| 2 | 0 | 31 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 检测广州市孕产妇、哺乳期女性、早期新生儿尿碘水平以及新生儿干血斑促甲状腺激素(bs TSH)水平，评估孕产妇碘营养状态，为孕期碘营养指导与新生儿先天性甲状腺功能减退症(CH)预防提供参考依据。方法 选取2023年12月1日—2024年3月31日在广州医科大学附属妇女儿童医疗中心就诊并留取随机尿样本的516例孕产妇，产后3个月以内的37例哺乳期女性，23例早期新生儿为研究对象。采用砷铈催化分光光度法检测尿碘浓度，对碘缺乏的孕妇进行问卷调查和电话随访。回顾性分析2023—2024年在广州市新生儿筛查中心进行CH筛查的315 338例新生儿的bs TSH结果。结果 孕早中期组、孕晚期组孕妇共439例，尿碘中位数为144.3(97.8,193.3)μg/L，其中碘缺乏233例，碘适宜137例，碘超足量52例，碘过量17例。孕早中期组、孕晚期组孕妇尿碘中位数分别为149.2(111.1,199.0)μg/L、137.2(91.0,190.6)μg/L，差异有统计学意义(Z=2.243,P<0.05)。77例围分娩组孕产妇尿碘中位数为937.5(462.0,1 653.6)μg/L，哺乳期女性尿碘中位数为142.2(86.1,217.5)μg/L。新生儿组尿碘中位数为565.2(205.4,1 630.4)μg/L，新生儿1组(<3日龄)与新生儿2组(4～14日龄)尿碘中位数分别为1 630.0(403.8,1 787.9)μg/L、400.2(146.9,714.3)μg/L，差异有统计学意义(Z=2.708,P<0.05)。2023年和2024年广州市新生儿bs TSH中位数分别为3.2(1.9,4.8 ) m U/L、3.1(1.9,4.7 ) m U/L,bs TSH>5 m U/L的比例分别为22.4%、21.9%。结论 广州市存在孕妇碘营养不足，围分娩期女性与新生儿碘暴露和碘过量的现象，可能是广州市新生儿CH患病率升高的重要原因。
Abstract：Objective To detect urinary iodine levels of pregnant women,lactating women,and early neonates,and the levels of dried blood spot thyroid stimulating hormone( bs TSH) of neonates in Guangzhou City,evaluate iodine nutritional status of pregnant and puerperal women,provide a reference for iodine nutrition guidance during pregnancy and prevention of congenital hypothyroidism( CH) in neonates.Methods Urinary iodine concentration was measured using arsenic and cerium catalysis spectrophotometry in 516 cases of pregnant women,37 lactating women,and 23 early neonates in Guangzhou Women and Children's Medical Center,Guangzhou Medical University from December 1st,2023 to March 31st,2024. The pregnant women with iodine deficiency were followed-up through questionnaire survey and telephonic. bs TSH results of 315 338 neonates who underwent CH screening in Guangzhou newborn Screening Center from 2023 to 2024 were retrospectively analyzed. Results There were 439 pregnant women in the first and the second trimesters group and the third trimester group,the median urinary iodine concentration of 439 pregnant women was 144. 3( 97. 8,193. 3) μg/L,among whom 233 cases were iodine deficient,137 cases were adequate,52 cases were more than adequate,and 17 cases were excessive. The median urinary iodine concentrations in the first and the second trimesters group and the third trimester group were 149. 2( 111. 1,199. 0) μg/L and 137. 2( 91. 0,190. 6) μg/L,respectively,the difference was statistically significant( Z = 2. 243,P<0. 05). The median urinary iodine concentration of 77 pregnant women in peri-delivery group was 937. 5( 462. 0,1 653. 6) μg/L,the median urinary iodine concentration of lactating women was 142. 2( 86. 1,217. 5) μg/L. The median urinary iodine concentration of neonate group was 565. 2( 205. 4,1 630. 4) μg/L,the median urinary iodine concentrations of neonate 1 group( < 3 days old) and neonate 2 group( 4-14 days old) were 1 630. 0( 403. 8,1 787. 9) μg/L and 400. 2( 146. 9,714. 3) μg/L,respectively,the difference was statistically significant( Z = 2. 708,P<0. 05). In 2023 and 2024,the medians of bs TSH of neonates in Guangzhou City were 3. 2( 1. 9,4. 8) m U/L and 3. 1( 1. 9,4. 7) m U/L,respectively,and the proportions of neonates with bs TSH > 5 m U/L were 22. 4% and 21. 9%, respectively.Conclusion The phenomenon of iodine deficiency in pregnant women,iodine exposure and iodine excess in women during perinatal period and neonates may be an important reason for the increase in the incidence rate of CH in neonates in Guangzhou City.
[1]Delange F. Iodine deficiency as a cause of brain damage[J]. Postgrad Med J,2001,77(906):217-220.
[2]Zimmermann MB,Jooste PL,Pandav CS. Iodine-deficiency disorders[J]. Lancet,2008,372(9645):1251-1262.
[3]Trumpff C,De Schepper J,Tafforeau J,et al. Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children:a review[J]. J Trace Elem Med Biol,2013,27(3):174-183.
[4]Glinoer D. Clinical and biological consequences of iodine deficiency during pregnancy[J]. Endocr Dev,2007,10:62-85.
[5]WHO/UNICEF/ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination:a guide for programme managers[R]. Geneva,Switzerland:WHO,2007.
