碘過量對(duì)孕婦及新生兒甲狀腺功能的影響
發(fā)布時(shí)間：2018-09-07 07:06
【摘要】：目的1.了解高水碘地區(qū)河北省滄州市海興縣及適碘地區(qū)天津市妊娠晚期孕婦的碘營養(yǎng)狀況。2.掌握兩地區(qū)孕婦及新生兒的甲狀腺功能及甲狀腺自身免疫功能。3.探討過量碘攝入與甲狀腺功能、甲狀腺自身免疫功能的關(guān)系,為高碘防治工作提供理論依據(jù)。4.探討不同碘水平攝入對(duì)新生兒生長發(fā)育的影響。 方法1.根據(jù)水源性高碘地區(qū)劃定標(biāo)準(zhǔn)及滄州市疾病預(yù)防控制中心的水碘監(jiān)測(cè)數(shù)據(jù),選擇海興縣為高碘地區(qū),并以地理位置毗鄰、基本消除碘缺乏的天津市為適碘地區(qū)。2.分別在海興縣醫(yī)院和天津市中心婦產(chǎn)科醫(yī)院收集18～45歲的待產(chǎn)孕婦,納入標(biāo)準(zhǔn)為無內(nèi)分泌疾病及其他自身免疫性疾病、無心臟病及家族遺傳病等、在當(dāng)?shù)鼐幼?年以上,飲食習(xí)慣無特殊、孕期未使用碘劑。3.記錄入選對(duì)象的基本資料,簽訂知情同意書。4.采集孕婦中段尿樣、靜脈血及其新生兒臍帶血,采用砷-鈰催化分光光度法測(cè)定孕婦尿碘水平,化學(xué)免疫發(fā)光法測(cè)定血清FT3、FT4和sTSH水平,放射免疫法測(cè)定TPOAb和TGAb水平。 結(jié)果1.高碘地區(qū)210名孕婦和適碘地區(qū)174名孕婦的尿碘中位數(shù)分別為1240.70μg/L和217.06μg/L,分別屬于碘過量和碘營養(yǎng)適宜狀態(tài)。2.高碘地區(qū)孕婦和新生兒的血清FT3、sTSH水平高于適碘地區(qū)孕婦和新生兒,FT4水平低于適碘地區(qū)孕婦和新生兒(P0.05)。3.高碘地區(qū)孕婦甲狀腺疾病總患病率尤其是亞甲減患病率高于適碘地區(qū)孕婦(P0.05)；高碘地區(qū)新生兒血清sTSH水平分布與適碘地區(qū)新生兒相比,偏向高值分布(P0.05)。4.兩地孕婦和新生兒的甲狀腺自身抗體陽性率差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。5.高碘地區(qū)患有甲狀腺疾病尤其是亞甲減的孕婦,其自身及新生兒的甲狀腺自身抗體陽性率與甲狀腺功能正常者相比有升高趨勢(shì),但差異無統(tǒng)計(jì)學(xué)意義(P0.05),所產(chǎn)新生兒的血清sTSH偏向高值分布(P0.05)。6.同一地區(qū)不同甲狀腺自身免疫功能孕婦及新生兒的血清甲狀腺激素水平差異無統(tǒng)計(jì)學(xué)意義(P0.05)；相同甲狀腺自身免疫狀態(tài)者,高碘地區(qū)孕婦甲狀腺疾病尤其是亞甲減患病率及新生兒血清FT3和sTSH水平均高于適碘地區(qū)、新生兒FT4水平低于適碘地區(qū)、抗體陽性孕婦血清FT3和sTSH水平高于適碘地區(qū)、FT4水平低于適碘地區(qū)、新生兒sTSH 5mIU/L比率低于適碘地區(qū)、sTSH10mIU/L比率高于適碘地區(qū)相應(yīng)人群(P0.05)。7.同一地區(qū)孕婦尿碘水平分別與其新生兒的TGAb和TPOAb陽性率呈正相關(guān)(P0.05)。8.高水碘是孕婦甲狀腺功能異常的危險(xiǎn)因素,OR值為26.535(P0.05)；高水碘和妊娠結(jié)局異常是新生兒甲狀腺功能異常(sTSH10mlU/L)的危險(xiǎn)因素,OR值分別為10.738和3.179(P0.05)。9.高碘地區(qū)新生兒的出生體重和雙頂徑均大于適碘地區(qū)新生兒(P0.05),而股骨徑小于適碘地區(qū)新生兒(P0.05)。高碘地區(qū)無甲狀腺疾病的孕婦所產(chǎn)新生兒的雙頂徑大于患有甲狀腺疾病尤其是亞甲減孕婦(P0.05)。 結(jié)論1.高碘地區(qū)被調(diào)查孕婦中大部分處于碘過量狀態(tài),提示應(yīng)盡快改治水源,保證適宜的碘攝入量。2.過量碘攝入能增加孕婦患甲狀腺疾病尤其是亞甲減的風(fēng)險(xiǎn),并影響新生兒的甲狀腺功能,使其TSH水平升高。3.孕婦碘過量合并甲狀腺自身抗體陽性時(shí)對(duì)新生兒甲狀腺功能影響較大。4.孕婦和新生兒的甲狀腺自身抗體陽性率有隨孕婦尿碘水平的增高而升高的趨勢(shì),應(yīng)監(jiān)測(cè)相關(guān)指標(biāo)。5.應(yīng)關(guān)注患有甲減或亞甲減孕婦所產(chǎn)新生兒的甲狀腺功能及生長發(fā)育情況,高碘對(duì)新生兒生長發(fā)育的影響有待進(jìn)一步研究。
[Abstract]:Objective 1. To understand the iodine nutritional status of pregnant women in late pregnancy in Haixing County of Cangzhou City and in Tianjin City where iodine is suitable. 2. To master thyroid function and thyroid autoimmune function of pregnant women and newborns in the two areas. 3. To explore the relationship between excessive iodine intake and thyroid function and thyroid autoimmune function, so as to provide a worker for prevention and treatment of iodine excess. To provide a theoretical basis for.4. to explore the effects of different iodine levels on the growth and development of newborns.
