{"id":10125,"date":"2020-04-23T04:57:20","date_gmt":"2020-04-23T01:57:20","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/iod-urinar\/"},"modified":"2025-02-07T16:45:30","modified_gmt":"2025-02-07T14:45:30","slug":"iod-urinar","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/iod-urinar\/","title":{"rendered":"\u0419\u043e\u0434 \u0432 \u043c\u043e\u0447\u0435"},"content":{"rendered":"

\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/p>\n

Iodul se g\u0103se\u015fte \u00een natur\u0103 sub diferite forme: s\u0103ruri anorganice de sodiu \u015fi potasiu (ioduri \u015fi ioda\u0163i), iod diatomic anorganic (iod molecular sau I2<\/sub>) \u015fi iod monoatomic organic. Oceanele reprezint\u0103 principala surs\u0103 de iod; cantitatea mic\u0103 de iod depozitat\u0103 \u00een sol este rezultatul procesului de evaporare a apei oceanice6<\/sup>.<\/p>\n

Alimentele cele mai bogate \u00een iod sunt pe\u015ftele (macrou, hering, somon, p\u0103str\u0103v, somn), fructele de mare \u015fi algele marine. Unele vegetale, precum \u015fi apa potabil\u0103 constituie de asemenea o surs\u0103 de iod, dar con\u0163inutul\u00a0\u00een iod al acestora variaz\u0103 \u00een func\u0163ie de concentra\u0163ia acestui element\u00a0\u00een sol. Sarea iodat\u0103 poate fi o surs\u0103 dietetic\u0103 de iod foarte important\u0103, acolo unde este\u00a0\u00een mod curent accesibil\u0103. Laptele matern are un con\u0163inut crescut de iod, care poate asigura necesarul pentru sugarii alimenta\u0163i natural. Legume ca varza, conopida, napii \u015fi guliile con\u0163in\u00a0\u00een mod natural substan\u0163e (tiociana\u0163i \u015fi izotiociana\u0163i), care au o ac\u0163iune competitiv\u0103 cu iodul, pe care \u00eel deplaseaz\u0103 din combina\u0163iile lui impiedic\u00e2nd astfel acumularea iodului\u00a0\u00een tiroid\u0103. Pe de alt\u0103 parte, aceste legume con\u0163in goitrina, substan\u0163\u0103 care interfer\u0103 cu biosinteza hormonilor tiroidieni. Excesul de fluor din ap\u0103 \u015fi alimente poate favoriza caren\u0163a de iod, deoarece fluorul este mai reactiv dec\u00e2t iodul \u015fi intr\u0103 \u00een competi\u0163ie cu acesta. Concentra\u0163ia crescut\u0103 de calciu \u015fi magneziu, caracteristic\u0103 apelor dure, diminueaz\u0103 absorb\u0163ia intestinal\u0103 a iodului2<\/sup>.<\/p>\n

Iodul molecular (I2<\/sub>) este absorbit intestinal prin difuziune facilitat\u0103, \u00een timp ce iodurile (I-<\/sup>) sunt absorbite prin intermediul unui transportor de tip simport Na+<\/sup>\/I situat la nivelul mucoasei gastrice.<\/p>\n

Iodul constituie un oligoelement esen\u0163ial necesar pentru func\u0163ionarea optim\u0103 a glandei tiroide \u015fi dezvoltarea neurologic\u0103 a f\u0103tului \u015fi copilului mic. Astfel, deficitul de iod este recunoscut ca fiind cauza cea mai obi\u015fnuit\u0103 de endocrinopatie (gu\u015f\u0103 \u015fi hipotiroidism primar), precum \u015fi de retard mental ce poate fi prevenit.<\/p>\n

