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目的研究孕妇妊娠不同时期碘营养及甲状腺功能的动态变化情况。方法选取我院2015年3月~2016年5月接收的196例常规产前检查的妊娠期妇女,根据妊娠周期分为孕早期组(n=52,1~12周)、孕中期组(n=70,13~27周)和孕晚期组(n=74,28~40周),另选取同期63例于我院进行健康体检的女性志愿者作为对照组,对比各组间碘营养水平及FT4、TSH、FT3水平。结果孕早期组和孕中期组尿碘中位数水平均达到世界卫生组织提出的碘足量水平,孕晚期组尿碘中位数水平低于世界卫生组织提出的碘足量水平,处于碘缺乏状态。经统计学检验可知,孕早期组尿碘水平高于孕中期组和孕晚期组,差异具有统计学意义(P<0.05)。孕中期组和孕晚期组尿碘水平分布情况比较差异无统计学意义(P>0.05)。孕早期组碘缺乏发生率低于孕中期组和孕晚期组,差异具有统计学意义(P<0.05)。孕早期组碘足量发生率高于孕中期组和孕晚期组,差异具有统计学意义(P<0.05)。孕早期组FT4、FT3水平与对照组相比,差异无统计学意义(P>0.05);孕中期组和孕晚期组FT4、FT3水平低于对照组,差异具有统计学意义(P<0.05)。孕早期组TSH水平低于对照组,差异具有统计学意义(P<0.05)。孕中期组和孕晚期组TSH水平与对照组相比,差异无统计学意义(P>0.05)。随着妊娠期的延长FT4、FT3水平呈逐渐降低趋势,各组间差异具有统计学意义(P<0.05),TSH水平呈逐渐上升趋势,孕中期组和孕晚期组TSH水平高于孕早期组,差异具有统计学意义(P<0.05);血清FT4、TSH、FT3水平先升高后降低,再升高后趋于稳定变化。孕早期组碘营养状态与甲状腺功能指标TSH呈U形关系曲线。结论孕妇妊娠不同时期碘营养及甲状腺功能呈特异性动态变化,妊娠中晚期较易出现碘营养缺乏和甲状腺功能减退情况,妊娠期应加强对碘营养和甲状腺功能的筛查,并根据筛查结果指导妊娠期妇女合理正确补碘,避免妊娠期甲状腺相关疾病的发生。
Objective To study the dynamic changes of iodine nutrition and thyroid function in pregnant women at different stages of pregnancy. Methods A total of 196 pregnant women undergoing prenatal care from March 2015 to May 2016 in our hospital were selected and divided into three groups according to the gestational age group (n = 52,1 ~ 12 weeks), the second trimester group (n = 70,13 ~ 27 weeks) and the third trimester (n = 74,28 ~ 40 weeks). Another 63 female volunteers in our hospital during the same period were selected as control group. FT4, TSH, FT3 levels. Results The levels of urinary iodine in the first trimester and the second trimester reached the level of iodine sufficient by WHO. The median urinary iodine level in the trimester trimester group was lower than the iodine level proposed by the World Health Organization (WHO) status. Statistically, the level of urinary iodine in the first trimester was higher than that in the second trimester and third trimester, the difference was statistically significant (P <0.05). There was no significant difference in the distribution of urinary iodine between the second trimester and the second trimester (P> 0.05). The incidence of iodine deficiency in early pregnancy was lower than that in the second trimester and third trimester, the difference was statistically significant (P <0.05). The incidence of adequate iodine in early pregnancy was significantly higher than that in the second trimester and late trimester (P <0.05). The levels of FT4 and FT3 in the first trimester of pregnancy were not significantly different from those in the control group (P> 0.05). The levels of FT4 and FT3 in the trimester and third trimester were lower than those in the control group (P <0.05) . The levels of TSH in the first trimester of pregnancy were lower than those in the control group, with statistical significance (P <0.05). TSH levels in the second trimester and third trimester were not significantly different from those in the control group (P> 0.05). With the extension of pregnancy, the levels of FT4 and FT3 decreased gradually with the increase of gestational age (P <0.05), and the level of TSH gradually increased. The levels of TSH in the second trimester and the third trimester were higher than those in the first trimester (P <0.05). The levels of serum FT4, TSH and FT3 increased at first and then decreased, then increased at a steady level. Early pregnancy iodine nutrition status and thyroid function index TSH showed a U-shaped curve. Conclusion The iodine nutrition and thyroid function of pregnant women at different stages of pregnancy have specific dynamic changes. In late pregnancy, iodine deficiency and hypothyroidism are more likely to occur. During pregnancy, iodine nutrition and thyroid function screening should be strengthened. According to the screening results Guidance of pregnant women rationally correct iodine, to prevent thyroid-related diseases during pregnancy.