鲁西南地区孕晚期孕妇的碘营养状态及其对孕妇心电活动的影响  

The iodine nutritional status of pregnant women in the third trimester in the Southwest of Shandong Province and its impact on their cardiac electrical activity

作　　者：吕新[1] 韩晓云[2] 刘苏城 李良军[1] 姜炜炜[1] 李泉 公海涛 王广兴 刘儒涛 Lyu Xin;Han Xiaoyun;Liu Sucheng;Li Liangjun;Jiang Weiwei;Li Quan;Gong Haitao;Wang Guangxing;Liu Rutao(Electrocardiogram Diagnosis Department,Affiliated Hospital of Jining Medical University,Jining 272029,China;Obstetrics Department,Affiliated Hospital of Jining Medical University,Jining 272029,China;Public Health Department,Affiliated Hospital of Jining Medical University,Jining 272029,China;Emergency Department,Heze Municipal Hospital,Heze 274000,China;Emergency Department,Zaozhuang Municipal Hospital,Zaozhuang 277000,China)

机构地区：[1]济宁医学院附属医院心电诊断科,济宁272029 [2]济宁医学院附属医院产科,济宁272029 [3]济宁医学院附属医院公共卫生处,济宁272029 [4]菏泽市立医院急诊科,菏泽274000 [5]枣庄市立医院急诊科,枣庄277000

出　　处：《中华地方病学杂志》2023年第9期742-747,共6页Chinese Journal of Endemiology

基　　金：济宁市重点研发计划(软科学项目,2021JNZC038)。

摘　　要：目的了解鲁西南地区孕晚期孕妇的碘营养状态,分析其对孕妇心电活动的影响,为孕期科学补碘提供依据。方法2021年1月至2022年6月,采用整群随机抽样方法行横断面调查,根据纳入排除标准,在鲁西南3个地市的3所三级医院分别选取孕晚期孕妇200例,设为孕晚组(n=600);分别选取非孕期女性100例,设为对照组(n=300)。采用砷铈催化分光光度法检测受试者的尿碘含量,依据尿碘中位数(MUIC)将孕晚组孕妇再分组:碘缺乏亚组(G1亚组,MUIC<150μg/L),碘过量亚组(G2亚组,MUIC≥500μg/L),碘适量亚组(G3亚组,150μg/L≤MUIC<500μg/L)。采用化学发光免疫分析法检测受试者的血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)水平。使用12导联体表心电图机检测受试者的心电指标。结果鲁西南3个地市间孕晚组孕妇、对照组非孕期女性尿碘水平比较差异均无统计学意义(H=3.63、3.27,均P>0.05)。孕晚组中,G1、G2、G3亚组孕妇构成比分别为27.67%(166/600)、6.83%(41/600)、65.50%(393/600),各亚组和对照组间孕妇尿碘水平比较差异有统计学意义(H=11.56,P<0.001)。G2亚组血清FT3、FT4水平均低于G1和G3亚组(均P<0.001),但3个亚组血清TSH水平比较,差异均无统计学意义(均P>0.05)。G1、G2、G3亚组和对照组ECG正常率分别为38.55%(64/166)、41.46%(17/41)、92.37%(363/393)、95.33%(286/300),各组间比较差异有统计学意义(χ^(2)=461.25,P<0.001),G1、G2亚组ECG正常率均低于对照组(均P<0.001)。孕晚组的异常ECG以短P-R间期、ST-T改变最为多见。结论鲁西南地区孕晚期孕妇碘缺乏、碘过量等碘营养状态异常发生率较高,由此所致的短P-R间期、ST-T改变等心律失常较为多见,应加强孕期碘营养状态和ECG的监测,及时调整补碘等干预策略。Objective To study the iodine nutritional status of pregnant women in the third trimester in the Southwest of Shandong Province,analyze its impact on their cardiac electrical activity,and provide a basis for scientific supplementation of iodine during pregnancy.Methods From January 2021 to June 2022,a cross-sectional survey was conducted using cluster random sampling method.According to the inclusion and exclusion criteria,200 pregnant women in the third trimester were selected from 3 tertiary hospitals in three cities in the Southwest of Shandong Province,and were divided into the third trimester group(n=600),and 100 non-pregnant women were selected as the control group(n=300).The urinary iodine content was detected by arsenic-cerium catalytic spectrophotometry,and the pregnant women in the third trimester group were subdivided into iodine deficiency subgroup[G1 subgroup,median urinary iodine(MUIC)<150μg/L]based on the MUIC,iodine excess subgroup(G2 subgroup,MUIC≥500μg/L)and moderate iodine subgroup(G3 subgroup,150μg/L≤MUIC<500μg/L).Chemiluminescence immunoassay was used to measure the serum levels of thyroid-stimulating hormone(TSH),free thyroxine(FT4)and free triiodothyronine(FT3).The cardiac electrical indexes were detected by a 12-lead surface electrocardiogram(ECG)machine.Results There was no statistically significant difference in urinary iodine levels between pregnant women in the third trimester group and non-pregnant women in the control group among the 3 tertiary hospitals in the Southwest of Shandong Province(H=3.63,3.27,P>0.05).In the third trimester group,the proportion of pregnant women in the G1,G2 and G3 subgroups was 27.67%(166/600),6.83%(41/600)and 65.50%(393/600),respectively.There was a statistically significant difference in urinary iodine levels between the subgroups and the control group(H=11.56,P<0.001).The serum FT3 and FT4 levels in the G2 subgroup were lower than those in the G1 and G3 subgroups(P<0.001),but there was no statistically significant difference in serum TSH levels

关 键 词：孕妇 孕晚期 碘 甲状腺 心电图 

分 类 号：R153.1[医药卫生—营养与食品卫生学]