不同程度碘缺乏孕妇甲低的发生率及对围产结局的影响

目的:了解不同程度碘缺乏孕妇甲低的发生率及对围产结局的影响。方法:对入选的734例孕妇筛查尿碘,根据尿碘值分为对照组、轻度缺碘组、中度缺碘组和重度缺碘组4组,B超测量甲状腺体积,同时检测孕妇血清TSH、T4、T3、TG、FT3、FT4水平,观察缺碘性甲低的发生率,并随诊新生儿脐血TSH、T4、T3、TG、FT3、FT4水平,与对照组比较,了解不同程度碘缺乏对围产结局的影响。结果:①孕妇亚临床型甲低的发生率为32.29%,对照组、轻度缺碘组、中度缺碘组3组亚临床型甲低的发生率递增,差异有统计学意义(P<0.05);重度缺碘组亚临床型甲低的发生率低于对照组,差异有统计学意义(P<0.01);②孕妇甲低的发生率为5.23%(29/554),对照组为0,轻度缺碘组、中度缺碘组、重度缺碘组甲低的发生率依次递增,差异有统计学意义(P<0.001),缺碘程度与甲低的发生率呈正相关;③甲状腺增大的发生率为87.00%,对照组为0,轻度缺碘组、中度缺碘组、重度缺碘组甲状腺增大的发生率依次升高,差异有统计学意义(P<0.001),同时监测TG含量与甲状腺增大的发生率和缺碘的程度呈正相关(P<0.001);T3、TSH的含量随甲状腺增大的发生率轻度升高(P<0.05);各组甲状腺结节的发生率差异无统计学意义(P>0.05);④新生儿亚甲低的发生率为2.71%,对照组为0,轻度缺碘组、中度缺碘组、重度缺碘组新生儿亚甲低的发生率依次递减,差异有统计学意义(P<0.05);⑤新生儿甲低的发生率为0.36%,全部来自重度缺碘组,与其他各组间差异有统计学意义(P=0.000);⑥妊娠合并症如FGR、妊高征、胎儿宫内窘迫、早产的发生率明显高于对照组,差异有统计学意义(P<0.01);流产、胎死宫内、胎盘早剥、产后出血等的发生率也较对照组高,差异有统计学意义(P<0.05)。结论:①孕妇碘缺乏会使其甲低、亚临床型甲低的发生率增加,甲状腺不同程度增大,增加新生儿甲低、亚临床型甲低的发生率,并可诱发多种围产期合并症;②孕期监测尿碘,异常者监测甲状腺功能,及时发现并积极治疗缺碘性疾病。

The incidence of hypothyroidism in the iodine-deficiency pregnant women and the influence of it on the perinatal outcome

Objective:To investigate the incidence of hypothyroidism in the iodine-deficiency pregnant women and the influence of perinatal period.Methods:734 pregnant women were selected to measure the thyroid volume with ultrasonography,at the time to monitor the biochemical parameters of thyroid function of maternal serum and their neonates umbilical vein serum:TSH,T4,T3,TG,FT3,FT4.Results:The morbidity of material hypothyroidism and the subclinical hypothyroidism was 5.23% and 32.29%.Whereas the frequency of neonatal hypothyroidism and subclinical hypothyroidism was 0.36% and 2.71%.To the iodine-deficiency mothers and their neonates,there was statistically significant difference in the rates of hypothyroididsm and subclinical hypothyroidism.Compared the group iodine-sufficient with the group iodine-deficiency,there was a significant treatment effect on the thyroid volume,results in the thyroid volume marked increase.Moreover iodine deficiency result in the higher rates of preterm delivery,low birth weight babies,PIH,FGR,Fetal dysess,Postpartuvm hemohaga.Conclusion:The thyroid function of pregnant women is damaged because of iodine deficiency during pregnancy,hypothyroididsm and subclinical hypothyroidism of mothers and their babies are increased,the rates of association of fetes and neonates are increased.