不同妊娠期孕妇血清甲状腺激素变化及与碘营养关系  

Change of the serum thyroid hormone level of pregnant women in different gestational weeks and its correlation with iodine nutrition

作　　者：路春梅[1] 赵云刚[2] 杨旭[1] 范春燕[1] LU Chunmei;ZHAO Yungang;YANG Xu;FAN Chunyan(The First Hospital of Qinhuangdao, Hebei Province, 066000;Haigang hospital of Qinhuangdao)

机构地区：[1]河北省秦皇岛市第一医院,066000 [2]河北省秦皇岛市海港医院

出　　处：《中国计划生育学杂志》2020年第12期2088-2092,共5页Chinese Journal of Family Planning

基　　金：秦皇岛科技局课题(201602A169)。

摘　　要：目的:分析不同妊娠期孕妇血清甲状腺激素水平变化及与碘营养关系。方法:选取2017年9月—2019年12月于本院产前检查妇女370例,分为妊娠早期(妊娠≤12+6周)、妊娠中期(妊娠13~27+6周)、妊娠晚期(妊娠28~40周),同期健康体检非妊娠妇女100例为对照组。比较各妊娠期孕妇及对照组妇女甲状腺功能指标,记录孕妇碘营养状况并分析与甲状腺激素水平关系。结果:中期组及晚期组尿碘水平低于早期组,轻度碘缺乏比例高于早期组(P<0.05);TPOAb阳性率早期组(11.5%)、中期组(13.7%)、晚期组(11.9%)均高于对照组(1.0%),FT4、FT3水平中期组和晚期组均低于对照组,TSH水平早期组和中期组均低于对照组(均P<0.05);370例孕妇中21.4%存在甲状腺功能异常,甲亢、亚甲亢、甲减、亚甲减及低T4血症患病率分别为12.7%、17.7%、39.2%、16.5%、15.2%。妊娠晚期组碘过量孕妇发生亚甲减比例高于碘适量组(P<0.001)。经非条件多因素logistic回归模型分析,TPOAb阳性是影响妊娠晚期妇女碘营养异常的独立危险因素(P<0.05)。结论:妊娠中、晚期孕妇存在轻度碘缺乏现象,随着妊娠期延长,碘缺乏呈加重趋势;TPOAb阳性是影响妊娠期孕妇碘营养异常的独立危险因素,临床对合并TPOAb阳性孕妇需严密检测其妊娠期、甚至产后甲状腺功能变化,避免甲状腺疾病的发生及影响胎儿神经智力发育。Objective:To analyze the change of the serum thyroid hormone level of pregnant women in different gestational weeks,and to study its correlation with iodine nutrition.Method:370 pregnant women were selected and were divided into group A(women with≤12+6 gestational weeks),group B(women with 13-27+6 gestational weeks),and group C(women with 28-40 gestational weeks)from September 2017 to December 2019.100 healthy women were selected in control group during the same time.The thyroid functional parameters of these women were compared among the four groups.The status of iodine nutrition of these women was recorded,and the relationship between their statuses of iodine nutrition and their thyroid hormone levels was analyzed.Results:The urine iodine level of women in group B and Group C was significant lower than that of women in group A,and the proportion of mild iodine deficiency of women in group B and Group C was significant higher than that of women in group A(P<0.05).TPOAb positive rate of women in group A(11.5%),in group B(13.7%),and in group C(11.9%)were all significant higher than that(1.0%)of women in the control group.The FT4 and FT3 levels of women in group B and C were significant lower than those of women in the control group,and the TSH level of women in group A and B was significant lower than that of women in the control group(all P<0.05).Among the 370 pregnant women,21.4%women had abnormal thyroid function,and the morbidity rates of hyperthyroidism,hyperthyroidism,hypothyroidism,hypothyroidism,and low T4 level were 12.7%,17.7%,39.2%,16.5%,and 15.2%,respectively.Among the pregnant women in group C,the proportion of subthyroidism of women with excessive iodine was significant higher than that of women with adequate iodine(P<0.001).The non-conditional multivariate logistic regression model analysis had showed that positive TPOAb was an independent risk factor of iodine nutrition abnormalities of pregnant women during the third trimester of pregnancy(P<0.05).Conclusion:There are some pregnant women with mi

关 键 词：妊娠 碘营养 甲状腺功能 甲状腺过氧化物酶抗体 尿碘 

分 类 号：R714.256[医药卫生—妇产科学]