不同碘摄入量地区妇女产后甲状腺炎患病情况的调查

目的　了解不同碘摄入量地区妇女产后甲状腺炎 (PPT)的患病情况 ,探讨PPT的环境致病因素。方法　对不同碘摄入量地区 ,既往未诊断过甲状腺疾病的产后 1年内的妇女共 119例 (观察组 )及在相同地区居住 3年以上的育龄妇女 2 38例 (对照组 ) ,进行问卷调查 ,并测定其甲状腺自身抗体、甲状腺功能及尿碘水平。结果　 (1)PPT患病率为 11 8% ,其中 ,临床PPT占 1 7% ,亚临床PPT占10 1% ;对照组甲状腺功能异常发生率为 5 9%。缺碘地区经补碘 4年后 [尿碘中位数 (MUI)为 374 μg L],亚临床PPT的患病率为 2 1 0 % ,显著高于未补碘地区 (MUI为 10 3μg L)和水源性高碘地区 (MUI为 6 14 μg L) (P <0 0 5 ) ;(2 )甲状腺自身抗体阳性率为 8 4 % ,其中有 1 2妇女发展成PPT。适碘摄入量地区产后妇女亚临床PPT的患病率高于持续轻度低碘摄入量地区和持续高碘摄入量地区。结论　碘与PPT的发生有关 ,补碘剂量应个体化 ;在加强补碘效果的监测 ,纠正碘不足的同时 ,也应防止因补碘过量而诱发的PPT。

Prevalence of postpartum thyroiditis in three different iodine intake areas

OBJECTIVE: To investigate the prevalence of postpartum thyroiditis (PPT) in three different iodine intake areas, to explore the relationship between iodine intake and PPT. METHODS: Panshan, Zhangwu and Huanghua are three different iodine intake areas. The median urinary iodine concentration were 103 micro g/L, 374 micro g/L and 614 micro g/L, respectively. One hundred and nineteen lactational women were investigated during the first year postpartum. Thyroid stimulating hormone (TSH), free thyroxine (FT(4)), free triiodothyronine (FT(3)), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were determined with immulite method, and UI was determined by As-Ce(4+) catalytic spectrophotometry method. RESULTS: The prevalence of PPT is 11.8%, 10.1% of subclinical PPT, whereas 1.7% of clinical PPT. There was statistically significant difference in the frequency of PPT in three areas (Panshan 5.6%, Zhangwu 23.1% and Huanghua 6.8%, P < 0.05), but no difference in the frequency of thyroid autoimmune antibody (TAA). 50% of positive TAA women developed into PPT. CONCLUSION: Higher prevalence of subclinical PPT was found in the area with moderate iodine deficiency after iodine supplementation, suggesting a possible role of iodine supplementation in PPT.