Methods 1. According to the demarcation standard of water-borne iodine excess area and the monitoring data of water iodine from Cangzhou Center for Disease Control and Prevention, Haixing County was selected as the high iodine area, and Tianjin, which is adjacent to Haixing County and basically eliminates iodine deficiency, was selected as the suitable iodine area. 2. Pregnancies aged 18-45 were collected from Haixing County Hospital and Tianjin Central Obstetrics and Gynecology Hospital respectively. Maternal inclusion criteria are no endocrine diseases and other autoimmune diseases, no heart disease and family hereditary diseases, living in the local for more than five years, no special dietary habits, no iodine during pregnancy. 3. Record the basic information of the selected subjects, sign informed consent. 4. Collection of urine samples of pregnant women, venous blood and umbilical cord blood of their newborns, using The urinary iodine level of pregnant women was determined by arsenic-cerium catalytic spectrophotometry, the serum FT3, FT4 and sTSH levels were determined by chemiluminescence method, and the levels of TPOAb and TGAb were determined by radioimmunoassay.
The median urinary iodine levels of 210 pregnant women in iodine excess area and 174 pregnant women in suitable iodine area were 1240.70 ug/L and 217.06 ug/L respectively, which were suitable for iodine excess and iodine nutrition. The prevalence of thyroid diseases, especially hypothyroidism, was higher in pregnant women with high iodine than in pregnant women with suitable iodine (P 0.05). The distribution of serum sTSH in pregnant women with high iodine was higher than that in neonates with suitable iodine (P 0.05). 4. There was no significant difference in the positive rate of thyroid autoantibodies between pregnant women and neonates with high iodine. The positive rate of thyroid autoantibodies in pregnant women with thyroid diseases especially hypothyroidism in Iodine-Excess areas was higher than that in normal thyroid function, but there was no significant difference (P 0.05). The serum sTSH of neonates in the same area tended to be higher (P 0.05). 6. There was no significant difference in serum thyroid hormone levels between pregnant women and neonates with immune function (P 0.05); the prevalence of thyroid diseases, especially hypothyroidism, and the levels of FT3 and sTSH in neonates in iodine-rich areas were higher than those in iodine-tolerant areas, and the levels of FT4 in neonates were lower than those in iodine-tolerant areas. The levels of FT3 and sTSH in maternal serum were higher than those in iodine-adapted areas, FT4 was lower than those in iodine-adapted areas, the ratio of sTSH 5 MIU/L in newborns was lower than that in iodine-adapted areas, and the ratio of sTSH 10 mIU/L was higher than that in iodine-adapted areas (P 0.05). 7. The urinary iodine levels of pregnant women in the same area were positively correlated with the positive rates of TGAb and TPOAb in newborns (P 0. The OR value was 26.535 (P 0.05), high water iodine and abnormal pregnancy outcome were the risk factors of thyroid dysfunction (sTSH 10 ml U/L), and the OR value was 10.738 and 3.179 (P 0.05). 9. The birth weight and biparietal diameter of neonates in high iodine area were higher than those in suitable iodine area (P 0.05), while the femoral diameter was smaller than that in suitable iodine area (P 0.05). Neonates (P 0.05). The biparietal diameter of newborns born to pregnant women without thyroid disease in high iodine area was larger than that of pregnant women with thyroid disease, especially hypothyroidism (P 0.05).