Iodul de\u0163ine un rol direct \u00een formarea hormonilor tiroidieni; la nivelul membranei bazolaterale a celulelor foliculului tiroidian se g\u0103se\u015fte transportorul de tip simport Na+<\/sup>\/I care sechestreaz\u0103 iodul din lichidul extracelular (I-<\/sup>) \u015fi a c\u0103rui activitate este controlat\u0103 de c\u0103tre tireotropin\u0103 (TSH). Aceast\u0103 protein\u0103 asigur\u0103 concentrarea iodului \u00een interiorul celulelor foliculare p\u00e2n\u0103 se ating niveluri de 20-40 ori mai mari dec\u00e2t cele prezente\u00a0\u00een s\u00e2nge. \u00cen continuare, I- <\/sup>este organificat (oxidat) la I2<\/sub> sub ac\u0163iunea tiroid-peroxidazei \u00a0(TPO) \u015fi \u00eencorporat \u00een molecula tiroglobulinei. \u00cen final rezult\u0103 hormonii tiroidieni tiroxin\u0103 (T4) \u015fi triiodotironin\u0103 (T3). Iodul reprezint\u0103 65% din greutatea molecular\u0103 a T4 \u015fi 59% din cea a T3.<\/p>\n

La adultul cu aport adecvat, aproximativ 15-20 mg de iod, reprezent\u00e2nd 30% din cantitatea total\u0103 din organism, sunt concentrate \u00een \u0163esutul \u015fi hormonii tiroidieni, iar restul de 70% este distribuit la nivelul glandelor mamare, ochilor, mucoasei gastrice, colului uterin \u015fi glandelor salivare. \u00cen celulele acestor \u0163esuturi iodul p\u0103trunde de asemenea printr-un transport de tip simport Na+<\/sup>\/I. Rolul \u0163esutului mamar de a concentra iodul este legat de func\u0163ionarea tiroidei nou-n\u0103scutului \u015fi \u00een consecin\u0163\u0103 de dezvoltarea cerebral\u0103 normal\u0103. \u00cen celelalte \u0163esuturi func\u0163ia sa r\u0103m\u00e2ne incomplet elucidat\u0103, unele studii demonstr\u00e2nd capacitatea de antioxidant a acestui oligoelement6<\/sup>.<\/p>\n

Doza zilnic\u0103 recomandat\u0103 de iod variaz\u0103 de la 150 \u00b5g\/zi pentru adul\u0163i la 290 \u00b5g\/zi pentru femeile care al\u0103pteaz\u0103. Cu toate acestea, glanda tiroid\u0103 nu are nevoie de mai mult de 70 \u00b5g\/zi pentru a sintetiza hormonii tiroidieni. Aceste nivele ridicate sunt necesare pentru optima func\u0163ionarea a mucoasei gastrice, glandelor salivare, mucoasei bucale, timusului, epidermei, plexului coroid1<\/sup>.<\/p>\n

Deficitul de iod este frecvent \u00een \u0163\u0103rile\u00a0\u00een curs de dezvoltare \u015fi\u00a0\u00een anumite p\u0103r\u0163i ale Europei \u015fi rar\u00a0\u00een zonele\u00a0\u00een care este utilizat\u0103 sarea iodat\u0103. Studii recente arat\u0103 c\u0103 lipsa iodului este un fapt comun\u00a0\u00een r\u00e2ndul femeilor adulte din SUA. Deficitul de iod se dezvolt\u0103 atunci c\u00e2nd aportul scade sub 20 \u00b5g\/zi. Drept consecin\u0163\u0103 se produce m\u0103rirea de volum a glandei tiroide cu posibila apari\u0163ie de noduli multipli (gu\u015f\u0103 endemic\u0103). De obicei pacien\u0163ii r\u0103m\u00e2n eutiroidieni; dar, cu toate acestea, deficitul sever la adul\u0163i poate cauza hipotiroidism clinic manifest (mixedem endemic) ce poate determina la femei anovula\u0163ie, infertilitate, hipertensiune gesta\u0163ional\u0103, avort spontan\u00a0\u00een primul trimestru \u015fi moartea f\u0103tului in utero<\/em>.<\/p>\n

