摘要
目的观察2015—2017年中国在实施全民食盐加碘政策20年后不同碘摄入地区甲状腺疾病的患病率及其相关因素。方法横断面调查。采用多阶段分层整群随机抽样,2015年1月至2017年12月在中国31个省、自治区、直辖市随机选择符合纳入标准的对象,并按年龄和性别进行分层。调查内容包括问卷调查、体格检查和甲状腺超声检查;同时,检测受试对象的血清促甲状腺激素、甲状腺素、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)和尿碘浓度等。根据以上结果判断患者是否患有某种甲状腺疾病;根据尿碘浓度定义不同的碘营养地区,分析不同碘摄入地区碘营养状态对甲状腺疾病的影响。结果共纳入78470名成年人,其中碘适量地区39893名,碘超足量地区28779名,碘过量地区9798名。3个地区中,亚临床甲状腺功能亢进症(甲亢)的患病率分别为0.45%(95%CI:0.39%~0.52%),0.50%(95%CI:0.35%~0.70%)和0.27%(95%CI:0.20%~0.35%),差异有统计学意义(χ^(2)=6.92,P=0.003);亚临床甲状腺功能减退症(甲减)的患病率分别为11.36%(95%CI:10.73%~12.02%),13.57%(95%CI:11.70%~15.69%)和16.18%(95%CI:12.41%~20.82%),差异有统计学意义(χ^(2)=5.08,P=0.009);3个地区间Graves病、TPOAb、甲状腺肿和甲状腺结节的患病率差异均有统计学意义(均P<0.05)。3个地区间临床甲亢和临床甲减的患病率及TgAb的阳性率差异均无统计学意义(均P>0.05)。多因素logistic回归模型分析发现,碘超足量是亚临床甲减发生的危险因素(OR=1.24,95%CI:1.06~1.44),是甲状腺结节发生的保护因素(OR=0.73,95%CI:0.57~0.94)。碘过量是亚临床甲减发生的危险因素(OR=1.47,95%CI:1.08~2.01),是亚临床甲亢(OR=0.56,95%CI:0.41~0.77)、TPOAb阳性(OR=0.93,95%CI:0.87~0.99)、甲状腺肿(OR=0.33,95%CI:0.17~0.66)和甲状腺结节(OR=0.77,95%CI:0.61~0.97)发生的保护因素。结论不同碘摄入地区的亚临床甲亢、亚临床甲减、TPOAb阳性、甲状腺结节和甲状腺肿的患病率有差异。不同碘摄入水平对甲状腺疾病的发病有影响。
Objective To observe the prevalence and related factors of thyroid diseases in different iodine intake areas from 2015 to 2017 after the implementation of national salt iodization policy in China for 20 years.Methods A cross-sectional survey.Multi-stage stratified cluster random sampling was used to randomly select subjects meeting the inclusion criteria from 31 provinces,municipalities and autonomous regions in China from January 2015 to December 2017,and stratified by age and sex.The survey included questionnaire,physical examination and thyroid ultrasonography.At the same time,the concentrations of serum thyrotropin,thyroxine,thyroid peroxidase antibody(TPOAb),thyroid globulin antibody(TgAb)and urinary iodine were measured.To determine whether the patient has a certain thyroid disease according to the above results.Different iodine nutrition areas were defined according to urinary iodine concentration,and the influence of iodine nutrition status in different iodine intake areas on thyroid diseases was analyzed.Results A total of 78470 adults were included,including 39893 in the area of moderate iodine,28779 in the area of adequate iodine,and 9798 in the area of excessive iodine.In the above three regions,the prevalence of subclinical hyperthyroidism(hyperthyroidism)was 0.45%(95%CI:0.39%-0.52%),0.50%(95%CI:0.35%-0.70%)and 0.27%(95%CI:0.20%-0.35%),respectively,with statistical significance(χ^(2)=6.92,P=0.003).The prevalence of subclinical hypothyroidism(hypothyroidism)was 11.36%(95%CI:10.73%-12.02%),13.57%(95%CI:11.70%-15.69%)and 16.18%(95%CI:12.41%-20.82%),respectively,with statistical significance(χ^(2)=5.08,P=0.009).The prevalence rates of Graves′disease,TPOAb,goiter and thyroid nodule among the three regions were statistically significant(all P<0.05).There were no significant differences in the prevalence of clinical hyperthyroidism and clinical hypothyroidism and the positive rate of TgAb among the three regions(all P>0.05).Multivariate logistic regression model analysis showed that excess iodine was a risk factor for subclinical hypothyroidism(OR=1.24,95%CI:1.06-1.44),and a protective factor for thyroid nodules(OR=0.73,95%CI:0.57-0.94).Iodine overdose was a risk factor for subclinical hypothyroidism(OR=1.47,95%CI:1.08-2.01),while it was a protective factor for subclinical hyperthyroidism(OR=0.56,95%CI:0.41-0.77),and TPOAb positive(OR=0.93,95%CI:0.87-0.99),goiter(OR=0.33,95%CI:0.17-0.66)and thyroid nodule(OR=0.77,95%CI:0.61-0.97).Conclusions There are significant differences in the prevalence of subclinical hyperthyroidism,subclinical hypothyroidism,positive TPOAb,thyroid nodule and goiter in different iodine intake regions.Different iodine intake levels have an effect on the incidence of thyroid diseases.
作者
李咏泽
滕卫平
单忠艳
TIDE项目组
Li Yongze;Teng Weiping;Shan Zhongyan;the Project Team of the Thyroid Disorders,Iodine Status and Diabetes:a National Epidemiological Survey(TIDE)(Department of Endocrinology and Metabolism,Institute of Endocrinology,the First Affiliated Hospital of China Medical University,NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases,Shenyang 110001,China;不详)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第5期350-355,共6页
National Medical Journal of China
基金
国家卫生健康委员会公益性行业科研专项(201402005)
关键词
碘营养
甲状腺疾病
患病率调查
尿碘
横断面研究
Iodine nutrition
Thyroid disorder
Prevalence survey
Urinary iodine
Cross-sectional study
