age was during 20～40 years.The indexes of thyroid function(including TSH,total thyroxine 4,free thyroxine 4,total thyroxine 3,free thyroxine 3,triglyceride)in blood samples were detected.115 neonates born by 115 investigated pregnant women were selected from high water iodine area,the level of TSH in their heel blood was detected. Results:The level of TSH in pregnant women with positive thyroid antibody was significantly higher than that in pregnant women with negative thyroid antibody,but their triglyceride level was significantly lower than that in pregnant women with negative thyroid antibody.The detection rate of TSH≥5 IU/ml in neonates born by pregnant women with positive thyroid antibody was higher than that in neonates born by pregnant women with negative thyroid antibody,but there was no significant difference(3/10 vs 8/98,P=0.064). Conclusion:The pregnant women with positive thyroid antibody maybe have subclinical hypothyroidism,and the level of TSH in their neonates may increase easily.Triglyceride,TSH and thyroid antibody can be used as indexes to monitor the thyroid functions of pregnant women and their neonates.