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目的评价韶关市适碘地区不同孕期孕妇甲状腺功能和自身抗体水平,并分析其变化规律,为孕妇科学补碘提供理论依据。方法查找韶关乐昌市2015年碘盐监测资料。在较大医疗机构妇产科门诊采用横断面方法随机抽取331名常住健康孕妇,其中孕早期(0~13周)、孕中期(14~27周)、孕晚期(28~40周)分别为68、126、137名。采集孕妇尿样测定尿碘,采集静脉血测定甲状腺素(TSH)、血清游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)。结果孕早、中、晚期孕妇尿碘中位数分别为185.6μg/L、174.2μg/L、152.7μg/L,全部达到WHO推荐标准,随妊娠的进展尿碘水平逐渐下降(χ~2=5.991,P=0.05);孕早、中、晚期孕妇FT3水平差异无统计学意义(P>0.05);孕早、中、晚期FT4水平差异有统计学意义(P<0.05);孕早、中、晚期TSH水平差异无统计学意义(P>0.05)。TSH水平随着妊娠的进展呈上升趋势,差异有统计学意义(P<0.001);FT3水平随妊娠的进展呈下降的趋势,差异有统计学意义(P<0.005);FT4水平随妊娠的进展呈下降的趋势,差异有统计学意义(P<0.001),各孕期呈“U”型曲线;各孕期TGAb阳性率差异无统计学意义(P>0.05);各孕期TPOAb阳性率差异无统计学意义(P>0.05);甲状腺功能正常率为88.52%;甲状腺TSH、FT3、FT4异常人数和TPOAb、TGAb阳性人数在各尿碘水平差异无统计学意义(P>0.05);农村与城镇孕妇尿碘中位数差异无统计学意义(P>0.05)。结论随妊娠进展孕妇碘营养不足增加,高FT4血症主要分布在孕晚期,建议定期检测甲状腺功能和自身抗体水平,相关机构开展甲状腺功能和自身抗体水平监测。
Objective To evaluate the levels of thyroid function and autoantibodies in different pregnant women in suitable iodine area of Shaoguan City and to analyze their changing rules to provide a theoretical basis for scientific iodine supplementation in pregnant women. Methods To find the 2015 iodine salt monitoring data of Lechang City, Shaoguan City. A total of 331 healthy pregnant women were randomly selected from the obstetrics and gynecology clinics of the larger medical institutions using the cross-sectional method. Among them, the first trimester pregnancy (0-13 weeks), the second trimester (14-27 weeks) and the third trimester (28-40 weeks) 68,126,137. Urinary iodine was collected from pregnant women for determination of urinary iodine, venous blood samples were collected for thyroxine (TSH), serum free thyroxine (FT4), free triiodothyronine (FT3), thyroglobulin antibody (TGAb), thyroid peroxidase Antibody (TPOAb). Results The median urinary iodine of pregnant women in the first trimester, middle and late pregnancy were 185.6μg / L, 174.2μg / L and 152.7μg / L respectively, all of which reached the WHO recommended standard. The urinary iodine level gradually decreased with the progress of pregnancy (χ ~ 2 = 5.991, P = 0.05). There was no significant difference in the levels of FT3 in early, middle and late pregnant women (P> 0.05), FT4 levels in early pregnancy, middle and late pregnancy were significantly different (P <0.05) , Late TSH level difference was not statistically significant (P> 0.05). TSH levels increased with the progress of pregnancy, the difference was statistically significant (P <0.001); FT3 levels with the progress of pregnancy showed a downward trend, the difference was statistically significant (P <0.005); FT4 levels with the progress of pregnancy (P <0.001). There was a curve of “U” in each pregnancy. There was no significant difference in the positive rates of TGAb between pregnancies (P> 0.05). There was no significant difference in the positive rate of TPOAb (P> 0.05). The normal rate of thyroid function was 88.52%. There were no significant differences in the number of thyroid TSH, FT3 and FT4 abnormalities and the numbers of TPOAb and TGAb positive urine iodine (P> 0.05) The median urinary iodine of pregnant women had no significant difference (P> 0.05). Conclusions The iodine deficiency in pregnant women increases with the progress of pregnancy. The high FT4 blood is mainly distributed in the third trimester of pregnancy. It is recommended to regularly monitor the thyroid function and autoantibodies levels, and the relevant agencies to monitor thyroid function and autoantibodies levels.