广州地区孕妇尿碘水平与甲状腺功能减退的相关性分析
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摘要
目的分析广州地区妊娠期妇女的碘营养状况,探讨其与甲状腺功能减退的关系。方法随机选取2017年1～12月于广州市妇女儿童医疗中心产科门诊进行产检的孕妇4 986例,对其空腹血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、甲状腺过氧化物酶抗体(TPOAb)及尿碘(UI)水平进行回顾性分析。结果 4 896例孕妇尿碘水平为5～1 476μg/L,中位数为179.3μg/L,碘缺乏、碘适量、碘超足量和碘过量的发生率分别为39.93%,28.42%,18.99%和12.66%。随着尿碘水平的升高,TSH和FT4水平随之升高,差异具有统计学意义(χ~2=20.19,P=0.001;χ~2=16.45,P=0.000);三组甲状腺功能异常在不同碘营养状态的发生率差异无统计学意义(χ~2=4.08,P=0.67);TPOAb的阳性率为24.11%,其在三组甲状腺疾病中的阳性率差异具有统计学意义(χ~2=10.18,P=0.006)。结论广州地区妊娠期碘不足或碘过量较为常见,维持适量的尿碘水平对预防甲状腺功能异常有重要意义。
Objective To investigate the association of urinary iodine nutritional of pregnant women with hypothyroidism in Guangzhou.Methods A total of 4 986 pregnant women were enrolled from January 2017 to December,and retrospectively analyzed their urinary iodine level(UI) and thyroid function index(included TSH,FT4 and TPOAb).Results The range of urine iodine level in pregnant women was 5～1 476 μg/L,the urine iodine median was 179.3 μg/L,the iodine deficiency,iodine in moderation,iodine adequate enough,and the incidence of iodine excess were 39.93%,28.42%,18.99% and 12.66%,respectively.With the increase of urinary iodine,the levels of TSH and FT4 increased,and the difference was statistically significant(χ~2=20.19,P=0.001;χ~2=16.45,P=0.000).The incidence of hypothyroidism,subclinical hypothyroidism and low thyroid hormone levels were 0.14%,0.62% and 2.05%,respectively.Compared three groups of thyroid disease incidence in different urinary iodine levels,there was no statistically significant(χ~2=4.08,P=0.67).The positive rate of TPOAb was 24.11%,and compared the positive rate of TPOAb between three group thyroid disease,there was statistically significant(χ~2=10.18,P=0.006).Conclusion Iodine deficiency or excess during pregnancy is common in Guangzhou.Maintaining adequate urinary iodine level is of great significance in preventing thyroid dysfunction.
Objective To investigate the association of urinary iodine nutritional of pregnant women with hypothyroidism in Guangzhou.Methods A total of 4 986 pregnant women were enrolled from January 2017 to December,and retrospectively analyzed their urinary iodine level(UI) and thyroid function index(included TSH,FT4 and TPOAb).Results The range of urine iodine level in pregnant women was 5～1 476 μg/L,the urine iodine median was 179.3 μg/L,the iodine deficiency,iodine in moderation,iodine adequate enough,and the incidence of iodine excess were 39.93%,28.42%,18.99% and 12.66%,respectively.With the increase of urinary iodine,the levels of TSH and FT4 increased,and the difference was statistically significant(χ~2=20.19,P=0.001;χ~2=16.45,P=0.000).The incidence of hypothyroidism,subclinical hypothyroidism and low thyroid hormone levels were 0.14%,0.62% and 2.05%,respectively.Compared three groups of thyroid disease incidence in different urinary iodine levels,there was no statistically significant(χ~2=4.08,P=0.67).The positive rate of TPOAb was 24.11%,and compared the positive rate of TPOAb between three group thyroid disease,there was statistically significant(χ~2=10.18,P=0.006).Conclusion Iodine deficiency or excess during pregnancy is common in Guangzhou.Maintaining adequate urinary iodine level is of great significance in preventing thyroid dysfunction.
引文
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[8] 赵树君,孙富军,田恩江,等.碘缺乏和碘过量对甲状腺自身免疫影响的实验研究[J].中华预防医学杂志,2006,40(1):18-20.ZHAO Shujun,SUN Fujun,TIAN Enjiang,et al.Experimental study on effects of iodine deficiency and excess on thyroid autoimmunity[J].Chinese Journal of Preventive Medicine,2006,40(1):18-20.
[9] STAGNARO-GREEN A.Approach to the patient wi-th postpartum thyroiditis[J].Journal of Clinical Endocrinology & Metabolism,2012,97(2):334-342.
