不同碘营养、不同孕期孕妇的甲状腺激素变化
【论文摘要】 目的 探讨北海市不同碘营养状况、不同孕期孕妇的甲状腺激素变化及其甲状腺功能状态。方法 采用ACS-180化学发光分析仪检测623例孕妇的血清游离三碘甲状腺原氨酸(FT3) 、游离甲状腺激素(FT4) 、促甲状腺激素(TSH) 和人绒毛膜促性腺激素(hCG);利用碘催化砷铈反应原理，采用冷消解快速尿碘定量检测方法测定孕妇1次随意尿的尿碘含量。结果 孕早、中期的FT3、FT4和hCG高于孕晚期(P<0.05)，而TSH低于孕晚期(P<0.05)。高尿碘组的FT3、FT4和hCG低于正常尿碘、低尿碘组(P<0.05)，3组的TSH差异无显著性(P>0.05)。甲状腺功能紊乱发生率为7.54%，不同孕期、不同尿碘组间的甲状腺功能紊乱发生率的差异无显著性(P>0.05)。亚临床甲状腺功能减退(甲减)、亚临床甲状腺功能亢进(甲亢)的发生率分别为3.53%、2.57%，甲减、甲亢的发生率分别为1.12%、0.32%。孕早、晚期和各尿碘组均以亚临床甲减居多，孕中期以亚临床甲亢居多。结论 碘营养水平及孕期激素变化不是引起孕妇甲状腺功能紊乱的主要因素，可能妊娠期母体免疫状态的改变才是主要的启动因素。
【论文关键词】 孕期;碘营养;甲状腺激素;孕妇
Abstract: Objective To investigate the variations of thyroid hormone levels and status of thyroid function in pregnant women with different iodine nutrition status and in stages of gestation in Beihai. Methods Free triiodothyronine (FT3)， free thyroxine (FT4)， thyroid stimulating hormone (TSH) and human choronic gonadotropin (hCG) were determined in 623 pregnant women by ACS-180 automatic chemiluninescence analyzer. The urinary iodine content in a random urination was measured using cold digestion method of rapid quantitative detection urinary iodine according to iodine catalytic effect of Arsenic-Cerium.Results Serum FT3， FT4 and hCG levels in the first and second trimesters were higher than those in the third trimester (P<0.05)， and TSH levels were lower than those in the third trimester (P<0.05). FT3， FT4 and hCG levels were lower in high urine iodine group than in normal and low urine iodine groups (P<0.05). No significant differences were found in the 3 groups (P>0.05). The incidence of thyroid dysfunction was 7.54%， with no significant differences between the gestation stages and urine iodine groups (P>0.05). The incidence of subclinical hyperthyroidism and subclinical hypothyroidism was 3.53% and 2.57%，respectively and the incidence of hyperthyroidism and hypothyroidism was 1.12% and 0.32%， respectively. The incidence of subclinical hyperthyroidism was dominant in the urinary iodine groups， while in the first and third trimesters， the incidence of subclinical hypothyroidism prevails in the second trimester. Conclusion The iodine nutrition conditions and the variations of hCG levels during pregnancy were not the major factors contributing to thyroid dysfunction， which might be initiated by the changes of materno-fetal immunity during pregnancy.
Key words: trimester of pregnancy; iodine nutrition; thyroid hormones; pregnant women
妊娠时由于下丘脑-垂体-甲状腺轴系统处于一种特殊的应激状态，甲状腺激素的产生和代谢发生改变，同时妊娠也带来母体免疫状态的变化，结果甲状腺功能会表现出许多特殊的变化。甲状腺激素水平反映了甲状腺的功能状况，由于孕期雌激素的影响，游离三碘甲状腺原氨酸( FT3) 、游离甲状腺激素( FT4) 、促甲状腺激素( TSH) 是反映孕妇甲状腺功能最准确、最具代表性的指标。我们检测了623例孕妇的FT3、FT4、TSH、人绒毛膜促性腺激素(hCG)和尿碘，探讨北海市不同碘营养状况、不同孕期孕妇的甲状腺激素变化及其甲状腺功能状态。现将资料分析如下。