孕妇不同孕期碘营养与新生儿甲状腺功能的关系

周荣华; 陶跃华; 董晓菊; 刘秋芝; 梁占凯; 杜永贵; 张新建; 贾玉玲; 辛英; 赵荣娟; 纪运改

Abstract

周荣华,陶跃华,董晓菊,刘秋芝,梁占凯,杜永贵,张新建,贾玉玲,辛英,赵荣娟,纪运改.孕妇不同孕期碘营养与新生儿甲状腺功能的关系[J].Chinese journal of Epidemiology,2002,23(5):356-359

孕妇不同孕期碘营养与新生儿甲状腺功能的关系

Study on the relation between iodine nutrition of pregnant women in different occasions and thyroid function of their neonates

Received:October 20, 2001

DOI：

KeyWord: 甲状腺功能新生儿碘营养

English Key Word: Thyroid function Neonate Iodine Nutrition

FundProject:河北省卫生厅基金资助项目 (98052 )

Author Name	Affiliation
ZHOU Ronghua	Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, 050011, China
TAO Yuehua	河北省卫生厅疾病控制处
DONG Xiaoju	河北省卫生监督所办公室
LIU Qiuzhi	Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, 050011, China
LIANG Zhankai	石家庄市铁路中心医院妇产科
DU Yonggui	050011 石家庄, 河北省疾病预防控制中心健康体检科
ZHANG Xinjian	石家庄市桥东区妇幼保健站化验室
JIA Yuling	石家庄市桥东区妇幼保健站化验室
XIN Ying	石家庄市铁路中心医院妇产科
ZHAO Rongjuan	石家庄市铁路中心医院妇产科
JI Yungai	石家庄市长安区妇幼保健站化验室

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Abstract:

目的研究孕妇在妊娠不同时期碘营养水平、甲状腺功能与新生儿甲状腺功能的关系。方法采用酸消化砷铈接触法测定尿碘,放射免疫分析法测定血清三碘甲腺原氨酸(T₃)、甲状腺素(T₄)、游离T₃(FT₃)、游离T₄(FT₄),免疫放射分析法测定促甲状腺激素(TSH),用ELISA法测定新生儿脐带血滤纸片TSH。结果妊娠早、中、晚期孕妇尿碘中位数分别为206.3μg/L、161.4μg/L、203.3μg/L,尿碘值<100μg/L的比率分别为14.6%、17.1%、11.1%。孕妇血清T3、T4水平明显高于婚检妇女(P<0.001);妊娠早、晚期妇女血清T₃、T₄水平差异不显著;孕晚期妇女血清FT₃、FT₄分别为(2.61±0.47)pmol/L、(5.50±1.57)pmol/L。妊娠晚期与妊娠早期、婚检妇女血清TSH水平比较,差异有显著性(P<0.05,P<0.01)。三组人群TSH频数分布比较,差异无显著性(χ2=1.138,P>0.5)。新生儿脐带血TSH中位数为1.99mU/L,>5mU/L的比率为9.4%。结论①在碘盐供应良好的地区,对孕妇不需要再补充碘盐以外的其他碘剂;②碘营养适宜、甲状腺功能正常的孕妇所生新生儿脐带血TSH>5mU/L的比率<10%;③用非妊娠正常人的FT₃、FT₄正常值范围评价孕妇甲状腺功能容易造成错误诊断。

English Abstract:

Objective To study iodine nutrition of pregnant women in different occasions and thyroid function of their neonates. Methods Urinary iodine of pregnant women and their serum T 3?T 4 ?FT 3?FT 4 were determined by chloric acid digestion thermostatic assay and RIA, TSH determination by IRMA; neonatal umbilical cord blood TSH was determined by ELISA. Results Median urinary iodine of pregnant women were 206.3 μg/L, 161.4 μg/L, 203.3 μg/L at 10 14 (first occasion),23 27 (second occasion) and 39 40 (third occasion) week but the percentage that lower than 100 μg/L were 14.6 %, 17.1 %, 11.1 % respectively. Serum T 3,T 4 of pregnant women was significantly higher than those women of premarital health inspection(PHIW, P 0.001 ). The difference of serum T 3,T 4 of pregnant women at 10 14 and 39 40 week was not significant. Serum FT 3,FT 4 of pregnant women at 39 40 week were 2.61± 0.47 pmol/L and 5.50± 1.57 pmol/L respectively. The difference of serum TSH concentration at third occasion and first occasion of pre pregnance was significant but the difference of TSH frequency distribution in three groups was not significant ( χ 2= 1.138, P 0.5 ).Blood TSH median neonatal umbilical cord was 1.99 mU/L but the percentage that higher than 5 mU/L was 9.4 %. Conclusion For those areas with high iodized salt coverage, pregnant women had had sufficient iodine supplement and good thyroid function. The percentage of neonates from iodine sufficient pregnant women with TSH5 mU/L was lower than 10%. Using the normal range of nonpregnant FT 3 and FT 4 to estimate the thyroid function of pregnant women could cause mis diagnosis.

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