天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (11): 1318-1321.doi: 10.11958/20161282

• 内分泌专题 • 上一篇    下一篇

碘缺乏病高危地区城镇维吾尔族孕妇甲状腺功能与 子女脑发育情况调查分析

刘思琦 1,孔思璎 1,李东阳 2,王晓伟 3,阿不来提 3， 王晟怡 1， 狄敏 1， 李永梅 1， 叶艳 1， 钱明 1△   

  1. 1 天津医科大学医学心理学教研室， 天津医科大学内分泌研究所、 卫生部激素与发育重点实验室 （邮编 300070）； 2 新疆阿克苏 地区行署地方病防治办公室； 3 新疆阿克苏地区疾病预防控制中心
  • 收稿日期:2016-11-07 修回日期:2016-11-11 出版日期:2016-11-15 发布日期:2016-11-15
  • 通讯作者: △通讯作者 E-mail: qianmingtmu@outlook.com E-mail:liuxiaoqi0319@126.com
  • 作者简介:刘思琦 （1991）， 女， 硕士在读， 主要从事碘缺乏病和精神卫生研究
  • 基金资助:
    国家自然科学基金资助项目 （81573103）； 雀巢基金 2008 资助 （Nestle Foundation 2008）

Investigation and analysis of thyroid function in Uygur pregnant women and neurocognitive development of their offspring in high risk area of iodine deficiency

LIU Siqi1, KONG Siying1, LI Dongyang2, WANG Xiaowei3, Abulaiti3, WANG Shengyi1, DI Min1, LI Yongmei1, YE Yan1, QIAN Ming1△   

  1. 1 Department of Medical Psychology, Institute of Endocrinology, Key Lab of Hormones and Development of Health Ministry and Tianjin, Tianjin Medical University, Tianjin 300070, China; 2 Aksu Endemic Disease Prevention Office; 3 Aksu Center for Disease Control and Prevention
  • Received:2016-11-07 Revised:2016-11-11 Published:2016-11-15 Online:2016-11-15
  • Contact: △Corresponding Author E-mail: qianmingtmu@outlook.com E-mail:liuxiaoqi0319@126.com

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摘要： 目的 评估碘缺乏病高危地区新疆阿克苏城镇采取持续补碘措施后孕妇甲状腺功能和子女脑发育状 况。方法 非孕育龄妇女（非孕组） 35 例和孕妇组 165 例， 其中 5 例孕妇因脱落未测促甲状腺激素（TSH）与甲状腺 激素（TH）； 孕妇组 160 例分为早、 中、 晚期组 3 个亚组， 分别对应为孕 0～13 周、 孕 14～27 周和孕 28～40 周。采集 2 组清晨一次性随意尿样和静脉血样， 使用过硫酸铵消化砷-铈催化分光光度法测定其尿碘浓度， 免疫化学发光法测 定其 TSH、 游离四碘甲状腺原氨酸（FT4）、 游离三碘甲状腺原氨酸（FT3）、 总甲状腺素（TT4）、 总三碘甲状腺原氨酸 （TT3） 水平。2 年后追踪入组孕妇所育子女， 使用格赛尔发展诊断量表 （Gesell） 测量其神经认知发育水平。结果 孕 妇总体尿碘中位数为 196.7（122.9， 269.2）μg/L； 孕妇总体尿碘水平≤150 μg/L 及＞150 μg/L 以上者分别为 52 例 （32.5%） 和 108 例 （67.5%）。孕妇组与非孕组比较， 孕早期 FT3水平降低， TT4、 TT3水平升高； 中期和晚期 FT4、 FT3水平 均降低， 而 TT4、 TT3水平均升高（P＜0.05）。孕早期 FT3水平高于孕中期和孕晚期（P＜0.05）， 3 组间其他指标差异均 无统计学意义。孕妇组甲状腺异常发生率为 8.75%（14/160）。其中， 亚临床甲减占 5.63%（9/160）； 甲状腺球蛋白抗 体 （Tg-Ab） 阳性 （Tg-Ab+） 占 3.13% （5/160）， 亚临床甲减与 Tg-Ab+无重叠病例； 无甲状腺功能减退、 甲状腺功能亢进 和低 T4血症病例。追踪观察的 80 例维吾尔族孕妇子女中， 语言商得分偏低， Gesell 诊断异常率为 3.75%（3/80）， 可 疑 12.50% （10/80）， 正常 83.75% （67/80）。结论 家庭合格碘盐食用率达标多年后， 维吾尔族城镇孕妇碘营养状况适 宜， 甲状腺功能正常， 结果可用于后续研究。

关键词: 妊娠, 婴儿, 新疆, 维吾尔族, 甲状腺激素, 参考值, 碘缺乏

Abstract: Objective To evaluate thyroid function of pregnant women and neurocognitive development of their offspring after continuous iodine supplementation in Aksu of Xinjiang, and to provide the basis for further research. Methods This study included 35 non-pregnancies (non-pregnant group) and 165 pregnant women (pregnant group). There were 5 pregnant cases did not take the detection of SH and TH due to the loss of follow-up. Pregnant group was subdivided into three groups including pregnancy week 0- 13 (early stage group), pregnancy week 14- 27 (middle stage group) and pregnancy week 28- 40 (late stage group). The random urine samples of early morning and venous blood samples were collected in two groups to determine the urinary iodine concentration by the arsenic cerium catalytic spectrophotometry, and thyroid hormone levels (TSH, FT4, FT3, TT4, and TT3 were detected by immunochemiluminometric assay. Offsprings of pregnant group were followed up two years. Gesell scale was used to assess their neurocognitive function. Results The total MUIC of pregnant women was 196.7 (122.9,269.2) μg/L. There were 52 cases in pregnant group (32.5%) and 108 in nonpregnant group (67.5%) with total UIC ≤150 μg/L and ＞150 μg/L. The FT3 level was lower and TT4 and TT3 levels wereincreased at the early stage of pregnancy in pregnant group compared with those of non-pregnant group. FT4 and FT3 levels were decreased and TT4 and TT3 levels increased in the middle stage group and late stage group (P<0.05). FT3 level was higher at the early stage group than that of middle stage group and late stage group (P<0.05). There were no significant differences in the other indicators between three groups. The abnormal rates of thyroid were 8.75% (14/160) in pregnant group, of which 5.63% cases were subclinical hypothyroidism (9/160), 3.13% were Tg- Ab + (5/160). There was no overlapping cases between subclinical hypothyroidism and Tg-Ab+ cases. There were no patients with overt hypothyroidism, hyperthyroidism and hypothyroxinemia in pregnant group. The offsprings of uygur pregnant women in this tracing study showed a lower language quotient score, and abnormal rate of Gesell was 3.75% (3/80), and the suspicious rate was 12.50% (10/80), normal rate was 83.75% (67/80). Conclusion After two years or more of family eligible iodized salt consumption come to qualified， the pregnant women in township of Aksu show adequate iodine nutrition with no overt abnormality of thyroid function, which can be considered as a group of control group for the subsequent research.

Key words: pregnancy, infant, XINJIANG, Uygur Nationality, thyroid hormones, reference values, iodine deficiency