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2022, 05, v.13 53-58
妊娠早期妇女碘营养状况及其与甲状腺功能关系的研究
基金项目(Foundation): 中国疾病预防控制中心妇幼保健中心2020年度“母婴营养与健康研究项目”(2020FYH018)
邮箱(Email): yangjingchangji@126.com;
DOI: 10.19757/j.cnki.issn1674-7763.2022.05.012
摘要:

目的 探讨陕西西安地区妊娠早期妇女碘营养状况及其与甲状腺功能的关系。方法 选取2020年11月—2021年5月在陕西西安地区西北妇女儿童医院产科门诊产检的6 510例妊娠早期妇女作为研究对象,测定其尿碘含量及血促甲状腺激素(thyroid stimulating hormone,TSH)、总三碘甲状腺原氨酸(total triiodothyronine,TT3)、总甲状腺素(total thyroxine,TT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)及甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)水平。比较不同碘营养水平的妊娠早期妇女的甲状腺功能及疾病检出率的差异,探讨二者的关联性。结果 陕西西安地区妊娠早期妇女尿碘中位数为216.15μg/L。随着尿碘水平的增高,FT3、FT4、TT3、TT4水平随之增高,TgAb阳性率随之下降,差异均有统计学意义(均P <0.05)。进一步行多因素logistic回归分析得出碘缺乏可使TgAb阳性率增加(OR=1.413,95%CI:1.086~1.839)。不同碘营养水平的妊娠早期妇女TSH、TPOAb及甲状腺疾病检出率差异均无统计学意义(均P> 0.05)。碘营养水平并非甲状腺疾病的影响因素(P> 0.05)。结论 陕西西安地区妊娠早期妇女处于碘充足水平,碘营养水平与甲状腺疾病检出情况无明显相关性,碘缺乏是TgAb阳性发生的危险因素。

Abstract:

Objective To explore the association between iodine nutritional status and thyroid function among women at first trimester of pregnancy in Xi'an.Methods Totally 6 510 pregnant women who registered at obstetric outpatient clinic, Northwest Women's and Children's Hospital were recruited as study subjects. Urinary iodine concentration and blood thyroid stimulating hormone(TSH), total triiodothyronine(TT4), total thyroxine(TT3), free triiodothyronine(FT3), free thyroxine(FT4), thyroid peroxidase antibody(TPOAb), thyroglobulin antibody(TgAb) were tested in order to compare the difference of thyroid function and disease prevalence at different iodine nutrition levels and explore their association.Results The median urine iodine(MUI) of early pregnant women in Xi'an was 216. 15 μg/L. With the increase of urine iodine level, the levels of FT3, FT4, TT3 and TT4 increased and the positive rate of TgAb decreased significantly(all P < 0. 05). Further multivariate Logistic regression analysis showed that iodine deficiency could increase the positive rate of TgAb(OR = 1. 413, 95% CI: 1. 086-1. 839). There was no significant difference in TSH, TPOAb and the prevalence of thyroid diseases among different iodine nutrition levels(all P > 0. 05). Iodine nutrition level was not the factor associated with thyroid diseases(P > 0. 05).Conclusion Iodine is adequate among pregnant women at first trimester of pregnancy in Xi'an. There is no association between iodine nutrition and thyroid diseases. Iodine deficiency is a risk factor for TgAb positive.

参考文献

[1] Gnocchi D, Steffensen KR, Bruscalupi G, et al. Emerging role of thyroid hormone metabolites[J]. Acta Physiol(Oxf),2016,217(3):184-216.

[2] Bertinato J. Iodine nutrition:disorders, monitoring and policies[J]. Adv Food Nutr Res,2021,96:365-415.

[3] Chen R, Li Q, Cui W, et al. Maternal iodine insufficiency and excess are associated with adverse effects on fetal growth:a prospective cohort study in Wuhan,China[J]. J Nutr,2018,148(11):1814-1820.

[4] Zhai X, Zhang L, Chen L, et al. An age-specific serum thyrotropin reference range for the diagnosis of thyroid diseases in older adults:a cross-sectional survey in China[J]. Thyroid,2018,28(12):1571-1579.

