CAJ | 학술논문

目的了解不同尿碘水平、不同孕期孕妇甲状腺功能变化.以孕妇正常甲状腺功能为金标准,探讨孕妇尿碘的正常值范围.方法在甘肃和吉林省,选择缺碘农村地区孕早、孕中、孕晚期孕妇,每个省每个孕期最少70例.要求孕妇体格健康,并排除直系血源亲属中有甲状腺疾病史者.测定孕妇尿碘、甲状腺功能5项:游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)及家中盐碘.尿碘测定采用尿中碘的砷铈催化分光光度法(WS/T 107-2006),甲状腺功能5项测定采用化学发光法,盐碘测定采用直接滴定法(GB/T 13025.7-1999).结果 439名孕妇尿碘中位数为178.6 μg/L,其中甘肃省215名,尿碘中位数为156.4 μg/L;吉林省224名,尿碘中位数为206.4 μg/L.随着尿碘水平的升高,甘肃省孕妇FT3由5.77 pmol/L下降至5.34 pmol/L,TSH由最低时的2.63 mU/L升高至3.75mU/L;吉林省孕妇的FT3由4.41 pmol/L升高至4.45 pmol/L,TSH由最低时的0.92 mU/L升高至1.50 mU/L.3个不同孕期中,＞97％的孕妇甲状腺功能5项指标均在正常值范围,最稳定的指标为FT3.其中甘肃省孕妇3个孕期FT3分别为6.27、5.76、5.28 pmol/L,吉林省孕妇3个孕期FT3分别为4.50、4.42、4.32 pmoL/L.两省中甲状腺功能正常的孕妇,第5％分位数时尿碘为55.24 μg/L;第95％分位数时尿碘为581.27 μg/L.结论不同尿碘水平、不同孕期的孕妇甲状腺功能相对稳定,TSH随尿碘的增加呈现升高趋势.随孕期的发展,虽然尿碘在不同孕期间有差别,但甲状腺功能变化不明显,甲状腺功能正常的孕妇尿碘范围在50 ～ 600 μg/L.
목적 료해불동뇨전수평、불동잉기잉부갑상선공능변화.이잉부정상갑상선공능위금표준,탐토잉부뇨전적정상치범위.방법 재감숙화길림성,선택결전농촌지구잉조、잉중、잉만기잉부,매개성매개잉기최소70례.요구잉부체격건강,병배제직계혈원친속중유갑상선질병사자.측정잉부뇨전、갑상선공능5항:유리삼전갑선원안산(FT3)、유리갑상선소(FT4)、촉갑상선소(TSH)、갑상선과양화물매항체(TPOAb)화갑상선구단백항체(TgAb)급가중염전.뇨전측정채용뇨중전적신시최화분광광도법(WS/T 107-2006),갑상선공능5항측정채용화학발광법,염전측정채용직접적정법(GB/T 13025.7-1999).결과 439명잉부뇨전중위수위178.6 μg/L,기중감숙성215명,뇨전중위수위156.4 μg/L;길림성224명,뇨전중위수위206.4 μg/L.수착뇨전수평적승고,감숙성잉부FT3유5.77 pmol/L하강지5.34 pmol/L,TSH유최저시적2.63 mU/L승고지3.75mU/L;길림성잉부적FT3유4.41 pmol/L승고지4.45 pmol/L,TSH유최저시적0.92 mU/L승고지1.50 mU/L.3개불동잉기중,＞97％적잉부갑상선공능5항지표균재정상치범위,최은정적지표위FT3.기중감숙성잉부3개잉기FT3분별위6.27、5.76、5.28 pmol/L,길림성잉부3개잉기FT3분별위4.50、4.42、4.32 pmoL/L.량성중갑상선공능정상적잉부,제5％분위수시뇨전위55.24 μg/L;제95％분위수시뇨전위581.27 μg/L.결론 불동뇨전수평、불동잉기적잉부갑상선공능상대은정,TSH수뇨전적증가정현승고추세.수잉기적발전,수연뇨전재불동잉기간유차별,단갑상선공능변화불명현,갑상선공능정상적잉부뇨전범위재50 ～ 600 μg/L.
Objectives To study the changes of thyroid function under different urinary iodine levels and pregnant trimesters,and to investigate the urinary iodine standard of pregnant women,taken thyroid function as a golden standard.Methods Early,mid and late trimester pregnant women in the iodine deficient rural areas of Gansu and Jilin Provinces were selected,at least 70 cases were included for each trimester in each province.Pregnant women included were physically healthy;cases should be excluded if their immediate relatives had a thyroid disease history.Urinary iodine,free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),thyroid peroxidase antibody (TPOAb),thyroglobulin antibody (TgAb),and edible salt iodine from pregnant women's home were tested.The urinary iodine was measured with the method for determination of iodine in urine by As3+-Ce4+ catalytic spectrophotometry (WS/T 107-2006).Thyroid function was tested by chemiluminescence method,salt iodine was determined by direct titration method (GB/T 13025.7-1999).Results Totally 439 pregnant women were investigated in the two provinces.Median of urine iodine was 178.6 μg/L;for the 215 women in Gansu,the value was 156.4 μg/L;for the 224 women in Jilin,the value was 206.4 μg/L.Along with the increase of urinary iodine,the FT3 of Gansu decreased from 5.77 pmol/L to 5.34 pmol/L,TSH increased from the lowest 2.63 mU/L to 3.75 mU/L;the FT3 of Jilin increased from 4.41 pmol/L to 4.45 pmol/L,TSH increased from the lowest 0.92 mU/L to 1.50 mU/L.Five indicators of thyroid function of more than 97％ pregnant women were in normal range and FT3 was the most stable in the three trimesters.FT3 of the three triimesters in Gansu was 6.27,5.76,5.28 pmol/L,respectively,and that in Jilin was 4.50,4.42,4.32 pmol/L,respectively.The 5％ and 95％ quantile were 55.24,581.27 μg/L of urinary iodine,of pregnant women with normal thyroid function.Conclusions Under different urinary iodine levels,pregnant women's thyroid function is relatively stable.TSH has showed an increasing trend with increasing iodine level.Along with the progress of pregnancy,the urinary iodine is different among the three pregnancy periods,but the thyroid function is stable.The pregnant women with normal thyroid function have a urinary iodine level between 50-600 μg/L.