[6]Zhou H,Ma ZF,Lu Y,et al. Assessment of iodine status among pregnant women and neonates using neonatal thyrotropin(TSH)in China's mainland after the introduction of new revised Universal Salt Iodisation(USI)in 2012:a re-emergence of iodine deficiency?[J].Int J Endocrinol,2019,2019:3618169.
[7]Mc Grath N,Hawkes CP,Mcdonnell CM,et al. Incidence of congenital hypothyroidism over 37 years in Ireland[J]. Pediatrics,2018,142(4):e185-e192.
[8]Hashemipour M,Ghasemi M,Hovsepian S,et al. Etiology of congenital hypothyroidism in Isfahan:Does it different?[J]. Adv Biomed Res,2014,3:21.
[9]Wassner AJ,Brown RS. Congenital hypothyroidism:recent advances[J]. Curr Opin Endocrinol Diabetes Obes, 2015, 22(5):407-412.
[10]Zou S,Wu F,Guo C,et al. Iodine nutrition and the prevalence of thyroid disease after salt iodization:a cross-sectional survey in Shanghai,a coastal area in China[J]. PLoS One,2012,7(7):e40718.
[11]Hang Z,Yiming L,Binyu P,et al. Iodine deficiency as assessed by neonatal TSH in a sample of mother-and-newborn pairs in Jiangsu Province,China[J]. Biol Trace Elem Res,2021,199(1):70-75.
[12]Nøhr SB,Laurberg P. Opposite variations in maternal and neonatal thyroid function induced by iodine supplementation during pregnancy[J]. J Clin Endocrinol Metab,2000,85(2):623-627.
[13]Tan MY,Jiang X,Mei HF,et al. Incidence tendency,etiological classification and outcome of congenital hypothyroidism in Guangzhou,China:an 11-year retrospective population-based study[J]. J Pediatr Endocrinol Metab,2022,35(9):1141-1146.
[14]中华医学会儿科学分会内分泌遗传代谢学组，中华预防医学会儿童保健分会新生儿疾病筛查学组.先天性甲状腺功能减低症诊疗共识[J]．中华儿科杂志，2011,49(6):421-424.
[15]陈文敏，邱文慧，黄永兰，等.新生儿先天性甲状腺功能减低症的超声特征分析[J]．临床超声医学杂志，2016,18(7):467-469.
[16]Andersson M,de Benoist B,Delange F,et al. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old:conclusions and recommendations of the technical consultation[J]. Public Health Nutr,2007,10(12A):1606-1611.
[17]Zimmermann MB,Aeberli I,Torresani T,et al. Increasing the iodine concentration in the Swiss iodized salt program markedly improved iodine status in pregnant women and children:a 5-y prospective national study[J]. Am J Clin Nutr,2005,82(2):388-392.
[18]WHO/UNICEF/ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization[R]. Geneva,Switzerland:WHO,1994.
[19]Delange F. Neonatal thyroid screening as a monitoring tool for the control of iodine deficiency[J]. Acta Paediatr Suppl,1999,88(432):21-24.
[20]Wassie MM,Yelland LN,Smithers LG,et al. Comparison of iodine status pre-and post-mandatory iodine fortification of bread in South Australia:a population study using newborn thyroid-stimulating hormone concentration as a marker[J]. Public Health Nutr,2019,22(16):3063-3072.
[21]赵霞，唐婕，吴韶清，等.妊娠期碘营养状态与甲状腺功能的关系研究[J]．国际检验医学杂志，2017,38(11):1490-1492.
[22]陈小娟，邱敏娟，高飞，等.广州地区孕妇尿碘水平与甲状腺功能减退的相关性分析[J]．现代检验医学杂志，2019,34(2):119-121.
[23]Farebrother J,Zimmermann MB,Andersson M. Excess iodine intake:sources,assessment, and effects on thyroid function[J].Ann N Y Acad Sci,2019,1446(1):44-65.
[24]Wolff J,Chaikoff IL,Goldberg RC,et al. The temporary nature of the inhibitory action of excess iodine on organic iodine synthesis in the normal thyroid[J]. Endocrinology,1949,45(5):504-513.
[25]Fisher DA,Klein AH. Thyroid development and disorders of thyroid function in the newborn[J]. N Engl J Med,1981,304(12):702-712.
[26]Sohn SY,Inoue K,Rhee CM,et al. Risks of iodine excess[J].Endocr Rev,2024,45(6):858-879.
[27]Jiang X,Huang YL,Feng Y,et al. Same-sex twins have a high incidence of congenital hypothyroidism and a high probability to be missed at newborn screening[J]. Clin Chim Acta,2020,502:111-115.
[28]van Trotsenburg P,Stoupa A,Leger J,et al. Congenital hypothyroidism:a 2020-2021 consensus guidelines update-an ENDO-European Reference Network initiative endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology[J]. Thyroid,2021,31(3):387-419.
[29]Valizadeh M,Moezzi F,Khavassi Z,et al. Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program[J]. J Pediatr Endocrinol Metab,2017,30(9):973-978.
[30]黄永兰，邹红梅，杨红玲，等.早期新生儿尿碘水平检测及其临床意义[J]．广东医学，2004,25(11):1299-1300.
基本信息:
DOI：10.19829/j.zgfybj.issn.1001-4411.2026.16.004
中图分类号:R153.1
引用信息:
[1]谢婷,谭敏沂,郑婕,等.广州市孕产妇碘营养状态评估[J].中国妇幼保健,2026,41(16):2733-2737.DOI:10.19829/j.zgfybj.issn.1001-4411.2026.16.004.
基金信息:
广东省广州市科技计划项目(202201020618)
2026-08-13
2026-08-13