[5] Instanes JT, Halmoy A, Engeland A, et al. Attentiondeficit/hyperactivity disorder in offspring of mothers with inflammatory and immune system diseases[J]. Biol Psychiatry,2017,81(5):452-459.

[6] WHO,ICCIDD,UNICEF. Assessment of iodine deficiency disorders and monitoring their elimination:a guide for programme managers(Third Edition)[R]. Geneva:WHO,2007.

[7]《妊娠和产后甲状腺疾病诊治指南》(第2版)编撰委员会,中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南(第2版)[J].中华围产医学杂志,2019,35(8):505-539.

[8] Ashoor G, Maiz N, Rotas M, et al. Maternal thyroid function at 11-13 weeks of gestation and spontaneous preterm delivery[J]. Obstet Gynecol,2011,117(2 Pt1):293-298.

[9] Emder PJ, Jack MM. Iodine-induced neonatal hypothyroidism secondary to maternal seaweed consumption:a common practice in some Asian cultures to promote breast milk supply[J]. J Paediatr Child Health,2011,47(10):750-752.

[10] Trumpff C, De Schepper J, Tafforeau J, et al. Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children:a review[J]. J Trace Elem Med Biol,2013,27(3):174-183.

[11] Yang L, Li M, Liu X, et al. Evaluation of iodine nutritional status among pregnant women in China[J].Thyroid,2020,30(3):443-450.

[12] Gutvirtz G, Walfisch A, Wainstock T, et al. Maternal hypothyroidism and future pediatric neurological morbidity of the offspring[J]. Arch Gynecol Obstet,2019,299(4):975-981.

[13] Hwang S, Lee EY, Lee WK, et al. Correlation between iodine intake and thyroid function in subjects with normal thyroid function[J]. Biol Trace Elem Res,2011,143(3):1393-1397.

[14] Soldin OP, Tractenberg RE, Pezzullo JC. Do thyroxine and thyroid-stimulating hormone levels reflect urinary iodine concentrations?[J]. Ther Drug Monit,2005,27(2):178-185.

[15]王晓雪,贾方,田晶,等.妊娠期碘营养、甲状腺自身抗体与甲状腺功能关系的研究[J].中华内分泌代谢杂志,2014,30(5):408-410.

[16]陈小娟,邱敏娟,高飞,等.广州地区孕妇尿碘水平与甲状腺功能减退的相关性分析[J].现代检验医学杂志,2019,34(2):119-121, 124.

[17] Eastman CJ, Ma G, Li M. Optimal assessment and quantification of iodine nutrition in pregnancy and lactation:laboratory and clinical methods, controversies and future directions[J]. Nutrients,2019,11(10):2378.

[18] Rohner F, Zimmermann M, Jooste P, et al. Biomarkers of nutrition for development--iodine review[J]. J Nutr,2014,144(8):S1322-S1342.

[19] Zhang X, Yuan N, Sun J, et al. Association between iodine nutritional status and adverse pregnancy outcomes in Beijing, China:a single-center cohort study[J]. Biol Trace Elem Res,2022,200(6):2620-2628.

[20] Chen X, Wu C, Wang Z, et al. Iodine nutrition status and thyroid autoimmunity during pregnancy:a crosssectional study of 4 635 pregnant women[J]. Nutr J,2022,21(1):7.

[21] Andersen S, Iversen F, Terpling S, et al. Iodine deficiency influences thyroid autoimmunity in old age-a comparative population-based study[J].Maturitas,2012, 71(1):39-43.

基本信息:

DOI:10.19757/j.cnki.issn1674-7763.2022.05.012

中图分类号:R153.1

引用信息:

[1]韩程成,续靖宁,王小凤等.妊娠早期妇女碘营养状况及其与甲状腺功能关系的研究[J].中国妇幼卫生杂志,2022,13(05):53-58.DOI:10.19757/j.cnki.issn1674-7763.2022.05.012.

基金信息:

中国疾病预防控制中心妇幼保健中心2020年度“母婴营养与健康研究项目”(2020FYH018)

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