本文選題：高碘 + 適碘�。� 參考：《南京醫(yī)科大學(xué)》2014年博士論文

【摘要】：第一部分 江蘇高碘和適碘地區(qū)孕婦不同孕期的甲狀腺疾病患病特征調(diào)查 背景妊娠合并甲狀腺疾病在臨床上十分常見,妊娠本身可影響甲狀腺疾病的發(fā)展,未得到控制的甲狀腺疾病亦可影響正常的妊娠結(jié)局。由于甲狀腺激素保證是胎兒神經(jīng)系統(tǒng)發(fā)育的重要激素,故在妊娠期發(fā)生甲狀腺功能改變或亞臨床甲狀腺功能異常,不僅會(huì)導(dǎo)致不良妊娠結(jié)局,亦可影響后代智力發(fā)育和認(rèn)知功能,甚至引起后代代謝性疾病發(fā)病風(fēng)險(xiǎn)增高,如糖尿病等。 目的為了了解高碘和適碘地區(qū)孕婦甲狀腺疾病患病情況,本課題組自2008年8月至2010年3月在江蘇省徐州市豐縣和凌城兩地對(duì)不同妊娠期的孕婦進(jìn)行了甲狀腺疾病的篩查。 對(duì)象和方法本研究的對(duì)象來自高碘區(qū)豐縣婦幼保健院和適碘區(qū)凌城中心醫(yī)院進(jìn)行早期妊娠確認(rèn)的當(dāng)?shù)卦袐D,共納入396名17-40歲的早孕女性,進(jìn)行問卷調(diào)查、體格檢查、留取血樣進(jìn)行甲狀腺功能及自身抗體測(cè)定,相關(guān)數(shù)據(jù)錄入Epidata數(shù)據(jù)庫,利用STATA10.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果兩地孕婦年齡無差別,各孕期測(cè)得的高血壓發(fā)生率和體重均無顯著差異,妊娠早期輕度嘔吐反應(yīng)情況亦相似,兩地孕婦的一般資料具有同質(zhì)性。高碘地區(qū)孕婦妊娠早期的FT3、FT4、TT4顯著低于適碘地區(qū),TSH顯著高于適碘地區(qū),孕中期高碘地區(qū)孕婦的TT4顯著低于適碘地區(qū),其余甲狀腺功能相關(guān)指標(biāo)在兩地孕婦中無差異。兩地孕婦的FT3、FT4隨孕周增加而下降。在整個(gè)孕期中,兩地孕婦甲狀腺疾病總體患病率為62.44%(246/394),疾病種類包括甲狀腺機(jī)能亢進(jìn)癥(甲亢),甲狀腺機(jī)能減退癥(甲減),亞臨床甲亢,亞臨床甲減,第T4血癥和TPOAb陽性。其中,高碘地區(qū)孕婦各類甲狀腺疾病的患病率為67.45%(201/298),而適碘地區(qū)為46.88%(45/96),χ,2為13.106,P值為0.000,提示高碘地區(qū)孕婦甲狀腺疾病患病率顯著高于適碘地區(qū),主要體現(xiàn)在孕早期。在妊娠早期和中期,各類甲狀腺疾病患病率在兩地孕婦中無差別,孕晚期適碘地區(qū)孕婦甲減患病率顯著高于高碘地區(qū)。江蘇省高碘地區(qū)孕婦妊娠早期甲狀腺功能參考范圍為FT33.29-5.99pmol/L, FT414.09-21.62pmol/L, TT468.97-197.03nmol/L, TSH0.12-2.40μIU/ml。用正常人群參考范圍作為診斷標(biāo)準(zhǔn)時(shí),在診斷甲減、亞臨床甲減和低T4血癥時(shí)敏感性均顯著低于妊娠特異性參考范圍,在妊娠早期體現(xiàn)特別顯著。以TT4代替FT4作為診斷低T4血癥的指標(biāo)時(shí),其診斷敏感性偏低。 結(jié)論高碘地區(qū)孕婦甲狀腺疾病總體患病率顯著高于適碘地區(qū),妊娠早期高碘地區(qū)孕婦甲狀腺疾病的患病率高于適碘地區(qū),但差異無統(tǒng)計(jì)學(xué)差異。用正常人群甲狀腺功能參考范圍診斷妊娠甲狀腺疾病會(huì)遺漏大部分甲狀腺功能不足的孕婦,特別是妊娠早期。TT4診斷低T4血癥的效能低于FT4。 第二部分 南京地區(qū)孕期特異性甲狀腺功能正常參考值范圍的研究 目的確立南京地區(qū)女性孕期特異性甲狀腺功能正常參考值范圍,比較新舊參考值范圍下孕期各甲狀腺功能異�；疾∏闆r的差異。 方法選取2012年7月至11月孕檢的育齡期婦女,其中,孕早期288例、孕中期255例、孕晚期262例,另設(shè)非妊娠育齡女性282例為對(duì)照組,受試者簽署知情同意書,填寫調(diào)查問卷表,留取受試者清晨血、尿標(biāo)本,利用化學(xué)發(fā)光法測(cè)甲狀腺功能(TSH、FT3、FT4、TT3、TT4, TPO-Ab),砷鈰催化法定量測(cè)量尿碘,四類人群分別抽取其中TPOAb陰性,碘營養(yǎng)正常,既往無甲狀腺疾病個(gè)人史、家族史,無雌激素、甲狀腺激素、抗甲狀腺藥物等用藥史,無嚴(yán)重肝功能、腎功能、心功能異常病的受試者各132例、124例、127例和125例,算得甲狀腺功能各指標(biāo)2.5%-97.5%可信區(qū)間,比較新舊參考值范圍下孕期各甲狀腺功能異�；疾∏闆r差異。 