高碘地区孕妇与新生儿甲状腺功能关系的研究

目的 了解高碘地区妊娠晚期孕妇的碘营养状况,以及孕妇与新生儿甲状腺功能的关系.方法 2010年4-6月,在河北省沧州市海兴县医院收集210名妊娠晚期孕妇的空腹晨尿、静脉血,以及新生儿的脐带血,砷-铈催化分光光度法测定尿碘,化学发光法测定游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)及敏感促甲状腺激素(sTSH).结果 210名妊娠晚期孕妇年龄为(27.69±4.73)岁,尿碘中位数为1240.70μg/L,84.3％(177/210)的孕妇碘营养过量,仅有0.5％(1/210)的孕妇碘营养适宜.孕妇甲状腺疾病患病率为19.5％(41/210),各疾病顺次为:亚临床甲状腺功能减退(16.2％,34/210)、亚临床甲状腺功能亢进(0.9％,2/210)、甲状腺功能减退(2.4％,5/210)、甲状腺功能亢进(0,0/210).新生儿sTSH在5～＜10 mU/L的有104人(49.5％)；10～＜20 mU/L的有44人(21.0％),≥20 mU/L的有16人(7.6％).患甲状腺疾病的孕妇所产新生儿的sTSH水平(10.18 mU/L)和sTSH＞10 mU/L的比率(50.0％,24/48)均高于非患病孕妇(6.78 mU/L,Z=- 2.867,P＜0.05;22.2％,36/162,x2=14.000,P＜ 0.05).新生儿与母亲的sTSH水平正相关(r=0.278,P＜ 0.05),新生儿sTSH水平异常(sTSH＞10 mU/L)与母亲sTSH水平异常正相关(r=0.240,P＜ 0.05).结论 高碘地区大部分孕妇碘营养过量,新生儿sTSH水平较高且与母亲sTSH水平异常及患有甲状腺疾病有关,故应加强孕妇碘营养状况、甲状腺功能及新生儿sTSH水平的监测.

Relationship between maternal and neonatal thyroid function in a high iodine area

Objective To find out iodine nutritional status of pregnant women in the third trimester and the relationship between pregnant women and their neonates thyroid function in a high iodine area.Methods From April to June 2010,210 copies of fasting morning urine and venous blood,and their neonatal umbilical cord blood samples were collected in Haixing Hospital,Cangzhou city,Hebei province.Urinary iodine was determined by arsenic-cerium catalytic spectrophotometry.The levels of free triiodothyronine(FT3),free thyroxine (FT4) and sensitive thyroid-stimulating hormone (sTSH) in serum were measured by chemiluminescence.Results Median urinary iodine of 210 pregnant women(average age 27.69 ± 4.73 years) in the third trimester was 1240.70 μg/L,84.3％(177/210) of them was in excessive iodine nutrition,and only 0.5％(1/210) of them was in adequate iodine nutrition.The prevalence rate of thyroid diseases was 19.5％ (41/210),and the spectrum of diseases were subclinical hypothyroidism(16.2％,34/210),subclinical hyperthyroidism(0.9％,2/210),hypothyroidism(2.4％,5/210) and hyperthyroidism (0,0/210).The number of newborns with sTSH 5 - ＞ 10 mU/L were 104 persons (49.5％); 10 - ＞ 20 mU/L were 44 persons(21.0％),and ≥20 mU/L were 16 persons(7.6％).Of pregnant women suffer from thyroid disease,the ratio(50.0％,24/48 ) of sTSH equal to 10.18 mU/L and ＞ 10 mU/L of their neonates was higher than that of their corresponding non-ill pregnant women(6.78 mU/L,Z =- 2.867,P ＜ 0.05; 22.2％,36/162,x2 =14.000,P ＜ 0.05).There was a positive correlation between neonates' and their mothers' sTSH levels (r =0.278,P ＜ 0.05).There was also a positive correlation between neonates' (sTSH ＞ 10 mU/L) and their mothers' abnormal sTSH levels (r =0.240,P ＜ 0.05).Conclusions Most of the pregnant women in high iodine areas are iodine excess.The level of neonates' sTSH is higher,and it is due to their mothers' abnormal sTSH and suffering from thyroid diseases to some extent.As a result,the monitoring of pregnant women's iodine nutrition and thyroid function and sTSH level of their neonates should be strengthened.