Manifest\u0103rile ap\u0103rute la copiii mici sunt rezultatul deficitului matern de iod. Astfel, deficitul matern sever determin\u0103 retard de cre\u015ftere, anomalii \u00een dezvoltarea creierului, malforma\u0163ii congenitale, iar la sugari produce cretinismul<\/em> caracterizat prin retard mental, surditate, dificult\u0103\u0163i de mers, deficit statural \u015fi, uneori, hipotiroidism. \u00cen concluzie, iodul constituie un element esen\u0163ial at\u00e2t \u00een cursul sarcinii c\u00e2t \u015fi\u00a0\u00een perioada lacta\u0163iei, pentru\u00a0 facilitarea dezvolt\u0103rii neurologice continue a copilului mic5;6<\/sup>.<\/p>\n

Determinarea nivelului de iod serve\u015fte ca indicator important al aportului alimentar adecvat de iod, dar \u015fi al supra\u00eenc\u0103rc\u0103rii, ce poate ap\u0103rea\u00a0\u00een cursul terapiei cu diverse medicamente, cum ar fi amiodarona4<\/sup>.<\/p>\n

Toxicitatea cronic\u0103 se poate dezvolta atunci c\u00e2nd aportul de iod dep\u0103\u015fe\u015fte 1,1 mg\/zi. Majoritatea persoanelor care inger\u0103 cantit\u0103\u0163i mari de iod r\u0103m\u00e2n eutiroidiene; unele persoane \u00eens\u0103,\u00a0\u00een special cele care anterior au fost deficitare, dezvolt\u0103 hipertiroidie. In mod paradoxal, captarea excesiv\u0103 de iod de c\u0103tre tiroid\u0103 poate inhiba sinteza hormonilor tiroidieni (efectul Wolff-Chaikoff). Astfel, toxicitatea poate provoca\u00a0\u00een cele din urm\u0103 gu\u015f\u0103, hipotiroidism sau mixedem. Cantit\u0103\u0163i foarte mari de iod pot produce un gust metalic, hipersaliva\u0163ie, irita\u0163ie gastrointestinal\u0103, precum \u015fi leziuni acneiforme. La pacien\u0163ii expu\u015fi la cantit\u0103\u0163i mari de substan\u0163e radiologice de contrast sau diverse medicamente ce con\u0163in iod este necesar s\u0103 se monitorizeze func\u0163ia tiroidian\u01035<\/sup>.<\/p>\n

Recomand\u0103ri pentru determinarea iodului<\/em><\/strong><\/p>\n

\u2013\u00a0determinarea statusului iodului \u00een organism;<\/div>\n
\u2013\u00a0monitorizarea nivelului de iod la persoanele c\u0103rora li se administreaz\u0103 medicamente care con\u0163in iod;<\/div>\n
\u2013\u00a0monitorizarea ratei de excre\u0163ie a iodului ca indicator al terapiei zilnice de substitu\u0163ie4<\/sup>;6<\/sup>.<\/div>\n

Preg\u0103tire pacient<\/em><\/strong> \u2013 nu este necesar\u0103 o preg\u0103tire special\u01033<\/sup>.<\/p>\n

Specimen recoltat<\/em><\/strong> \u2013 o prob\u0103 de urin\u0103 spontan\u01033<\/sup>.<\/p>\n

Recipient de recoltare <\/em><\/strong>-<\/em> eprubeta pentru urin\u01033<\/sup>.<\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare<\/em><\/strong> \u2013 urina se men\u0163ine la 2-8\u00b0C p\u00e2n\u0103 \u00een momentul lucrului3<\/sup>.<\/p>\n

Cantitate recoltat\u0103 <\/em><\/strong>\u2013 cca. 5 mL3<\/sup>.<\/p>\n

Stabilitate prob\u0103 <\/em><\/strong>\u2013 urina este stabil\u0103 7 zile \u00a0<\/em>la 2-8\u00b0C3<\/sup>.<\/p>\n

Metod\u0103<\/em><\/strong> - plasm\u0103 cuplat\u0103 inductiv cu spectrometrie de mas\u0103 (ICP\/MS)3<\/sup><\/span>.<\/p>\n

