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Value of the Indicators of Urinary Iodine Metabolism in Identifying Iodine Excess during Pregnancy
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摘要:
目的 探讨不同尿碘代谢指标在识别孕前有碘暴露史女性妊娠期碘过量的临床价值。 方法 收集并分析2018年1—12月于北京协和医院临床营养科进行孕期营养咨询或管理，且孕前行子宫输卵管碘油造影(hysterosalpinography, HSG)检查孕妇的临床资料。以血清碘＞90 μg/L为诊断碘过量的金标准，比较血清碘＞90 μg/L与≤90 μg/L孕妇随机尿碘、尿碘肌酐比、24 h尿碘排泄量差异，并采用Spearman相关法分析上述尿碘指标与血清碘的相关性。采用受试者工作特征(receiver operating characteristic，ROC)曲线分析随机尿碘、尿碘肌酐比、24 h尿碘排泄量诊断碘过量的临床价值。 结果 共70例符合纳入和排除标准的孕妇入选本研究。血清碘中位数为138.00(79.00，510.50)μg/L，其中50例(71.43%)＞90 μg/L，20例(28.57%)≤90 μg/L。血清碘＞90 μg/L孕妇的随机尿碘、尿碘肌酐比、24 h尿碘排泄量均显著高于血清碘≤90 μg/L孕妇(P均＜0.001)。Spearman相关法分析显示，随机尿碘(rs=0.749，P＜0.001)、尿碘肌酐比(rs=0.794，P＜0.001)、24 h尿碘排泄量(rs=0.768，P＜0.001)均与血清碘呈显著正相关。ROC曲线结果显示，随机尿碘(最佳诊断界值654 μg/L)、尿碘肌酐比(最佳诊断界值307.5 μg/g)、24 h尿碘排泄量(最佳诊断界值340.5 μg)诊断碘过量的曲线下面积分别为0.732(95% CI: 0.619~0.846)、0.780(95% CI: 0.662~0.898)、0.802(95% CI: 0.697~0.907)，且两两比较均无显著差异(P均＞0.05)。 结论 孕前有碘暴露史的女性，妊娠期碘过量比率较高。随机尿碘、尿碘肌酐比、24 h尿碘排泄量对识别孕前有碘暴露史的女性妊娠期碘过量具有一定的应用价值，由于尿碘肌酐比检测方便，其值＞307.5 μg/g可能有助于进一步提高妊娠期碘过量的识别率。 Abstract:Objective To assess the application value of indicators of urinary iodine metabolism in iden- tifying iodine excess during pregnancy. Methods The clinical data were collected and analyzed of pregnant women undergoing hysterosalpinography(HSG) examination before pregnancy and pregnancy nutrition consultation or management in the Clinical Nutrition Department of Peking Union Medical College Hospital from January to December, 2018. Serum iodine > 90 μg/L was used as the gold standard for diagnosing iodine overdose, and the difference of random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion were compared between pregnant women with serum iodine > 90 μg/L and pregnant women ≤90 μg/L. Spearman correlation method was used to analyze the correlation between the above indicators of urinary iodine metabolism and serum iodine. The receiver operating characteristic(ROC)curve was used to analyze the clinical value of random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion in the diagnosis of iodine excess. Results A total of 70 pregnant women meeting the inclusive and exclusive criteria were included in the study.The median value of serum iodine was 138.00(79.00, 510.50) μg/L, 50 cases(71.43%) of serum iodine > 90 μg/L, 20 cases(28.57%) ≤90 μg/L. The random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion rate of pregnant women with serum iodine > 90 μg/L were significantly higher than those pregnant women with serum iodine ≤90 μg/L(all P < 0.001). Spearman correlation analysis showed that random urinary iodine(rs=0.749, P < 0.001), urinary iodine-to-creatinine ratio(rs=0.794, P < 0.001), 24-hour urinary iodine excretion(rs=0.768, P < 0.001) were all positively related to serum iodine. ROC curve results showed that the area under curve of random urinary iodine(the best cut-off value was 654 μg/L), urinary iodine-to-creatinine ratio(the best cut-off value was 307.5 μg/g), and 24-hour urinary iodine excretion(the best cut-off value was 340.5 μg) on diagnosis iodine excess were 0.732(95% CI: 0.619-0.846), 0.780(95% CI: 0.662-0.898), 0.802(95% CI: 0.697-0.907), respectively, and there was no significant difference between pairwise comparisons(all P > 0.05). Conclusions Women with a history of iodine exposure before pregnancy have a higher rate of excess iodine during pregnancy. Random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion have certain application value in identifying iodine excess during pregnancy in women with a history of iodine exposure before pregnancy. Because urinary iodine-to-creatinine ratio is convenient to detect, that of > 307.5 μg/g may help to further improve the recognition rate of excess iodine during pregnancy. 作者贡献: 李融融负责研究设计、数据采集与分析、结果解读、论文撰写；李蕊、张金芳参与研究设计、数据采集；刘燕萍、马良坤、邱玲、柴晓峰参与数据分析、研究实施并指导论文修改；刘燕萍、马良坤负责研究设计、论文修改与结果解读。利益冲突: 无 -
表 1 70例孕妇妊娠期尿碘代谢指标比较[M(P25, P75)]
组别 血清碘(μg/L) 随机尿碘(μg/L) 尿碘肌酐比(μg/g) 24 h尿碘排泄量(μg) 血清碘＞90 μg/L(n=50) 286.00(139.00, 1177.50) 1045.00(500.00, 2567.50) 870.00(439.00, 2451.00) 540.00(236.00, 925.00) 血清碘≤90 μg/L(n=20) 71.50(56.00, 79.00) 204.00(131.00, 352.00) 135.00(79.00, 231.00) 199.50(104.25, 314.75) P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 
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表 2 不同尿碘代谢指标识别妊娠期碘过量的受试者工作特征曲线分析结果
指标 曲线下面积(95% CI) P值 最大Youden指数 最佳诊断界值 灵敏度(%) 特异度(%) 随机尿碘 0.732(0.619~0.846) 0.003 0.491 654 μg/L 48.5 100 尿碘肌酐比 0.780(0.662~0.898) ＜0.001 0.468 307.5 μg/g 69.1 73.3 24 h尿碘排泄量 0.802(0.697~0.907) ＜0.001 0.502 340.5 μg 75.4 75.0
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