山西省不同水碘地区孕妇和哺乳期妇女甲状腺功能调查  

Prevalence of thyroid function in pregnant and lactating women in areas with different iodine levels of Shanxi province

作　　者：任艳婷[1] 贾清珍[1] 张向东[1] 郭百锁[1] 张峰峰[1] 程晓天[1] 王永平[1] Ren Yanting, Jia Qingzhen, Zhang Xiangdong, Guo Baisuo, Zhang Fengfeng, Cheng Xiaotian, Wang Yongping(Shanxi Institute for Endemic Disease Prevention and Treatment, Linfen 041000, Chin)

机构地区：[1]山西省地方病防治研究所,临汾041000

出　　处：《中华流行病学杂志》2018年第5期609-613,共5页Chinese Journal of Epidemiology

基　　金：山西省卫生厅科研课题计划（2014）

摘　　要：目的 分析高碘摄入对孕妇及哺乳期妇女甲状腺功能的影响。方法 采用描述流行病学横断面对比研究方法，于2014年在山西省水碘含量〉300及50-100 μg/L的地区选择调查点，抽取19-40岁孕妇130名、哺乳期妇女220名作为调查对象。记录一般资料，采集尿样、水样及血样，利用砷铈催化分光光度法检测水碘、尿碘含量，并通过电化学发光免疫分析法检测血清促甲状腺素（TSH）水平、化学发光免疫分析法检测血清游离甲状腺素（FT4）、抗甲状腺过氧化物酶自身抗体（TPOAb）、抗甲状腺球蛋白抗体（TGAb）水平。结果 适碘地区孕妇、哺乳期妇女、高碘地区孕妇、哺乳期妇女尿碘M分别为221.9、282.5、814.1、818.6 μg/L。高、适碘两地区内哺乳期妇女血FT4 M分别为12.96、13.22 pmol/L，TSH M分别为2.45、2.17 mIU/L；孕妇血FT4 M分别为14.66、16.16 pmol/L，TSH M分别为2.13、1.82 mIU/L。高、适碘两地区内哺乳期妇女血FT4水平低于孕妇、TSH异常值率高于孕妇，差异有统计学意义（FT4：Z=-6.677、-4.041，均P〈0.01；TSH：Z=8.797、8.910，均P〈0.01），高碘地区哺乳期妇女血FT4异常值率高于该地区孕妇，差异有统计学意义（Z=7.338，P=0.007），高碘地区哺乳期妇女血FT4水平低于适碘地区哺乳期妇女，差异有统计学意义（Z=-4.687，P=0.000）。高碘地区T1、T2、T3期孕妇血FT4 M分别为16.26、14.22、14.80 pmol/L，TSH M分别为1.74、1.91、2.38 mIU/L，高碘地区内T1期孕妇血FT4高于T2、T3期孕妇、TSH水平低于T2、T3期孕妇，差异有统计学意义（FT4：Z=-2.174、-2.238，均P〈0.05；TSH：Z=-2.985、-1.978，均P〈0.05）。4组妇女间、不同孕期妇女血清中甲状腺自身抗体阳性率组内和组间比较差异均无统计学意义（均P〉0.05）。高碘地区孕妇、哺乳期妇女亚临床甲状腺功能减退症（甲减）率均高于适碘地区，差异有统计学意义（χ^2=5.36Objective To investigate the effects of high iodine intake on thyroid function in pregnant and lactating women. Methods A cross sectional epidemiological study was conducted among 130 pregnant women and 220 lactating women aged 19-40 years in areas with high environment iodine level （〉300 μg/L） or proper environment iodine level （50-100 μg/L） in Shanxi in 2014. The general information, urine samples and blood samples of the women surveyed and water samples were collected. The water and urine iodine levels were detected with arsenic and cerium catalysis spectrophotometric method, the blood TSH level was detected with electrochemiluminescence immunoassay, and thyroid stimulating hormone （FT4）, antithyroid peroxidase autoantibody （TPOAb） and anti-thyroglobulin antibodies （TGAb） were detected with chemiluminescence immunoassay. Results The median urine iodine levels of the four groups were 221.9, 282.5, 814.1 and 818.6 μg/L, respectively. The median serum FT4 of lactating women in high iodine area and proper iodine area were 12.96 and 13.22 pmol/L, and the median serum TSH was 2.45 and 2.17 mIU/L, respectively. The median serum FT4 of pregnant women in high iodine area and proper iodine area were 14.66 and 16.16 pmol/L, and the median serum TSH was 2.13 and 1.82 mIU/L, respectively. The serum FT4 levels were lower and the abnormal rates of serum TSH were higher in lactating women than in pregnant women in both high iodine area and proper iodine area, the difference was statistically significant （FT4：Z=-6.677, -4.041, P〈0.01; TSH：Z=8.797, 8.910, P〈0.01）. In high iodine area, the abnormal rate of serum FT4 in lactating women was higher than that in pregnant women, the difference was statistically significant （Z=7.338, P=0.007）. The serum FT4 level of lactating women in high iodine area was lower than that in proper iodine area, the difference was statistically significant （Z=-4.687, P=0.000）. In high iodine area, the median serum FT4 in early pregnancy, mid-pregnancy and lat

关 键 词：碘 过量 孕妇 哺乳期妇女 甲状腺功能 

分 类 号：R173[医药卫生—妇幼卫生保健]