[10] 叶文慧,何柳瑜,吕小飞,等.妊娠早期合并亚临床甲状腺功能减退妇女自身抗体阳性对不良妊娠结局的影响[J].实用妇产科杂志,2018,34(1):34-37.YE Wenhui,HE Liuyu,L Xiaofei,et al.The impact of subclinical hypothyroidism combined with autoantibody positive in first trimester of pregnancy on pregnancy outcomes[J].Journal of Practical Obstetrics and Gynecology,2018,34(1):34-37.
[11] 徐艳红,吴艺捷,罗越,等.孕妇血清甲状腺过氧化物酶抗体阳性对妊娠结局的影响[J].中华内分泌代谢杂志,2012,28(5):377-381.XU Yanhong,WU Yijie,LUO Yue,et al.Influence of positive serum thyroid peroxidase antibody on pregnancy outcomes[J].Chinese Journal of Endocrinology and Metabolism,2012,28(5):377-381.
[2] 丁榕,范建霞.美国甲状腺学会《2017年妊娠及产后甲状腺疾病诊治指南》解读[J].中华围产医学杂志,2017,20(3):165-169.DING Rong,FAN Jianxia.American Interpretation of Guidelines of the Thyroid Association for the diagnosis and management of thyroid diseases during pregnancy and the postpartum in 2017[J].Chinese Journal of Perinatal Medicine,2017,20(3):165-169.
[3] 赵霞,唐婕,吴韶清,等.妊娠期碘营养状态与甲状腺功能的关系研究[J].国际检验医学杂志,2017,38(11):1490-1492.ZHAO Xia,TANG Jie,WU Shaoqing,et al.Study on iodine nutrition and thyroid function in pregnant women[J].International Journal of Laboratory Medicine,2017,38(11):1490-1492.
[4] DEMIRKAYA M,KELSAKA E,SARIH-ASAN B,et al.The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade[J].J Clin Anesth,2012,24(5):392-397.
[5] 王晓雪,贾方,田晶,等.妊娠期碘营养、甲状腺自身抗体与甲状腺功能关系的研究[J].中华内分泌代谢杂志,2014,30(5):408-410.WANG Xiaoyue,JIA Fang,TIAN Jing,et al.Iodine nutrition and thyroid autoantibodies in pregnancy and their relation to thyroid function[J].Chinese Journal of Endocrinology and Metabolism,2014,30(5):408-410.
[6] 杨金,郑合明,李小烽,等.河南省碘缺乏地区孕妇碘营养及甲状腺功能变化的纵向研究[J].中华流行病学杂志,2015,36(1):35-39.YANG Jin,ZHENG Heming,LI Xiaofeng,et al.A longitudinal study regarding the gestational changes in iodine nutrition and thyroid function among pregnant women in the iodine deficient areas of Henan province[J].Chinese Journal of Epidemiology,2015,36(1):35-39.
[7] 李晨嫣,单忠艳.妊娠期碘营养与甲状腺功能[J].中华地方病学杂志,2016,35(3):161-165.LI Chenyan,SHAN Zhongyan.Iodine intake and thyroid function during pregnancy[J].Chinese Journal of Endemiology,2016,35(3):161-165.
[8] 赵树君,孙富军,田恩江,等.碘缺乏和碘过量对甲状腺自身免疫影响的实验研究[J].中华预防医学杂志,2006,40(1):18-20.ZHAO Shujun,SUN Fujun,TIAN Enjiang,et al.Experimental study on effects of iodine deficiency and excess on thyroid autoimmunity[J].Chinese Journal of Preventive Medicine,2006,40(1):18-20.
[9] STAGNARO-GREEN A.Approach to the patient wi-th postpartum thyroiditis[J].Journal of Clinical Endocrinology & Metabolism,2012,97(2):334-342.
[10] 叶文慧,何柳瑜,吕小飞,等.妊娠早期合并亚临床甲状腺功能减退妇女自身抗体阳性对不良妊娠结局的影响[J].实用妇产科杂志,2018,34(1):34-37.YE Wenhui,HE Liuyu,L Xiaofei,et al.The impact of subclinical hypothyroidism combined with autoantibody positive in first trimester of pregnancy on pregnancy outcomes[J].Journal of Practical Obstetrics and Gynecology,2018,34(1):34-37.
[11] 徐艳红,吴艺捷,罗越,等.孕妇血清甲状腺过氧化物酶抗体阳性对妊娠结局的影响[J].中华内分泌代谢杂志,2012,28(5):377-381.XU Yanhong,WU Yijie,LUO Yue,et al.Influence of positive serum thyroid peroxidase antibody on pregnancy outcomes[J].Chinese Journal of Endocrinology and Metabolism,2012,28(5):377-381.