中孕期孕妇的碘营养状态对心脏电信号的影响
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摘要
目的探讨中孕期孕妇碘营养状态对其心脏电信号的影响。方法 2015年7月至2017年7月,采取方便抽样法,于山东省海阳市某2家二级医院,选取1 600例中孕期孕妇为研究对象,纳入观察组。按照年龄匹配原则,采取同样的方法,选择同期在这2家医院进行健康体检,碘含量检测结果正常的非妊娠女性800例,纳入对照组(C组)。对观察组受试者进行尿碘含量检测,同时对观察组及C组受试者进行心电图检查。根据观察组中孕期孕妇碘含量检测结果,将其分为碘营养缺乏亚组(G1亚组),碘营养过量亚组(G2亚组)和碘营养正常亚组(G3亚组)。对于观察组3个亚组与C组的心电图检查结果正常和大致正常率、窦性心律不齐等异常结果发生率的比较,采用χ~2检验,进一步两两比较,采用调整检验水准后进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。本研究分组,均征得受试者本人的知情同意,并签署临床研究知情同意书。结果①观察组进一步分组及组间一般临床资料比较结果:观察组中,G1、G2及G3亚组孕妇分别为502、179及919例。观察组3个亚组孕妇的年龄、孕龄分别总体比较,差异均无统计学意义(P>0.05)。这3个亚组孕妇与C组受试者年龄总体比较,差异亦无统计学意义(P>0.05)。②心电图检查结果正常和大致正常率比较:观察组3个亚组与C组总体比较,差异有统计学意义(χ~2=79.889,P<0.001);G1与G2亚组孕妇心电图正常和大致正常率分别为72.71%(365/502)与70.95%(127/179),均显著低于G3亚组(86.51%,795/919)与C组(88.25%,706/800),并且差异均有统计学意义(均为P<0.001)。③G1、G2及G3亚组孕妇心电图检查异常结果中,窦性心律不齐发生率最高。G1、G2及G3亚组与C组窦性心动过缓、窦性心动过速、窦性心律不齐、室性早搏、短P-R间期、ST-T改变发生率分别整体比较,差异均有统计学意义(χ~2=38.423、37.687、296.887、20.933、50.112、30.783,均为P<0.001);而电轴左偏或右偏、QRS低电压、传导阻滞分别总体比较,差异均无统计学意义(P>0.05)。④G1、G2及G3亚组与C组心电图检查异常结果两两比较,差异有统计学意义的为窦性心动过缓(G1亚组vs C组:χ~2=19.659,G2亚组vs C组:χ~2=17.409,G1亚组vs G3亚组:χ~2=20.592,G2亚组vs G3亚组:χ~2=17.703,均为P<0.001);窦性心动过速(G1亚组vs C组:χ~2=17.433,G2亚组vs C组:χ~2=35.622,G2亚组vs G3亚组:χ~2=16.992,均为P<0.001);窦性心律不齐(G1亚组vs C组:χ~2=178.673,G2亚组vs C组:χ~2=110.717,G1亚组vs G3亚组:χ~2=168.011,G2亚组vs G3亚组:χ~2=93.579,均为P<0.001);室性早搏(G1亚组vs C组:χ~2=14.593,G1亚组vs G3亚组:χ~2=13.472,均为P<0.001);短P-R间期(G1亚组vs C组:χ~2=43.563,G2亚组vs C组:χ~2=19.291,G1亚组vs G3亚组:χ~2=20.191,均为P<0.001);ST-T改变(G1亚组vs C组:χ~2=19.796,G2亚组vs C组:χ~2=23.314,G2亚组vs G3亚组:χ~2=10.630,均为P≤0.001)。结论中孕期孕妇体内碘营养状态失衡,可增加异常心电图的发生。
Objective To investigate the effects of iodine nutritional status on cardiac electrical signals of pregnant women in the second trimester pregnancy. Methods From July 2015 to July 2017, a total of 1 600 pregnant women in the second trimester pregnancy were selected from two hospitals in Haiyang City, Shandong Province by convenience sampling method as the observation group, and 800 healthy non-pregnant women with normal iodine nutritional status were selected in the principle of age-matched as the control group(C group) during the same period in the same hospitals and by the same method. The iodine nutritional statuses of pregnant women in observation group were measured, and the electrocardiograms of all subjects were analyzed. According to the results of iodine nutritional status, the pregnant women in the second trimester pregnancy were divided into iodine deficiency subgroup(G1 subgroup), iodine excess subgroup(G2 subgroup), and iodine sufficiency subgroup(G3 subgroup), respectively. The rates of normal and almost normal electrocardiogram and the incidence of sinus arrhythmia and the other abnormal electrocardiogram results were compared by chi-square test. The study protocol was performed in accordance with the Helsinki Declaration of the World Medical Association revised