結(jié)果南京地區(qū)孕期特異性甲狀腺功能正常參考值范圍為：孕早期,TSH：0.02-3.78mIU/1, FT4:13.93-26.49pmol/1, TT4:103.39-319.43nmol/1;孕中期,TSH:0.47-3.89mIU/1, FT4:12.33-19.33pmol/1, TT4:92.28-234.88nmol/1;孕晚期：TSH:0.55-4.91mIU/1, FT4:11.38-19.21pmol/1, TT4:83.54-258.12nmol/1；對(duì)照組:TSH:0.76-4.88mIU/1, FT4:13.04-22.18pmol/1, TT4:75.70-175.76nmol/1,使用ATA推薦的孕期TSH參考范圍,南京地區(qū)亞臨床甲狀腺功能減退癥檢出率為12.42%,甲狀腺功能減退癥檢出率為0.50%,亞臨床甲狀腺功能亢進(jìn)癥檢出率為0.99%,甲狀腺功能亢進(jìn)癥檢出率為1.61%,低T4血癥檢出率為0.99%,TPO-Ab陽性檢出率為11.80%；以本研究所得新標(biāo)準(zhǔn)為正常范圍,上述各類型甲狀腺功能異常的檢出率則分別變?yōu)?.99%、0.25%、1.61%、0.37%、8.81%,相比之下,亞臨床甲狀腺功能減退、甲狀腺功能亢進(jìn)癥檢出率較下降,而低T4血癥檢出率則升高。 結(jié)論孕期特異性甲狀腺功能正常參考值范圍較ATA推薦標(biāo)準(zhǔn)存在差異,各地區(qū)實(shí)驗(yàn)室需建立獨(dú)立的孕期特異性甲狀腺功能正常參考值范圍。
[Abstract]:Part one
Prevalence of thyroid diseases in pregnant women with iodine deficiency and iodine deficiency in Jiangsu
Background pregnancy with thyroid disease is very common clinically. Pregnancy itself can affect the development of thyroid diseases. Uncontrolled thyroid diseases can also affect normal pregnancy outcomes. Thyroid function changes or subclinical armour may occur during pregnancy due to thyroid hormone assurance as an important hormone in the development of the fetal nervous system. Abnormal glandular function can not only lead to bad pregnancy outcome, but also affect the intellectual development and cognitive function of offspring, and even increase the risk of metabolic diseases in future generations, such as diabetes.
Objective in order to understand the prevalence of thyroid diseases in pregnant women in high iodine and iodized areas, the subjects were screened from August 2008 to March 2010 in Fengxian County and Lingcheng, Xuzhou, Jiangsu, on the thyroid diseases of pregnant women in different pregnancy periods.
Object and methods: the subjects of this study were from the local pregnant women of Fengxian County maternal and child health care hospital of high iodine district and Lingcheng Central Hospital for early pregnancy confirmation. A total of 396 women aged 17-40 years of early pregnancy were included in the study. A questionnaire survey, physical examination, blood samples were taken to determine the thyroid function and autoantibodies. The related data were recorded in the Epidata database. STATA10.0 software was used for statistical analysis.
