碘强化后丹麦孕妇的甲状腺球蛋白抗体和甲状腺过氧化物酶抗体水平升高，但早产率没有升高。
Increase in thyroglobulin antibody and thyroid peroxidase antibody levels, but not preterm birth-rate, in pregnant Danish women upon iodine fortification.
机构信息
Departments of Medical EndocrinologySection 2132.
Departments of Growth and Reproduction.
出版信息
Eur J Endocrinol. 2017 May;176(5):603-612. doi: 10.1530/EJE-16-0987.
OBJECTIVE
The presence of thyroid antibodies in pregnancy has been associated with preterm birth. In the non-pregnant population, the implementation of the Danish iodine fortification program has increased the prevalence of thyroid antibodies. This study investigated the prevalence of thyroid peroxidase antibodies (TPOAbs) and thyroglobulin antibodies (TgAbs) in pregnant Danish women before, during and after implementation of the iodine fortification program and association with preterm birth.
DESIGN
Comparative cohort study of 1368 pregnancies from three cohorts gathered before (1996-1998), during (2000-2003) and after (2008-2009) the iodine fortification program.
METHODS
In cohort 1 ( = 297), TPOAbs were measured (DYNOtest (BRAHMS)). In cohorts 2 ( = 148) and 3 ( = 923), both TPOAbs and TgAbs were measured (Kryptor immunofluorescent assay (BRAHMS)). The prevalence and effect of antibody positivity were explored using three cut-offs: TPOAbs and/or TgAbs >100 kU/L, TPOAbs and/or TgAbs >60 kU/L and TPOAbs >30 and/or TgAbs >20 kU/L. National preterm birth data were extracted from the National Birth Registry.
RESULTS
In the three cohorts, TPOAb levels >60 kU/L were found in 5.4, 8.1 and 12.0% ((2, = 1367) = 11.7, = 0.003) respectively, and TPOAbs and/or TgAbs >60 kU/L in 8.1 and 16.2% in cohorts 2 and 3 respectively ((2, = 1070) = 6.5, = 0.01). TgAb levels (>20 kU/L) had increased plenty-fold from cohort 2 to 3 ((1, = 1071) = 136.5, < 0.001). Preterm birth occurred in 4.1% of all pregnancies with no effect from antibody positivity (TPOAbs and/or TgAbs >60 kU/L, (1, = 1039) = 0.0, = 0.98, aOR = 1.1, 95% CI (0.4-2.7)). The national preterm birth-rate showed no increase over the same period.
CONCLUSIONS
Thyroid antibody positivity in Danish pregnant women has more than doubled upon the implementation of the iodine fortification program without an increase in preterm birth-rate.
目的
已有研究表明，妊娠期间甲状腺抗体的存在与早产有关。在非妊娠人群中，丹麦碘强化计划的实施增加了甲状腺抗体的流行率。本研究旨在调查在碘强化计划实施前后，丹麦孕妇在妊娠期间甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）的流行率，并探讨其与早产的关系。
设计
比较队列研究，纳入了三个队列的 1368 例妊娠病例，分别在碘强化计划实施前（1996-1998 年）、实施期间（2000-2003 年）和实施后（2008-2009 年）进行。
方法
在队列 1（ = 297）中，采用 DYNOtest（BRAHMS）检测 TPOAb。在队列 2（ = 148）和 3（ = 923）中，采用 Kryptor 免疫荧光测定法（BRAHMS）同时检测 TPOAb 和 TgAb。使用三个截断值来探索抗体阳性的患病率和影响：TPOAb 和/或 TgAb >100 kU/L、TPOAb 和/或 TgAb >60 kU/L、TPOAb >30 和/或 TgAb >20 kU/L。从国家出生登记处提取了国家早产数据。
结果
在三个队列中，TPOAb 水平 >60 kU/L 的分别占 5.4%、8.1%和 12.0%（(2, = 1367) = 11.7， = 0.003），TPOAb 和/或 TgAb >60 kU/L 的分别占 8.1%和 16.2%（队列 2 和 3）（(2, = 1070） = 6.5， = 0.01）。TgAb 水平（>20 kU/L）从队列 2 到队列 3呈指数级增长（(1, = 1071) = 136.5， < 0.001）。所有妊娠中，早产发生率为 4.1%，但抗体阳性（TPOAb 和/或 TgAb >60 kU/L）对早产无影响（(1, = 1039) = 0.0， = 0.98，aOR = 1.1，95% CI (0.4-2.7)）。同期，丹麦的早产率并未增加。
结论
丹麦孕妇的甲状腺抗体阳性率在碘强化计划实施后增加了一倍以上，但早产率并未增加。
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