江苏省镇江地区妊娠期女性碘水平及甲状腺疾病患病情况的研究

王涛涛; 曹晓霞; 刘煜洲; 刘艳秋; 潘丽娟; 高琳; 夏松; 周晶晶; 俞力

doi:10.7619/jcmp.20210797

江苏省镇江地区妊娠期女性碘水平及甲状腺疾病患病情况的研究

Study on iodine level and thyroid disease prevalence of pregnant female in Zhenjiang area of Jiangsu Province

摘要

摘要:
目的分析镇江地区妊娠期女性碘营养水平及孕期甲状腺疾病患病情况，为制订孕期适宜碘营养标准提供依据。
方法通过分层整群随机抽样法，选取妊娠期女性467例。检测受试者血清游离三碘甲腺原氨酸（FT₃）、游离甲状腺素（FT₄）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）及甲状腺球蛋白抗体（TgAb）及尿碘含量。分析本地区孕妇碘水平及其甲状腺疾病的关联。
结果孕妇尿碘浓度（UIC）中位数为124.1 μg/L，孕早期（T₁期）、中期（T₂期）、晚期（T₃期）均处于轻度碘缺乏水平。T₁期亚临床甲减患病率高于T₂、T₃期，差异有统计学意义（P < 0.001）。T₂、T₃期低甲状腺素（T₄）血症患病率高于T₁期，差异有统计学意义（P < 0.05）。排除年龄、孕周等因素影响后，UIC 250~ < 500 μg/L的亚临床甲减患病风险是UIC 150~ < 250 μg/L的2.65倍（P < 0.05）；UIC≥500 μg/L的亚临床甲减患病风险是UIC 150~ < 250 μg/L的4.97倍（P < 0.05），是UIC 50~150 μg/L（轻中度碘缺乏）的3.65倍（P < 0.05）；T₁期UIC≥250 μg/L的FT₄水平低于UIC 150~ < 250 μg/L、UIC 50~150 μg/L，差异有统计学意义（P < 0.01）。
结论实施碘盐新标准后，本地区不同妊娠阶段妊娠期女性均处于轻度碘缺乏状态，UIC≥250 μg/L（尤其UIC≥500 μg/L）可显著增高妊娠期亚临床甲减患病风险，妊娠期间应保持合理碘营养水平并实施定期监测。

Abstract:
Objective To analyze the iodine nutrition level of pregnant female in Zhenjiang area and the incidence of thyroid diseases during pregnancy, so as to provide the basis for formulating the appropriate iodine nutrition standard during pregnancy.
Methods A total of 467 pregnant female were selected by stratified cluster random sampling. Serum free triiodothyronine (FT₃), free thyroxine (FT₄), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TgAb) and urinary iodine were detected. The association between iodine level and thyroid disease in pregnant female in the region was analyzed.
Results The median urinary iodine concentration (UIC) of pregnant women was 124.1 μg/L, and mild iodine deficiency was found in the first trimester (T₁ stage), second trimester (T₂ stage) and last trimester (T₃ stage) of pregnancy. The prevalence of subclinical hypothyroidism in T₁ stage was significantly higher than that in T₂ and T₃ stages (P < 0.001). The prevalence of hypothyroxinemia (T₄) in T₂ and T₃ stage was significantly higher than that in T₁ stage (P < 0.05). After controlling for age, gestational age and other factors, the risk of subclinical hypothyroidism of UIC 250~ < 500 μg/L was 2.65 times higher than that of UIC 150~ < 250 μg/L (P < 0.05); the risk of subclinical hypothyroidism with UIC≥500 μg/L was 4.97 times higher than that with UIC 150~ < 250 μg/L(P < 0.05), and 3.65 times higher than that with UIC 50~150 μg/L(mild and moderate iodine deficiency) (P < 0.05). The level of FT₄ in T₁ stage with UIC≥250 μg/L was significantly lower than that of UIC 150~ < 250 μg/L and UIC 50~150 μg/L (P < 0.01).
Conclusion After the implementation of the new standard of iodized salt, the famale in different stages of pregnancy in this region are in a state of mild iodine deficiency. UIC≥250 μg/L(especially UIC≥500 μg/L) can significantly increase the risk of subclinical hypothyroidism during pregnancy. Therefore, reasonable iodine levels and regular monitoring should be maintained during pregnancy.

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