in 2013, and clinical research informed consents were obtained from all participants. Results ①There were 502 pregnant women in the second trimester pregnancy at the status of iodine deficiency, 179 cases of iodine excess, and 919 cases of iodine sufficiency. They were divided into G1, G2 and G3 subgroup, respectively. There were no statistical differences among 3 subgroups in age and gestational age(P>0.05). There was no statistical difference among 3 subgroups and C group in age(P>0.05). ②There was statistically significant difference in rate of normal and almost normal electrocardiogram among 3 subgroups in observation group and C group(χ~2=79.889,P<0.001). The rate of normal and almost normal electrocardiogram was 72.71%(365/502), 70.95%(127/179) in G1 and G2 subgroup, respectively, which both were lower than those of 86.51%(795/919) and 88.25%(706/800) in G3 subgroup and C group, respectively, and all the differences were statistically significant(all P<0.001). ③The incidence of sinus arrhythmia was the highest among all abnormal electrocardiogram in observation group. There were statistically significant differences in incidence of sinus bradycardia(χ~2=38.423, P<0.001), sinus tachycardia(χ~2=37.687, P<0.001), sinus arrhythmia(χ~2=296.887, P<0.001), premature ventricular contractions(χ~2=20.933, P<0.001), short P-R interval(χ~2=50.112, P<0.001), and ST-T changes(χ~2=30.783, P<0.001) among 3 subgroups in observation group and C group. There were no statistically significant differences in the incidences of left or right deviation of electric axis, QRS low voltage, or conduction block among 3 subgroups in observation group and C group(P>0.05). ④There were statistically significant differences on the abnormal results of electrocardiogram examination in the pairwise comparison in sinus bradycardia(G1 subgroup vs C group: χ~2=19.659, G2 subgroup vs C group: χ~2=17.409, G1 subgroup vs G3 subgroup: χ~2=20.592, G2 subgroup vs G3 subgroup: χ~2=17.703, all P<0.001), sinus tachycardia(G1 subgroup vs C group: χ~2=17.433, G2 subgroup vs C group: χ~2=35.622, G2 subgroup vs G3 subgroup: χ~2=16.992, all P<0.001), sinus arrhythmia(G1 subgroup vs C group: χ~2=178.673, G2 subgroup vs C group: χ~2=110.717, G1 subgroup vs G3 subgroup: χ~2=168.011, G2 subgroup vs G3 subgroup: χ~2=93.579, all P<0.001), ventricular premature beats(G1 subgroup vs C group: χ~2=14.593, G1 subgroup vs G3 subgroup: χ~2=13.472, all P<0.001), short P-R interval(G1 subgroup vs C group: χ~2=43.563, G2 subgroup vs C group: χ~2=19.291, G1 subgroup vs G3 subgroup: χ~2=20.191, all P<0.001), and ST-T changes(G1 subgroup vs C group: χ~2=19.796, G2 subgroup vs C group: χ~2=23.314, G2 subgroup vs G3 subgroup: χ~2=10.630, all P≤0.001) among G1, G2, G3 subgroup and C group. Conclusion Imbalance of iodine nutritional status of pregnant women in the second trimester pregnancy can lead to abnormal electrocardiogram.
