摘要目的 描述孕妇妊娠不同时期碘营养及甲状腺功能的动态变化,探索妊娠期甲状腺激素水平的影响因素.方法 从2012年10月至2013年5月对130名孕妇进行纵向调查,于妊娠早、中、晚期各采集1次空腹静脉血及晨尿,检测甲状腺功能及尿碘,并在首次调查时收集孕妇的社会人口学资料和生活方式等信息,妊娠早、中、晚期分别调查130、74、66名孕妇.结果 妊娠早、中、晚期孕妇的尿碘M(MUI)分别为238.9、150.8、306.4 μg/L,差异有统计学意义(P＜0.05).各妊娠期游离三碘甲状腺原氨酸(FT3)变化不大(P＞0.05);随着孕周增加,游离甲状腺激素(FT4)呈下降趋势(P＜0.05);促甲状腺激素(TSH)呈现先下降后上升的趋势,各期差异有统计学意义(P＜0.05).碘营养与甲状腺激素水平呈“U”形分布,随着碘水平增加,TSH先降低后升高(P＜0.05),FT3和FT4先上升后下降(P＞0.05).文化程度、慢性病病史、CT/X线检查史、腌制食品与TSH水平的高低有关联,而城乡之间、最近一年内有无心理应激事件、日常交通方式、久坐时间、工作和睡眠时间与FT4水平的高低有关联.结论 不同妊娠期孕妇的碘营养与甲状腺激素水平有显著性差异,妊娠期甲状腺激素水平与碘营养水平、居住地、工作时间长短、外出交通方式等因素有一定关联.

abstractsObjective To characterize the gestational changes of iodine nutrition and thyroid function and to explore the factors associated with the thyroid function in pregnant women.Methods A longitudinal survey was conducted in 130 pregnant women in Luohe city of Henan province from October 2012 to May 2013.Samples of fasting blood and urine were collected in each trimester to test on thyroid function and urinary iodine.Data regarding social demography and lifestyle behavior were collected through questionnaire in the first trimester.Results The medians of urinary iodine (MUI) for pregnant women were 238.9,150.8 and 306.4 μg/L in the first,second and third trimesters,respectively (P＜0.05).With the increase of gestational age,the level of free triiodothyronine (FT3) showed no significant change (P＞0.05) but the level of free thyroxine(FT4) decreased (P＜0.05),with the level of thyroid stimulating hormone (TSH) increased and then declined (P＜0.05).A U-shaped curve were seen between iodine nutrition and thyroid function.With the increase of iodine level,the level of TSH first increased and then decreased while the levels of FT3 and FT4 showed the opposite trend.The level of TSH was influenced by factors as education level,history of chronic diseases,history of CT and X-ray examination,and intake of pickled food etc.The level of FT4 was associated with residence (urban or rural),stressful events in the previous year,daily means of transportation,and the hours of sedentariness,working and sleeping.Conclusion Significant differences were noticed in iodine nutrition and thyroid function of pregnant women during the three trimesters.It was essential to establish specific reference ranges for different trimesters.Thyroid functions of pregnant women seemed to be associated with iodine level and lifestyle.