目的探讨黔南地区孕早、中、晚期布依族妇女甲状腺疾病的患病情况及影响因素,为制定妊娠期甲状腺疾病防治干预措施提供依据。方法 2013年3月-2014年12月在黔南布依族苗族自治州中医医院、长顺县妇幼保健院门诊进行产前检查的布依族妇女735例。按孕期分为孕早期231例、孕中期256例和孕晚期248例。分别对3期孕妇进行问卷调查和甲状腺功能水平检测。采用全自动化学发光分析仪检测血清促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)水平,以及甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)阳性率。结果 735例孕妇甲状腺功能异常、TPOAb和TGAb阳性者共176例,总患病率为23.95%。66例甲状腺异常,孕早期患病率为3.03%,孕中期患病率为5.08%,孕晚期患病率为18.55%。孕晚期甲状腺功能患病率分别与孕早、中期比较,差异均有统计学意义(χ~2=29.27和25.51,均P<0.01)。33例TPOAb阳性孕妇中,孕早期阳性率为7.36%,孕中期阳性率为3.91%,孕晚期阳性率为2.42%。孕早期血清TPOAb阳性率分别与孕中、晚期比较,差异均有统计学意义(χ~2=2.97和6.38,均P<0.01)。77例TGAb阳性孕妇中,孕早期阳性率为16.02%,孕中期阳性率为10.94%,孕晚期阳性率为4.84%。孕早期血清TPOAb阳性率分别与孕中、晚期比较,差异均有统计学意义(χ~2=2.71和16.275,均P<0.01)。多因素非条件Logistic回归分析,首次妊娠年龄小(OR=3.84,P=0.012)、X线检查史(OR=14.23,P=0.001)、有避孕史(OR=2.45,P=0.049)、甲状腺疾病家族史(OR=3.57,P=0.019)、饮食习惯(OR=3.32,P=0.021)为影响甲状腺功能异常的独立危险因素。结论黔南地区布依族妇女甲状腺功能异常患病率较高,要充分了解影响孕妇甲状腺功能异常的因素,建议早期对孕妇进行甲状腺功能监测,为孕期碘营养摄入及开展必要干预提供指导意义。 Objective To investigate the prevalence and influencing factors of thyroid disease among women in early, middle and late stages of pregnancy in Qiannan area and provide evidence for the prevention and treatment of thyroid disease during pregnancy. Methods From March 2013 to December 2014, 735 women of Buyi women were examined at Qiannan Buyi and Miao Autonomous Prefecture Chinese Medicine Hospital and Changshun County Maternal and Child Health Hospital. Divided by pregnancy during the first trimester of 231 cases, 256 second trimester and 248 cases of late pregnancy. Questionnaire investigation and thyroid function test were conducted on the third stage pregnant women respectively. Serum thyrotropin (TSH), free triiodothyronine (FT_3), free thyroxine (FT_4), and thyroid peroxidase antibody (TPOAb), anti-thyroglobulin Antibody (TGAb) positive rate. Results 735 pregnant women had abnormal thyroid function, and 176 patients were positive for TPOAb and TGAb, with a total prevalence of 23.95%. 66 cases of abnormal thyroid, pre-pregnancy prevalence rate of 3.03%, pre-pregnancy prevalence was 5.08%, the third trimester of pregnancy was 18.55%. The prevalence of thyroid function in the third trimester of pregnancy was significantly higher than that of the first trimester and the second trimester, respectively (χ ~ 2 = 29.27 and 25.51, both P <0.01). In 33 cases of TPOAb-positive pregnant women, the positive rate in the first trimester was 7.36%, the positive rate in the second trimester was 3.91%, and the second trimester pregnancy rate was 2.42%. The positive rate of TPOAb in early pregnancy was significantly higher than that in middle and late pregnancy (χ ~ 2 = 2.97 and 6.38, both P <0.01). Among 77 TGAb positive pregnant women, the positive rate was 16.02% in the first trimester, the positive rate was 10.94% in the second trimester, and the positive rate was 4.84% in the third trimester of pregnancy. The positive rates of serum TPOAb in early pregnancy were significantly different from those in middle and late stages of pregnancy (χ ~ 2 = 2.71 and 16.275, both P <0.01). Multivariate non-conditional logistic regression analysis showed that the first gestational age was lower (OR = 3.84, P = 0.012), history of X-ray examination (OR = 14.23, P = 0.001) Family history of disease (OR = 3.57, P = 0.019) and eating habits (OR = 3.32, P = 0.021) were independent risk factors for thyroid dysfunction. Conclusion The prevalence of thyroid dysfunction in Buyi women in Qiannan area is high. To fully understand the factors affecting abnormal thyroid function in pregnant women, it is suggested that the monitoring of thyroid function in pregnant women in the early stage may provide guidance for iodine intake during pregnancy and necessary intervention.