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目的:研究淄博市孕期女性碘营养状况、不同妊娠阶段甲状腺功能变化及妊娠期甲状腺疾病种类分布,制定淄博地区孕期女性特异的血清甲状腺功能指标参考值,为孕期实施碘营养监测及甲状腺功能筛查提供理论依据。方法:选取2013年3月至2014年2月在淄博市妇幼保健院门诊行产检的1268例孕妇。采用化学发光法测定妊娠早、中、晚期孕妇的血清促甲状腺素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(即TPOAb)。采用酸消化砷一铈接触法测定尿碘水平。结果:1268例孕妇中,孕早、中、晚期尿碘中位数分别为100.3、110.5、105.2,孕早期尿碘水平最低,孕中期尿碘中位数高于孕晚期。孕期FT4参考值范围设定:孕早期12.50~25.10pmmol/L,孕中期12.10~23.10pmmol/L,孕晚期11.20~20.16pmmol/L;孕期TSH参考值范围设定:孕早期0.15~3.20m IU/L,孕中期0.40~3.90m IU/L,孕晚期0.50~4.12m IU/L。正常尿碘组、低尿碘组及高尿碘组的FT4、TSH均在正常范围,高尿碘组、低尿碘组的FT4均低于正常尿碘组(P<0.05),3组的TSH值比较差异均无统计学意义(P>0.05)。1268例孕妇中,甲状腺功能异常者368例(29.02%),孕早期的甲状腺功能异常发生率高于孕中期及孕晚期,甲状腺功能异常以亚临床型甲减为主,其次为单纯TPOAb阳性。结论:淄博市孕期女性碘营养缺乏严重,需定期监测尿碘水平。随着孕周的增加,FT4值逐渐下降,而TSH值则呈上升趋势;尿碘异常早期可引起FT4的改变,对TSH影响不大。建议在妊娠早期对有甲状腺疾病危险因素的女性积极筛查甲状腺功能。
Objective: To study the nutritional status of iodine in pregnant women in Zibo city, thyroid function changes in different stages of pregnancy and the distribution of thyroid disease during pregnancy, and to establish female reference value of serum thyroid function in pregnant women in Zibo area during the pregnancy period for iodine nutrition monitoring and thyroid function screening Provide a theoretical basis. Methods: From March 2013 to February 2014, 1268 pregnant women undergoing outpatient clinics in Zibo MCH Hospital were selected. Chemiluminescence method was used to determine serum thyrotropin (TSH), free thyroxine (FT4) and thyroid peroxidase antibody (TPOAb) in pregnant women of early, middle and late pregnancy. Determination of urinary iodine by acid digestion of arsenic - cerium contact method. Results: In 1268 pregnant women, the median urinary iodine in early, middle and late pregnancy was 100.3,110.5,105.2 respectively. The urinary iodine level was lowest in early pregnancy, and the median urinary iodine in early pregnancy was higher than that in late pregnancy. Pregnancy FT4 reference range set: 12.50 ~ 25.10pmmol / L in early pregnancy, the second trimester 12.10 ~ 23.10pmmol / L, the third trimester 11.20 ~ 20.16pmmol / L; pregnancy TSH reference range settings: first trimester 0.15 ~ 3.20m IU / L, the second trimester 0.40 ~ 3.90m IU / L, the third trimester 0.50 ~ 4.12m IU / L. FT4 and TSH in the normal urinary iodine group, low urinary iodine group and high urinary iodine group were in the normal range, FT4 in high-urinary iodine group and low urinary iodine group were lower than those in normal urinary iodine group (P <0.05) TSH values were no significant difference (P> 0.05). Among 1268 pregnant women, 368 (29.02%) had abnormal thyroid function. The incidence of thyroid dysfunction in early pregnancy was higher than that in the second trimester and the third trimester. The abnormal thyroid function was mainly sub-clinical hypothyroidism, followed by TPOAb-only. Conclusion: There is a lack of iodine nutrition in pregnant women in Zibo City. Urinary iodine levels should be monitored periodically. With the increase of gestational age, the value of FT4 gradually decreased, while the value of TSH increased. The change of FT4 in the early stage of urinary iodine abnormality had little effect on TSH. It is recommended that women with thyroid disease risk factors be actively screened for thyroid function in early pregnancy.