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目的研究碘适量地区城市妊娠妇女亚临床甲状腺功能异常状况,为今后实施妊娠妇女甲状腺功能筛查提供依据。方法随机采集杭州市5个调查点160名妊娠妇女及51名正常非妊娠妇女的血、尿样品,酸消化砷-铈接触法测定尿碘,化学发光法测定促甲状腺激素(TSH)、游离甲状腺素(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)和甲状腺过氧化物酶抗体(TPOAb)。结果妊娠早、中、晚期妇女与非妊娠妇女间尿碘水平差异均无统计学意义(Z=2.21,P=0.53);采用正常妊娠妇女甲状腺激素参考值范围检出亚临床甲状腺功能异常率为10.0%(16/160),如采用非妊娠妇女甲状腺激素正常参考值范围,妊娠妇女亚临床甲状腺功能异常漏诊率为8.75%(14/160),两种参考范围在判断亚临床甲状腺功能方面差异有统计学意义(χ2=8.46,P=0.04)。结论必须用正常妊娠妇女不同孕期甲状腺激素参考值范围对妊娠妇女甲状腺功能进行判断。虽然杭州市城市妊娠妇女人群尿碘处于适宜水平,但亚临床甲状腺功能异常检出率为10.0%,建议在早、中期妊娠妇女中开展甲状腺功能筛查。
Objective To study the subclinical thyroid function abnormalities in pregnant women in urban areas of iodine suitable area and provide the basis for the future thyroid function screening in pregnant women. Methods Blood and urine samples were collected from 160 pregnant women and 51 normal nonpregnant women at 5 investigation points in Hangzhou City. Urinary iodine was determined by acid-digested arsenic-cerium contact method. The levels of thyroid-stimulating hormone (TSH), free thyroid (FT4), free triiodothyronine (FT3), total thyroxine (TT4), total triiodothyronine (TT3) and thyroid peroxidase antibody (TPOAb). Results There was no significant difference in urinary iodine level between women with early pregnancy, non-pregnant women and pregnant women (Z = 2.21, P = 0.53). The abnormal thyroid function abnormalities in thyroid hormone reference value range 10.0% (16/160). If the normal reference value of thyroid hormone in nonpregnant women was used, the missed diagnosis rate of subclinical thyroid dysfunction in pregnant women was 8.75% (14/160). There were significant differences in judging subclinical thyroid function between the two reference ranges There was statistical significance (χ2 = 8.46, P = 0.04). Conclusions The thyroid hormone of pregnant women must be judged by thyroid hormone reference value in different pregnant women. Although urinary iodine levels in urban pregnant women in Hangzhou are at an appropriate level, the detection rate of subclinical thyroid dysfunction is 10.0%. It is recommended that thyroid function screening should be carried out in early and mid-term pregnant women.