1、摘要目的了解青島地區(qū)妊娠前半期(即≤20周)婦女的碘營(yíng)養(yǎng)狀況及甲狀腺功能減退癥的患病率，探討碘營(yíng)養(yǎng)狀況與甲狀腺功能減退癥的關(guān)系。方法選取201112—20128青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院產(chǎn)科門診進(jìn)行產(chǎn)前檢查的妊娠前半期婦女338例，同時(shí)選取年齡匹配的健康非妊娠婦女94例作為對(duì)照組，檢測(cè)尿碘及血清TSH、FT4、FT3、TPOAb水平。(1)根據(jù)WHO推薦的人群碘營(yíng)養(yǎng)以及妊娠期婦女碘營(yíng)養(yǎng)評(píng)價(jià)標(biāo)準(zhǔn)，判斷本地區(qū)妊娠婦女人群總體是否存在碘缺乏，并按

2、照尿碘水平分為4組，即碘缺乏組、碘足量組、碘超足量組、碘過量組，了解不同尿碘水平的分布頻數(shù)，獲得妊娠前半期婦女碘營(yíng)養(yǎng)狀況；(2)根據(jù)妊娠時(shí)期分為4組，即妊娠8周、12周、16周、20周，了解不同妊娠期婦女碘營(yíng)養(yǎng)狀況以及血清TSH、FT4、FT3的生理性變化；(3)采用妊娠期特異性甲狀腺功能指標(biāo)作為評(píng)價(jià)標(biāo)準(zhǔn)，獲得妊娠前半期甲狀腺功能減退癥的患病率；(4)對(duì)妊娠前12周不同碘營(yíng)養(yǎng)狀態(tài)與血清TSH、FT4以及亞臨床甲減患病率之間的相關(guān)性進(jìn)行分

3、析；(5)分析TPOAb與甲狀腺功能減退癥患病率以及碘營(yíng)養(yǎng)之間的關(guān)系。結(jié)果(1)妊娠前半期婦女尿碘中位數(shù)為19210ug／L，碘缺乏、碘足量、碘超足量、碘過量者的分布比例分別為4142％、3373％、1805％、680％，尿碘≤lOOug／L的比率為1621％O05)；(2)妊娠前半期婦女甲狀腺功能隨著妊娠期的增加而變化，血清TSH水平均低于非妊娠組，12周降至最低值，TSH中位數(shù)為144mlU／L，較非妊娠下降3425％，之后隨著妊娠

4、期的增加而逐漸升高；FT4水平隨著妊娠期的增加呈先升高后下降的趨勢(shì)，8周、12周FT4水平高于非妊娠組(分別PO05)，F(xiàn)T4中位數(shù)分別升高1150％、689％，之后逐漸下降，妊娠16周、20周FT4水平較非妊娠組明顯下降(均PO05)，之后，F(xiàn)T3水平逐漸降低，16周、20周明顯低于非妊娠組(分別PO05)；(4)妊娠前12周婦女碘營(yíng)養(yǎng)狀態(tài)與血清TSH中位數(shù)之間呈“U”字型曲線，各尿碘組之間血清TSII、FT4水平比較，差異均無(wú)統(tǒng)計(jì)學(xué)

5、意義(均PO05)；碘缺乏、碘足量、碘超足量、碘過量各組亞臨床甲減的患病率分別為538％4、225％、232％、76904，AbstractObjective：ToobservetheurineiodinelevelandoccurrenceofhypothyroidismduringthefirsthalfofpregnancyinwomeninQingdaoAndtoexploretherelationshipbetweentheu

6、rineiodinelevelandhypothyroidismMethods：338pregnantwomenand94non—pregnantwomenwerecollectedUrinaryiodineexcretionandserumthyrotropin(TSH)，F(xiàn)reethyroxine(FT4)，thyroidperoxidaseantibody(TPOAb)leVelsweredeterminedinallsubjec

7、ts(1)AccordingtothecriteriaofgeneralpopulationandpregnantwomenwhichwasmadebyWHO，weseparatedthesamplestodifferentgroupsaccordingtotheurineiodine：iodinedeficiency，iodineadequate，iodinemorethanadequmeandiodineexcessive，andt

8、oinvestigatethechangesofthyroidfunctionandprevalencesofhypothyroidismindifferenturineiodine；(2)Accordingtotheweeksofgestation，weasloseparatedthesamplestodifferentgroups：8th，12th，16th，20thweeksofgestation，tostudychangesof

9、theurineiodineandthyroidfunction；(3)Screeningprevalencesofhypothyroidismbythegestationalage—specificreferenceintervals；(4)AnalyingtheassosiationbetweentheurineiodineandTSH，F(xiàn)T4，theprevalenceofsubclinicalhypothyrodism；(5)E

10、xploringtherelationshipbetweenthepositiveTPOAbandthyroiddisease，urineiodineResults：(1)Themedianofurineiodinewas19210ug／L，theratioofiodinedeficiency，iodineadequate，iodinemorethanadequateandiodineexcessivewas4142％，3373％，18

11、05％，and680％，respectivelyTheratioofurineiodine≤100ug／Lwas1621％，50ug／Lwas4。73％；therewerenosignificantdifferencesabouturineiodineinthefirst20weeks(2)Thethyroidfunctionofwomeninthefirsthalfofpregnancychangedwithincreaseinges

12、tationalweeks，serumTSHwaslowerthanthenon—pregnantandthelowestlevelatweek12，themedianofTSHwas144mIU／L，whichwas3425％lowerthanthenon—pregnantlevel，afterthatincreasedgraduallywithincreaseingestationalweeks；SerumFT4initiallyi

13、ncreasedandthendecreasedgradually，attheweekof8and12，1150％，6890％increasingcomparedwithnon—pregnantlevelrespectively，andthendecreasedgradually；SerumFT3decreasedgraduallywithincreaseingestationalweeks；(3)Basedonthepregnanta

14、ge—specificreferenceintervals，theprevalencesofoverthypothyroidism，subclinicalhypothyroidismandhypothyroxinemiawere089％，355％，621％；(4)Duringthefirst12weeksofgestation，therewasaU—shapedcurvebetweeniodineintakelevelsandserum