改水对高水碘地区孕妇碘营养状况及甲状腺功能的影响  

The effect of water improvement on iodine nutritional status and thyroid function of pregnant women in areas with high water iodine level

作　　者：张可心 程元贵 武文 张鼎言 蒋雯[3] 王晓明[3] 董淑瑶 张万起[1,4,5] Zhang Kexin;Cheng Yuangui;Wu Wen;Zhang Dingyan;Jiang Wen;Wang Xiaoming;Dong Shuyao;Zhang Wanqi(Department of Nutrition and Food Hygiene,School of Public Health,Tianjin Medical University,Tianjin 300070,China;Gaoqing County People1s Hospital,Gaoqing 256300,China;Shandong Institute for Endemic Disease Control,Jinan 250014,China;Key Laboratory of Environmental Nutrition and Public Health,Tianjin International Cooperative Research Center for Environmental Nutrition and Public Health,Tianjin 300000,China;Department of Endocrinology and Metabolism,Afiliated Hospital of Tianjin Medical University,Tianjin 300000,China)

机构地区：[1]天津医科大学公共卫生学院营养与食品卫生系,天津300070 [2]山东省高青县人民医院,高青256300 [3]山东省地方病防治研究所,济南250014 [4]天津市环境营养与公共卫生国际合作研究中心环境营养与公共卫生重点实验室,天津300000 [5]天津医科大学附属医院内分泌代谢科,天津300000

出　　处：《中华地方病学杂志》2023年第6期447-452,共6页Chinese Journal of Endemiology

摘　　要：目的探讨高水碘地区改换低碘饮用水后对孕妇碘营养状况和甲状腺功能的影响。方法采用横断面调查,在水源性高水碘地区山东省淄博市高青县,以2019-2021年于山东省高青县人民医院产科门诊进行产检的孕妇为调查对象;参照《水源性高碘地区和高碘病区的划分标准》(GB/T 19380-2016),以孕妇饮用水水碘>100μg/L为高水碘组,≤100μg/L为非高水碘组。采集孕妇基本信息、空腹血样、一次随意尿样、24 h尿样及饮用水水样,并对孕妇进行甲状腺B超检查。采用电感耦合等离子体质谱法检测尿碘(UI)浓度(UIC)、饮用水水碘浓度(WIC),并计算24 h尿碘排泄量(UIE)和孕妇每日碘摄入量(TII);全自动化学发光免疫检测法检测血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)水平;去蛋白终点微孔板法测定尿肌酐(CR),计算UI/CR。结果共纳入孕妇797名,UIC为150.2(88.1,281.3)μg/L,碘营养总体处于适宜水平。其中,非高水碘组孕妇584名,UIC为120.9(74.9,191.5)μg/L,处于碘缺乏水平;高水碘组孕妇213名,UIC为321.1(201.9,569.1)μg/L,处于碘超适宜水平;两组孕妇WIC、UIC、UIE、TII、UI/CR比较,差异均有统计学意义(Z=21.63、13.34、15.14、15.14、11.81,均P<0.001)。按不同孕期分层后,非高水碘组孕妇WIC、TSH和高水碘组孕妇UI/CR不同孕期间比较,差异均有统计学意义(H=59.13、7.30、13.60,均P<0.05)。共检测744名孕妇甲状腺功能,检出TSH>2.5 mU/L 128例、低甲状腺素血症15例、亚临床甲状腺功能减退症19例,检出率分别为17.2%、2.0%、2.6%;高水碘组和非高水碘组孕妇TSH、TPOAb水平及TSH>2.5 mU/L孕妇比例比较,差异均有统计学意义(Z=3.04、-2.17,χ^(2)=6.94,P=0.002、0.030、0.008)。检查孕妇甲状腺720例,检出甲状腺肿大30例、甲状腺结节150例,检出率分别为4.2%、20.8%;高水碘组和非高水�Objective To investigate the impact of switching to low iodine drinking water in areas with high water iodine levels on the iodine nutritional status and thyroid function of pregnant women.Methods A cross sectional survey was conducted in Gaoqing County,Zibo City,Shandong Province.Pregnant women who underwent prenatal examinations at the Obstetrics Clinic of Gaoqing County People's Hospital from 2019 to 2021 were selected as the survey subjects.With reference to the Criteria for the Classification of Water Source High Iodine Areas and High Iodine Disease Areas(GB/T 19380-2016),pregnant women with drinking water iodine>100μg/L were considered as the high water iodine group and≤100μg/L was the non-high water iodine group.Basic information,one random urine sample,fasting blood sample,24-hour urine sample and drinking water sample of pregnant women were collected,and thyroid ultrasound examination was performed on pregnant women.Urinary iodine(UI)concentration(UIC)and drinking water iodine concentration(WIC)were measured by inductively coupled plasma mass spectrometry,and 24-hour urinary iodine excretion(UIE)and daily iodine intake(TII)of pregnant women were calculated.Serum thyroid hormone(TSH),free triodothyronine(FT:),free thyroxine(FTa),thyroid peroxidase antibody(TPOAb)and anti-thyroid autoantibodies(TgAb)were determined by automatic chemiluminescence immunoassay.Creatinine(CR)was determined using deproteinized endpoint microplate method and UI/CR was calculate.Results A total of 797 pregnant women were included,and the UIC was 150.2(88.1,281.3)μg/L,the iodine nutrition was generally at an appropriate level.Among them,584 pregnant women in the non-high water iodine group had a UIC of 120.9(74.9,191.5)μg/L,which was at the iodine deficiency level;213 pregnant women in the high water iodine group had a UIC of 321.1(201.9,569.1)μg/L,which was at the iodine super-appropriate level;the differences in WIC,UIC,UIE,TII,and UI/CR between the two groups were statistically significant(Z=21.63,13.34,15.14,15.14,11.81

关 键 词：碘 尿 饮水 孕妇 碘营养状况 甲状腺功能 

分 类 号：R153.1[医药卫生—营养与食品卫生学]