Conclusion 1. Most of the pregnant women in iodine excess areas were in iodine excess state, suggesting that the water source should be changed as soon as possible to ensure the appropriate iodine intake. 2. Excessive iodine intake can increase the risk of thyroid disease, especially hypothyroidism, and affect the thyroid function of the newborn, so that TSH level increased. 3. Pregnant women with iodine excess combined with thyroid self-control. The positive rate of thyroid autoantibodies in pregnant women and newborns increased with the increase of urinary iodine level of pregnant women. The related indicators should be monitored. 5. The thyroid function and growth of newborns born to pregnant women with hypothyroidism or hypothyroidism should be paid attention to. The effect of growth and development needs further study.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R151
本文編號(hào)：2227555
[Abstract]:Objective 1. To understand the iodine nutritional status of pregnant women in late pregnancy in Haixing County of Cangzhou City and in Tianjin City where iodine is suitable. 2. To master thyroid function and thyroid autoimmune function of pregnant women and newborns in the two areas. 3. To explore the relationship between excessive iodine intake and thyroid function and thyroid autoimmune function, so as to provide a worker for prevention and treatment of iodine excess. To provide a theoretical basis for.4. to explore the effects of different iodine levels on the growth and development of newborns.
Methods 1. According to the demarcation standard of water-borne iodine excess area and the monitoring data of water iodine from Cangzhou Center for Disease Control and Prevention, Haixing County was selected as the high iodine area, and Tianjin, which is adjacent to Haixing County and basically eliminates iodine deficiency, was selected as the suitable iodine area. 2. Pregnancies aged 18-45 were collected from Haixing County Hospital and Tianjin Central Obstetrics and Gynecology Hospital respectively. Maternal inclusion criteria are no endocrine diseases and other autoimmune diseases, no heart disease and family hereditary diseases, living in the local for more than five years, no special dietary habits, no iodine during pregnancy. 3. Record the basic information of the selected subjects, sign informed consent. 4. Collection of urine samples of pregnant women, venous blood and umbilical cord blood of their newborns, using The urinary iodine level of pregnant women was determined by arsenic-cerium catalytic spectrophotometry, the serum FT3, FT4 and sTSH levels were determined by chemiluminescence method, and the levels of TPOAb and TGAb were determined by radioimmunoassay.
The median urinary iodine levels of 210 pregnant women in iodine excess area and 174 pregnant women in suitable iodine area were 1240.70 ug/L and 217.06 ug/L respectively, which were suitable for iodine excess and iodine nutrition. The prevalence of thyroid diseases, especially hypothyroidism, was higher in pregnant women with high iodine than in pregnant women with suitable iodine (P 0.05). The distribution of serum sTSH in pregnant women with high iodine was higher than that in neonates with suitable iodine (P 0.05). 4. There was no significant difference in the positive rate of thyroid autoantibodies between pregnant women and neonates with high iodine. The positive rate of thyroid autoantibodies in pregnant women with thyroid diseases especially hypothyroidism in Iodine-Excess areas was higher than that in normal thyroid function, but there was no significant difference (P 0.05). The serum sTSH of neonates in the same area tended to be higher (P 0.05). 6. There was no significant difference in serum thyroid hormone levels between pregnant women and neonates with immune function (P 0.05); the prevalence of thyroid diseases, especially hypothyroidism, and the levels of FT3 and sTSH in neonates in iodine-rich areas were higher than those in iodine-tolerant areas, and the levels of FT4 in neonates were lower than those in iodine-tolerant areas. The levels of FT3 and sTSH in maternal serum were higher than those in iodine-adapted areas, FT4 was lower than those in iodine-adapted areas, the ratio of sTSH 5 MIU/L in newborns was lower than that in iodine-adapted areas, and the ratio of sTSH 10 mIU/L was higher than that in iodine-adapted areas (P 0.05). 7. The urinary iodine levels of pregnant women in the same area were positively correlated with the positive rates of TGAb and TPOAb in newborns (P 0. The OR value was 26.535 (P 0.05), high water iodine and abnormal pregnancy outcome were the risk factors of thyroid dysfunction (sTSH 10 ml U/L), and the OR value was 10.738 and 3.179 (P 0.05). 9. The birth weight and biparietal diameter of neonates in high iodine area were higher than those in suitable iodine area (P 0.05), while the femoral diameter was smaller than that in suitable iodine area (P 0.05). Neonates (P 0.05). The biparietal diameter of newborns born to pregnant women without thyroid disease in high iodine area was larger than that of pregnant women with thyroid disease, especially hypothyroidism (P 0.05).
Conclusion 1. Most of the pregnant women in iodine excess areas were in iodine excess state, suggesting that the water source should be changed as soon as possible to ensure the appropriate iodine intake. 2. Excessive iodine intake can increase the risk of thyroid disease, especially hypothyroidism, and affect the thyroid function of the newborn, so that TSH level increased. 3. Pregnant women with iodine excess combined with thyroid self-control. The positive rate of thyroid autoantibodies in pregnant women and newborns increased with the increase of urinary iodine level of pregnant women. The related indicators should be monitored. 5. The thyroid function and growth of newborns born to pregnant women with hypothyroidism or hypothyroidism should be paid attention to. The effect of growth and development needs further study.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R151
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