Objective To investigate the effects of iodine nutritional status on cardiac electrical signals of pregnant women in the second trimester pregnancy. Methods From July 2015 to July 2017, a total of 1 600 pregnant women in the second trimester pregnancy were selected from two hospitals in Haiyang City, Shandong Province by convenience sampling method as the observation group, and 800 healthy non-pregnant women with normal iodine nutritional status were selected in the principle of age-matched as the control group(C group) during the same period in the same hospitals and by the same method. The iodine nutritional statuses of pregnant women in observation group were measured, and the electrocardiograms of all subjects were analyzed. According to the results of iodine nutritional status, the pregnant women in the second trimester pregnancy were divided into iodine deficiency subgroup(G1 subgroup), iodine excess subgroup(G2 subgroup), and iodine sufficiency subgroup(G3 subgroup), respectively. The rates of normal and almost normal electrocardiogram and the incidence of sinus arrhythmia and the other abnormal electrocardiogram results were compared by chi-square test. The study protocol was performed in accordance with the Helsinki Declaration of the World Medical Association revised in 2013, and clinical research informed consents were obtained from all participants. Results ①There were 502 pregnant women in the second trimester pregnancy at the status of iodine deficiency, 179 cases of iodine excess, and 919 cases of iodine sufficiency. They were divided into G1, G2 and G3 subgroup, respectively. There were no statistical differences among 3 subgroups in age and gestational age(P>0.05). There was no statistical difference among 3 subgroups and C group in age(P>0.05). ②There was statistically significant difference in rate of normal and almost normal electrocardiogram among 3 subgroups in observation group and C group(χ~2=79.889,P<0.001). The rate of normal and almost normal electrocardiogram was 72.71%(365/502), 70.95%(127/179) in G1 and G2 subgroup, respectively, which both were lower than those of 86.51%(795/919) and 88.25%(706/800) in G3 subgroup and C group, respectively, and all the differences were statistically significant(all P<0.001). ③The incidence of sinus arrhythmia was the highest among all abnormal electrocardiogram in observation group. There were statistically significant differences in incidence of sinus bradycardia(χ~2=38.423, P<0.001), sinus tachycardia(χ~2=37.687, P<0.001), sinus arrhythmia(χ~2=296.887, P<0.001), premature ventricular contractions(χ~2=20.933, P<0.001), short P-R interval(χ~2=50.112, P<0.001), and ST-T changes(χ~2=30.783, P<0.001) among 3 subgroups in observation group and C group. There were no statistically significant differences in the incidences of left or right deviation of electric axis, QRS low voltage, or conduction block among 3 subgroups in observation group and C group(P>0.05). ④There were statistically significant differences on the abnormal results of electrocardiogram examination in the pairwise comparison in sinus bradycardia(G1 subgroup vs C group: χ~2=19.659, G2 subgroup vs C group: χ~2=17.409, G1 subgroup vs G3 subgroup: χ~2=20.592, G2 subgroup vs G3 subgroup: χ~2=17.703, all P<0.001), sinus tachycardia(G1 subgroup vs C group: χ~2=17.433, G2 subgroup vs C group: χ~2=35.622, G2 subgroup vs G3 subgroup: χ~2=16.992, all P<0.001), sinus arrhythmia(G1 subgroup vs C group: χ~2=178.673, G2 subgroup vs C group: χ~2=110.717, G1 subgroup vs G3 subgroup: χ~2=168.011, G2 subgroup vs G3 subgroup: χ~2=93.579, all P<0.001), ventricular premature beats(G1 subgroup vs C group: χ~2=14.593, G1 subgroup vs G3 subgroup: χ~2=13.472, all P<0.001), short P-R interval(G1 subgroup vs C group: χ~2=43.563, G2 subgroup vs C group: χ~2=19.291, G1 subgroup vs G3 subgroup: χ~2=20.191, all P<0.001), and ST-T changes(G1 subgroup vs C group: χ~2=19.796, G2 subgroup vs C group: χ~2=23.314, G2 subgroup vs G3 subgroup: χ~2=10.630, all P≤0.001) among G1, G2, G3 subgroup and C group. Conclusion Imbalance of iodine nutritional status of pregnant women in the second trimester pregnancy can lead to abnormal electrocardiogram.
