妊娠早期孕妇血清碘和铁水平与甲状腺功能及甲状腺自身抗体的关系  

Associations of serum iodine and iron levels with thyroid function and thyroid antibodies during early pregnant women

作　　者：从相国[1] 陈欣欣 吴英[1] 曹梦蝶 李淑湘[2] 陈蕾[1] 沈琼[1] CONG Xiangguo;CHEN Xinxin;WU Ying;CAO Mengdie;LI Shuxiang;CHEN Lei;SHEN Qiong(Department of Endocrinology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China;Department of Medical Laboratory,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院内分泌科,江苏苏州215002 [2]南京医科大学附属苏州医院苏州市立医院医学检验科,江苏苏州215002

出　　处：《吉林大学学报（医学版）》2022年第4期988-994,共7页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金项目(81900714);江苏省苏州市卫健委科技项目(LCZX202009);江苏省苏州市卫健委科教兴卫青年科技项目(KJXW2021029)。

摘　　要：目的:探讨妊娠早期孕妇血清碘和铁水平与甲状腺功能及甲状腺过氧化物酶抗体(TPOAb)之间的关系,为指导妊娠早期个体化补碘补铁提供科学依据。方法:选取来本院初次产检建卡的单胎妊娠孕妇共404名,收集孕妇一般资料并检测血清中血清铁蛋白(SF)、血红蛋白(Hb)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、TPOAb和尿肌酐(UCr)水平及尿碘浓度(UIC)。孕妇根据不同碘营养水平分为碘缺乏组(UIC/UCr<150μg·g^(-1))、碘充足组(150μg·g^(-1)≤UIC/UCr<250μg·g^(-1))和碘超足量/碘过量组(UIC/UCr≥250μg·g^(-1)),根据不同铁营养水平分为铁缺乏组(SF<20μg·L^(-1))、铁充足组(20μg·L^(-1)≤SF≤150μg·L^(-1))和铁过量组(SF>150μg·L^(-1)),分别比较各组孕妇的甲状腺功能和血清TPOAb阳性率以及亚临床甲状腺功能减退(甲减)和亚临床甲状腺功能亢进(甲亢)的患病率。结果:404名孕妇血清中TSH水平中位数(四分位数)1.15 mIU·L^(-1)(0.62 mIU·L^(-1),1.63 mIU·L^(-1)),FT4水平中位数(四分位数)12.96 pmol·L^(-1)(12.06 pmol·L^(-1),13.96 pmol·L^(-1)),UIC/UCr和SF水平中位数(四分位数)分别为158.66μg·g^(-1)(106.93μg·g^(-1),239.41μg·g^(-1))和60.93μg·L^(-1)(33.86μg·L^(-1),89.61μg·L^(-1))。碘缺乏组和碘超足量/碘过量组孕妇血清中TSH水平明显高于碘充足组(P<0.05),碘超足量/碘过量组孕妇TPOAb阳性率高于碘缺乏组和碘充足组(P<0.05),3组孕妇血清中FT4水平比较差异无统计学意义(P>0.05);铁缺乏组孕妇血清中TSH水平和TPOAb阳性率高于铁充足组和铁过量组(P<0.05),铁缺乏组孕妇血清中FT4水平低于铁过量组(P<0.05)。碘缺乏组和碘超足量/碘过量组孕妇亚临床甲减患病率高于碘充足组(P<0.05);铁缺乏组孕妇亚临床甲减患病率高于铁充足组和铁过量组(P<0.05),铁过量组孕妇亚临床甲亢患病率高于铁缺乏组和铁充足组(P<0.05)。相关性分析,孕妇UIC/UCr比值与TSH和FT4水平无相�Objective:To explore the relationships between the serum iodine and iron levels and the thyroid function and thyroid peroxidase antibodies(TPOAb)in the pregnant women during the early pregnancy,and to provide a scientific basis for guiding the individualized iodine and iron supplementation.Methods:A total of 404 pregnant women during early pregnancy in our hospital were enrolled.The general information of patients was collected;the levels of serum ferritin(SF),haemoglobin(Hb),free thyroxine(FT4),thyroid-stimulating hormone(TSH),TPOAb,urinary creatinine(UCr)and urinary iodine concentration(UIC)were measured in the pregnant women.The pregnant women were divided into iodine deficiency group(UIC/UCr<150μg·g^(-1)),idodine adequate group(150μg·g^(-1)≤UIC/UCr<250μg·g^(-1))and more-than-adequate/excessive iodine group(UIC/UCr≥250μg·g^(-1))according to the different idodine levels.The pregnant women were divided into iron deficiency group(SF<20μg·L^(-1)),iron adequate group(20μg·L^(-1)≤SF<150μg·L^(-1))and iron excess group(SF≥150μg·L^(-1))according the different iron levels.The thyroid function,the serum TPOAb positive rates and the prevalence of subclinical hypothyroidism and subclinical hyperthyroidism of the pregnant women in various groups were compared.Results:The median of TSH,FT4,UIC/UCr and SF of 404 pregnant women were 1.15 mIU·L^(-1)(0.62 mIU·L^(-1),1.63 mIU·L^(-1)),12.96 pmol·L^(-1)(12.06 pmol·L^(-1),13.96 pmol·L^(-1)),158.66μg·g^(-1)(106.93μg·L^(-1),239.41μg·L^(-1))and 60.93 mg·L^(-1)(33.86μg·L^(-1),89.61μg·L^(-1)).The serum TSH levels of pregnant women in iodine deficiency group and more-than-adequate/excessive iodine group were higher than that in iodine adequate group(P<0.05).The TPOAb positive rate in more-than-adequate/excessive iodine group was higher than those in iodine deficiency group and iodine adequate group(P<0.05);the FT4 levels had no significant differences among various groups(P>0.05).The serum TSH levels and the TPOAb positive rate of pregnant women in

关 键 词：妊娠早期 甲状腺功能 甲状腺过氧化物酶抗体 尿碘/尿肌酐比值 血清铁蛋白 

分 类 号：R714.1[医药卫生—妇产科学] R581[医药卫生—临床医学]