Results there was no difference in age between the two pregnant women. There was no significant difference in the incidence of high blood pressure and weight during pregnancy. The mild vomiting reaction in early pregnancy was similar. The general data of pregnant women in both places were homogeneity. The FT3, FT4 and TT4 in the early pregnancy of pregnant women in high iodine region were significantly lower than those in the area of iodine, and the TSH was significantly higher than that in the area of iodide, high iodine in the middle of pregnancy. The TT4 of pregnant women in the region was significantly lower than that in the area of iodine. The other thyroid function related indexes were not different among the two pregnant women. The FT3 and FT4 decreased with the increase of gestational age in both pregnant women. In the whole pregnancy, the overall prevalence rate of thyroid disease was 62.44% (246/394) in two pregnant women, and the type of disease included hyperthyroidism (hyperthyroidism) and thyroid function. Hypothyroidism (hypothyroidism), subclinical hyperthyroidism, subclinical hypothyroidism, subclinical hypothyroidism, T4 and TPOAb positive. Among them, the prevalence of thyroid diseases in pregnant women in high iodine areas was 67.45% (201/298), while iodine was 46.88% (45/96), Chi, 2, 13.106 and 0, indicating that the prevalence of thyroid disease in pregnant women in high iodine areas was significantly higher than that in the area of iodine. In the early and mid trimester of pregnancy, there was no difference in the prevalence of all kinds of thyroid diseases among the two pregnant women. The incidence of hypothyroidism in pregnant women in the late pregnant areas was significantly higher than that in the high iodine areas. The thyroid function reference range of pregnant women in high iodine areas in Jiangsu province was FT33.29-5.99pmol/L, FT414.09-21.62pmol/L, TT468.97-197.03nmol/L, TS. The sensitivity of H0.12-2.40 mu IU/ml. to the diagnosis of hypothyroidism, subclinical hypothyroidism and hypothyroidism in the diagnosis of hypothyroidism, subclinical hypothyroidism and hypothyroidism was significantly lower than that of pregnancy specific reference, especially in the early pregnancy. The sensitivity of TT4 to the diagnosis of low T4 was lower than that of FT4 as an indicator of FT4 for the diagnosis of hypothyroidism.
Conclusion the overall prevalence rate of thyroid diseases in pregnant women in high iodine areas is significantly higher than that in the area of iodine. The prevalence of thyroid diseases in pregnant women with high iodine in early pregnancy is higher than that in the area of iodine - suitable, but there is no difference in the difference. In women, especially in early pregnancy, the efficacy of.TT4 in diagnosing low T4 is lower than that in FT4..
The second part
Study on the reference range of specific thyroid function during pregnancy in Nanjing area
Objective to establish the normal range of normal thyroid function reference values for women during pregnancy in Nanjing, and to compare the differences of the abnormal thyroid function in the pregnant period of the new and old reference values.
Methods the women of childbearing age from July 2012 to November were selected, including 288 cases of early pregnancy, 255 cases in the middle of pregnancy, 262 cases in the late pregnancy, and 282 cases of non pregnant women of childbearing age as the control group. The subjects signed the informed consent book, filled out the questionnaire, left the subjects in the morning blood, urine specimens, and measured the thyroid function by chemiluminescence (TSH, FT3, FT4, TT). 3, TT4, TPO-Ab), the arsenic cerium catalysis method was used to measure urine iodine quantitatively. The four groups were divided into 132 cases, 132 cases, 124 cases, 127 cases and 125 of the subjects without serious liver function, renal function, and heart function disorder. The 2.5%-97.5% confidence interval of each index of thyroid function was calculated, and the difference of thyroid function abnormality during pregnancy was compared between the old and new reference values.
Results the normal reference value of normal thyroid function during pregnancy in Nanjing was: early pregnancy, TSH:0.02-3.78mIU/1, FT4:13.93-26.49pmol/1, TT4:103.39-319.43nmol/1; mid trimester, TSH:0.47-3.89mIU/1, FT4:12.33-19.33pmol/1, TT4:92.28-234.88nmol/1; TSH:0.55-4.91mIU/1, FT4:11.38-19.21pmol/1, TT4:83.54-258. in the late pregnancy. 12nmol/1; the control group: TSH:0.76-4.88mIU/1, FT4:13.04-22.18pmol/1, TT4:75.70-175.76nmol/1, using the TSH reference range recommended by ATA, the detection rate of subclinical hypothyroidism in Nanjing region was 12.42%, the detection rate of hypothyroidism was 0.50%, the detection rate of hyperthyroidism was 0.99%, thyroid function was 0.99%. The detection rate of hyperthyroidism was 1.61%, the detection rate of hypothyroidemia was 0.99%, and the positive rate of TPO-Ab was 11.80%. The new standard of this study was normal, and the detection rates of all types of thyroid dysfunction were 1.99%, 0.25%, 1.61%, 0.37%, 8.81% respectively, compared with subclinical hypothyroidism and detection of hyperthyroidism. The rate of T4 was decreased, while the low detection rate of hypoemia was increased.
Conclusion there is a difference in the range of normal reference value of normal thyroid function during pregnancy compared with that of the ATA recommended standard, and the regional laboratory needs to establish an independent normal range of reference values for specific thyroid function during pregnancy.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.256

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