引文
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[3] 于海华, 宫建, 于嵩, 等. 不同碘营养状态对晚孕期孕妇心电图的影响[J/CD]. 中华妇幼临床医学杂志(电子版), 2015, 11(6): 685-688.
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[5] 李萌, 桑仲娜, 沈钧, 等. 适碘地区成人、儿童和孕妇碘营养状况调查[J]. 中国公共卫生, 2014, 30(8): 1060-1062.
[6] Gong J, Liu W, Dong J, et al. Developmental iodine deficiency and hypothyroidism impair neural development in rat hippocampus involvement of doublecortin and NCAM-180[J]. BMC Neuroscience, 2010, 11(1):50.
[7] Gong J, Dong J, Wang Y, et al. Developmental iodine deficiency and hypothyroidism impair neural development, up-regulate caveolin-1 and down-regulate synaptophysin in rat hippocampus[J]. J Neuroendocrinol, 2010, 22(2): 129-139.
[8] 单晓静, 宫建, 孙云萍, 等. 妊娠早期碘营养状态与母体血压关系[J]. 中国公共卫生, 2018, 34(12): 1681-1682.
[9] 陈海平, 宫建, 杨传家, 等. 妊娠期亚临床甲状腺功能减退对血压的影响[J]. 现代预防医学, 2012, 39(15): 3822-3823.
[10] Roberts CG, Ladenson PW. Hypothyroidism[J]. Lancet, 2004, 363(9411): 793-803.
[11] Dunn JT, Semigran MJ, Delange F. The prevention and management of iodine-induced hyperthyroidism and its cardiac features[J]. Thyroid, 1998, 8(1): 101-106.
[2] Stagnaro-Green A, Pearce E. Thyroid disorders in pregnancy[J]. Nat Rev Endocrinol, 2012, 8(11): 650-658.
[3] 于海华, 宫建, 于嵩, 等. 不同碘营养状态对晚孕期孕妇心电图的影响[J/CD]. 中华妇幼临床医学杂志(电子版), 2015, 11(6): 685-688.
[4] 于海华, 宫建, 孙晓辉, 等. 妊娠早期孕妇不同碘营养状态的心电图分析[J/CD]. 中华临床医师杂志(电子版), 2015, 9(21): 4006-4008.
[5] 李萌, 桑仲娜, 沈钧, 等. 适碘地区成人、儿童和孕妇碘营养状况调查[J]. 中国公共卫生, 2014, 30(8): 1060-1062.
[6] Gong J, Liu W, Dong J, et al. Developmental iodine deficiency and hypothyroidism impair neural development in rat hippocampus involvement of doublecortin and NCAM-180[J]. BMC Neuroscience, 2010, 11(1):50.
[7] Gong J, Dong J, Wang Y, et al. Developmental iodine deficiency and hypothyroidism impair neural development, up-regulate caveolin-1 and down-regulate synaptophysin in rat hippocampus[J]. J Neuroendocrinol, 2010, 22(2): 129-139.
[8] 单晓静, 宫建, 孙云萍, 等. 妊娠早期碘营养状态与母体血压关系[J]. 中国公共卫生, 2018, 34(12): 1681-1682.
[9] 陈海平, 宫建, 杨传家, 等. 妊娠期亚临床甲状腺功能减退对血压的影响[J]. 现代预防医学, 2012, 39(15): 3822-3823.
[10] Roberts CG, Ladenson PW. Hypothyroidism[J]. Lancet, 2004, 363(9411): 793-803.
[11] Dunn JT, Semigran MJ, Delange F. The prevention and management of iodine-induced hyperthyroidism and its cardiac features[J]. Thyroid, 1998, 8(1): 101-106.