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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(FT_4)、游离三碘甲状腺原氨酸(FT_3)、总甲状腺素(TT_4)、总三碘甲状腺原氨酸(TT_3)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≤150μg/L及>150μg/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FT_3水平降低,TT_4、TT_3水平升高;中期和晚期FT_4、FT_3水平均降低,而TT_4、TT_3水平均升高(P<0.05)。孕早期FT_3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T_4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。
Objective To evaluate thyroid function and brain development status of pregnant women in Aksu towns and cities in Xinjiang in the high risk areas of iodine deficiency disorders. Methods 35 non-pregnant women (non-pregnant group) and 165 pregnant women, including 5 cases of pregnant women due to shedding of thyroid-stimulating hormone (TSH) and thyroid hormone (TH); pregnant women group of 160 cases were divided into early, Group 3 subgroups, corresponding to the pregnancy 0 to 13 weeks, pregnant 14 to 27 weeks and pregnant 28 to 40 weeks. Two groups of early random urine samples and venous blood samples were collected. The urinary iodine concentration was determined by arsenic-cerium catalytic spectrophotometry with ammonium persulfate digestion. The levels of TSH, free tetraiodothyronine (FT_4) Free triiodothyronine (FT_3), total thyroxine (TT_4), total triiodothyronine (TT_3) levels. Two years later, the children of the pregnant group were followed up and their neurocognitive development was measured using the Gesell Diagnostic Scale (Gesell). Results The median urinary iodine of pregnant women was 196.7 (122.9,269.2) μg / L. The overall urinary iodine level of 150μg / L or less than 150μg / L for pregnant women was 52 cases (32.5%) and 108 cases (67.5% . The levels of FT_3, TT_4 and TT_3 in the pregnant women group were lower than those in the non-pregnant women group in the first trimester. The levels of FT_4 and FT_3 in the middle and late stages were decreased, while the levels of TT_4 and TT_3 in the pregnant women were increased (P <0.05). The level of FT_3 in early pregnancy was higher than that in second trimester and third trimester (P <0.05). There was no significant difference in other indexes among the three groups. The incidence of thyroid abnormalities in pregnant women was 8.75% (14/160). Among them, subclinical hypothyroidism accounted for 5.63% (9/160), thyroglobulin antibody (Tg-Ab) positive (Tg-Ab +) accounted for 3.13% (5/160), subclinical hypothyroidism and Tg-Ab + non-overlapping cases ; No hypothyroidism, hyperthyroidism and low T_4 cases of blood. Among the 80 Uighur pregnant women who tracked and observed, the language score was low. The abnormal rate of Gesell diagnosis was 3.75% (3/80), suspicious 12.50% (10/80) and normal 83.75% (67/80). Conclusion After many years of compliance with the family-approved iodized salt rate, pregnant women in urban Uyghur have adequate iodine nutrition status and normal thyroid function. The results can be used for follow-up studies.