Valori de referin\u0163\u0103 \u015f<\/em><\/strong>i interpretarea rezultatelor<\/em><\/strong>\u00a0 <\/em><\/p>\n

Iod urinar: se poate exprima at\u00e2t \u00een \u03bcg\/L (vezi tabelul) fie \u00een \u03bcg\/creatinin\u0103 (valori de referin\u0163\u0103: 11-403).<\/p>\n

\u00cen func\u0163ie de valoarea iodului urinar se poate evalua statusul iodului \u00een organism:<\/p>\n\n\n\n\n\n\n\n\n\n
\n

Nivel iod urinar\u00a0 (<\/strong>\u03bc<\/strong>g\/L)<\/strong><\/p>\n<\/td>\n

\n

Statusul iodului \u00een organism<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

<20<\/p>\n<\/td>\n

\n

Deficit sever<\/p>\n<\/td>\n<\/tr>\n

\n

20 \u2013 49<\/p>\n<\/td>\n

\n

Deficit moderat<\/p>\n<\/td>\n<\/tr>\n

\n

50 \u2013 99<\/p>\n<\/td>\n

\n

Deficit u\u015for<\/p>\n<\/td>\n<\/tr>\n

\n

100 \u2013 199<\/p>\n<\/td>\n

\n

Aport de iod optim<\/p>\n<\/td>\n<\/tr>\n

\n

200 \u2013 299<\/p>\n<\/td>\n

\n

Aport de iod mai mult dec\u00e2t adecvat<\/p>\n<\/td>\n<\/tr>\n

\n

>299<\/p>\n<\/td>\n

\n

Aport de iod \u00een exces<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Valoarea cut-off pentru deficitul de iod a fost stabilit\u0103 de Organiza\u0163ia Mondial\u0103 a S\u0103n\u0103t\u0103\u0163ii (OMS) ca fiind 100 \u03bcg\/L. OMS a constatat c\u0103 \u00een popula\u0163iile care prezint\u0103 valori medii ale iodului urinar sub acest cut-off prevalen\u0163\u0103 gu\u015fei cre\u015fte semnificativ.<\/p>\n

Pacien\u0163ii c\u0103rora li s-au administrat substan\u0163e de contrast sau medicamente pe baz\u0103 de iod (amiodarona), vor prezenta valori serice \u015fi urinare crescute3;4;6<\/sup>.<\/p>\n

Limite \u015fi interferen\u0163e<\/em><\/strong><\/p>\n

Un nivel seric crescut de gadoliniu interfer\u0103 cu testele la metale, de aceea \u00een cazul \u00een care au fost administrate substan\u0163e de contrast cu gadoliniu, recoltarea trebuie am\u00e2nat\u0103 cel pu\u0163in 48 de ore.<\/div>\n
Dezinfectan\u0163ii care con\u0163in iod (cum ar fi Betadina) nu trebuie utiliza\u0163i la locul de punc\u0163ie venoas\u01034<\/sup>.<\/div>\n

\u00a0<\/span><\/p>\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

1. Brown-Grant, K. Extrathyroidal iodide concentrating mechanisms. In Physiol Rev. , 1961, 41: 189.<\/span><\/div>\n
2. Florentina Moldovanu. Micromineralele \u2013 nutrien\u0163i esen\u0163iali pentru s\u0103n\u0103tatea copilului. \u00cen Medicina Modern\u0103, Vol. XII \u2013 Nr. 7 (iulie 2005).<\/span><\/div>\n
3. Laborator Synevo. Referin\u0163e specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog.<\/span><\/div>\n
4. Mayo Clinic, Mayo Medical Laboratories. Test Catalog. Iodine, Serum. Iodine, Urine. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/div>\n
5. The Merck Manuals for Healthcare Professional. Iodine. Ref Type: Internet Communication http:\/\/www.merck.com\/mmpe\/sec01\/ch005\/ch005e.html.<\/span><\/div>\n
6. Patrick L. Iodine: deficiency and therapeutic considerations. In Altern Med Rev, 2008, 13: 116.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

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