摘要目的 调查轻度碘摄入量不足孕妇的甲状腺功能和自身抗体状态,比较与碘摄入量适宜孕妇之间的差异,为指导孕妇科学补碘提供依据.方法 于2015年12月至2016年3月选择广东省遂溪县为调查点,乐昌市为对照点,抽取当地常住孕妇和8～10岁学生为调查对象.测定孕妇尿碘、甲状腺功能和自身抗体5项:促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb);测定学生智商.甲状腺功能3项和TPOAb检测采用自动化学发光法,TgAb检测采用抗原抗体结合率法,尿碘检测采用电感耦合等离子体质谱仪法,学生智商测定采用中国联合型瑞文测验法.结果 调查组和对照组孕妇尿碘中位数分别为113.0和172.1 μg/L,尿碘水平组间比较差异有统计学意义(Z=-9.37,P＜0.05).调查组孕早、孕中和孕晚期的TSH中位数分别为0.89、1.23、1.18 mU/L,FT4均值分别为16.61、14.74、14.19 pmol/L,n3均值分别为4.88、4.18、3.91 pmol/L;对照组孕早、孕中和孕晚期的TSH分别为0.81、1.12、1.39 mU/L,FT4分别为17.02、14.71、15.21 pmol/L,FT3分别为4.89、4.26、4.25 pmol/L.两组的三种激素水平在孕早、孕中期比较差异无统计学意义(TSH∶Z早=-0.36,P=0.72;Z中=-0.33,P=0.74.T4∶t早=-0.82,P=0.41;t中=-0.09,P=0.93.FT3∶t早=-0.11,P=0.91;t中=-1.45,P=0.15),孕晚期调查组TSH和FT4低于对照组(Z=-3.03,P＜0.05;t=-2.34,P＜0.05).调查组与对照组孕妇甲状腺功能异常发生率分别为13.7％ (40/293)和10.8％(32/296),组间比较差异无统计学意义(x2=1.11,P=0.29);低FT4血症发生率均为0.3％(1/293、1/296,x2=0.00,P=1.00);亚甲减发生率分别为1.0％和0.3％(3/293、1/296,x2=1.03,P=0.37).调查组与对照组孕妇甲状腺自身抗体阳性率分别为12.0％和10.6％,(40/333、35/331,x2=0.34,P=0.56).调查组和对照组8～10岁小学生智商均值分别为105.0和106.6,智商水平比较差异有统计学意义(t=-2.64,P＜ 0.05),但智商等级的分布构成比无明显变化(x2=8.93,P=0.18).结论 遂溪县孕妇尿碘中位数在100～149 μg/L,对孕妇的甲状腺功能和自身抗体未造成明显的影响,但孕妇FT4水平低于对照组,值得关注.建议我国类似地区孕妇补碘的重点仍是努力提高居民合格碘盐食用率,尽量使孕妇尿碘水平达到或接近国际推荐的150 μg/L为宜的标准.

abstractsObjective To investigate the effects of mild insufficient iodine intake on thyroid function and autoantibodies in pregnant women,and to provide a basis for scientific supplementation of iodine to pregnant women.Methods From December 2015 to March 2016,Suixi County in Guangdong Province was selected as a survey site,Lechang City as a control site,local pregnant women and 8 to 10 years old students were selected as study subjects.Urinary iodine,thyroid function and 5 autoantibodies of the pregnant woman were tested:thyrotropin (TSH)and free thyroxine (FT4),free triiodothyronine (FT3),anti-thyroid peroxidase (TPOAb) and anti-thyroglobulin (TgAb).Student's intelligence was determined.Automatic chemiluminescence method was used to test 3 items of thyroid function and TPOAb,TgAb was tested by antigen-antibody combining,the level of urinary iodine was detected by the method of inductively coupled plasma mass spectrometer,and student's intelligence was determined by China joint raven's test.Results The median urinary iodine of the investigation group and control group in pregnant women was 113.0 and 172.1 μg/L,respectively,the difference was statistically significant (Z =-9.37,P ＜ 0.05).The TSH median of early,mid and late pregnant women in the investigation group was 0.89,1.23 and 1.18 mU/L,mean of FT4 was 16.61,14.74 and 14.19 pmol\L,mean of FT3 was 4.88,4.18 and 3.91 pmol/L,respectively.The TSH of the control group was 0.81,1.12 and 1.39 mU/L in early,middle and late pregnancy women,FT4 was 17.02,14.71 and 15.21 pmol/L,and FT3 was 4.89,4.26 and 4.25 pmol/L,respectively.No difference was found between the two groups of the three kinds of hormone levels in pregnant early and mid pregnancy (TSH∶ Zearly-=-0.36,Zmid =-0.33,P =0.72,0.74;FT4∶ tearly =-0.82,tmid =-0.09,P =0.41,0.93;FT3∶ teraly =-0.11,tmid =-1.45,P =0.91,0.15),in late pregnancy FT4 and TSH were lower than those of control group (Z =-3.03,P ＜ 0.05;t =-2.34,P ＜ 0.05).The incidence of thyroid dysfunction was 13.6％ (40/293) and 10.8％ (32/296) in the investigation and control pregnant women,respectively,no statistical difference was found (x2 =1.11,P =0.29);the incidence of low FT4 hematic disease was all 0.3％,and no significant difference was found (x2 =0.00,P =1.00);the thyroid dysfunction incidence rates were 1.0％ (3/293) and 0.3％ (1/296),respectively,also no statistical difference was found (x2 =1.03,P =0.37).Thyroid autoantibodies positive rate of the investigated pregnant women and the control was 12.0％ (40/ 333) and 10.6％ (35/331),respectively,no statistical difference was found (x2 =0.34,P =0.56).The IQ scores of investigated and control groups were 105.0 and 106.6,respectively,and there were significantly different (t =-2.64,P ＜ 0.05),but the distribution of intelligence quotient was not different (x2 =8.93,P =0.18).Conclusions Urine iodine median of Suixi pregnant women is in 100-149 μg/L level,which has no significant effect on thyroid function and autoantibodies,but FT4 levels are lower than those of the control group,which merit attention.We suggest that pregnant women in similar regions to supplement iodine in order to make urinary iodine level of pregnant women reaching the level of 150 μg/L recommended by WHO.