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尿碘代谢评价指标识别孕前碘暴露女性妊娠期碘过量的价值

李融融 刘燕萍 马良坤 邱玲 柴晓峰 李蕊 张金芳

李融融, 刘燕萍, 马良坤, 邱玲, 柴晓峰, 李蕊, 张金芳. 尿碘代谢评价指标识别孕前碘暴露女性妊娠期碘过量的价值[J]. 协和医学杂志, 2021, 12(3): 346-352. doi: 10.12290/xhyxzz.20200146
引用本文: 李融融, 刘燕萍, 马良坤, 邱玲, 柴晓峰, 李蕊, 张金芳. 尿碘代谢评价指标识别孕前碘暴露女性妊娠期碘过量的价值[J]. 协和医学杂志, 2021, 12(3): 346-352. doi: 10.12290/xhyxzz.20200146
LI Rongrong, LIU Yanping, MA Liangkun, QIU Ling, CHAI Xiaofeng, LI Rui, ZHANG Jinfang. Value of the Indicators of Urinary Iodine Metabolism in Identifying Iodine Excess during Pregnancy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(3): 346-352. doi: 10.12290/xhyxzz.20200146
Citation: LI Rongrong, LIU Yanping, MA Liangkun, QIU Ling, CHAI Xiaofeng, LI Rui, ZHANG Jinfang. Value of the Indicators of Urinary Iodine Metabolism in Identifying Iodine Excess during Pregnancy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(3): 346-352. doi: 10.12290/xhyxzz.20200146

尿碘代谢评价指标识别孕前碘暴露女性妊娠期碘过量的价值

doi: 10.12290/xhyxzz.20200146
基金项目: 

中央高校基本科研业务费项目青年教师项目 3332018014

北京市科学技术委员会北京市科技计划课题 Z191100008619006

详细信息
    通讯作者:

    刘燕萍 电话:010-69155550,E-mail:liuyp1227@vip.sina.com

  • 中图分类号: R581

Value of the Indicators of Urinary Iodine Metabolism in Identifying Iodine Excess during Pregnancy

Funds: 

the Young Teachers Project of Fundamental Research Funds for the Central Universities 3332018014

the Beijing Project of Science and Technology of Beijing Municipal Commission of Science and Technology Z191100008619006

More Information
  • 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。
    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
  • 图  1  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

    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 <0.001 <0.001 <0.001 <0.001
    下载: 导出CSV

    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 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
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-06-03
  • 录用日期:  2020-06-24
  • 刊出日期:  2021-05-30

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