摘要
目的为探讨和研究沿海轻度缺碘地区全民食盐加碘（USI）后对甲状腺疾病的影响,为制定科学的补碘策略提供依据。方法2002-2004年采用整群抽样方法选择1996年开始USI的吴川县黄坡镇和至今尚未实施USI的徐闻县迈陈镇为调查点,用回顾性和横断面调查方法,逐户调查每个居民的一般情况、健康情况（主要是与甲状腺疾病相关的）、食用碘盐情况等15项指标;对甲状腺疾病患者及疑似患者的现病史、既往史、家族史、治疗及转归等36项指标进行个案调查。同时调查两镇外环境碘水平和人群碘营养状况。甲状腺功能采用化学发光免疫法测定,尿碘采用砷鈰催化分光光度法测定。结果黄坡镇和迈陈镇外环境水碘中位数分别为9.9μg/L和3.9μg/L。补碘前黄坡镇人群尿碘水平、8~10岁儿童甲状腺肿大率分别为70.7μg/L、12.5%;补碘（人均食用碘盐量达到3.44 kg/年）7年后分别为142.7μg/L、2.25%;迈陈镇则分别为52.7μg/L、10.3%。补碘前（1993-1995年）黄坡镇和迈陈镇的甲状腺功能亢进症（甲亢）平均年发病率分别为27.16/10万和18.63/10万（P〉0.05）。黄坡镇居民于1996年食用加碘盐后,甲亢病例迅速上升至49.42/10万,明显高于补碘前（P〈0.05）;至1999年发病率（59.75/10万）上升至最高峰,直至2002年（34.24/10万）才开始明显回落,至2003年甲亢发病率（25.68/10万）已经回落到补碘前的水平（P〉0.05）;1996-1999年连续4年黄坡镇的甲亢发病率明显高于迈陈镇（P〈0.05）,2000-2004年两镇居民的甲亢发病率差异均无统计学意义（P〉0.05）。补碘后黄坡镇的甲状腺肿和甲状腺瘤患病率明显低于未补碘的迈陈镇（P〈0.01）。黄坡镇甲低患病率明显高于迈陈镇（P〈0.05）。结论轻度碘缺乏地区实行USI后,能有效控制碘缺乏病的流行,但出现碘致甲亢发病率呈一过性升高的现象,随着人群缺碘状况被纠正,碘致甲亢逐渐消失。在加强碘缺乏病防治工作的同时,应正视和关注对USI副作用的预防和处理。
Objective To explore the effect of universal salt iodization （ USI ） on the incidence of thyroid disease in minor iodine deficiency coastal areas and provide scientific evidence for developing scientific iodine supply strategies in China, Methods Cluster sampling was used to select Huanpo town in Wuchuan county with USI since 1996 and Maichen town in Xuwen county without USI from 2002 to 2004, to conduct retrospective and cross-sectional door to door surveys on general information, personal health related thyroid disease and iodized salt consumption, etc, of each residents. Each patient or suspect patient with thyroid disease was asked to complete a structured questionnaire containing 36 items such as disease history, family history, treatment and outcomes etc. The iodine level of environment and iodine nutritional status of residents in two towns were investigated. The function of the thyroid was detected by chemiluminescence immunoassay and iodine in urine was determined by As^3＋ - Ce^4＋ catalytic spectrophotometry.Results The median of water iodine was 9.9 μg/L and 3.9 μg/L in Huangpo town and Maichen town, respectively. Before US1, the average urine iodine was 70.7 μg/L in Huangpo town and 52.7 μg/L in Maichen town. The total goiter rates （TGR） was 12.5% and 10. 3% among children aged from 8 to 10 years respectively. After USI （per capita iodine consumption reached 3.44 kg/year） for 7 years in Huangpo town, the average urine iodine and TGR among children of 8 - 10 years were 142.7 μg/L and 2.25%. The yearly average incidences of hyperthyroidism were 27.16/100 000 and 18.63/100 000 in two towns before USI. After USI in Huangpo town since 1996, the incidence of hyperthyroidism increased quickly to 49.42/100 000, which was significantly higher than before（P 〈 0.05）. It reached peak（59.75/100 000） in 1999, then began to decrease obviously（34. 24/100 000） in 2002 and restore to the similar level （ 25. 68/100 000 ） before USI in 2003. The initial four years （ 1996 - 1999 ） was signifieantly higher in Huangpo town than in Maichen town （ P 〈 0. 05 ） while no significant difference exited in following 2000 to 2004 （ P 〉 0.05 ）. After USI, the incidence of goiter and thyrophyma in Huangpo town was significantly lower than Maichen town without USI（ P 〈0. 01） , while there was a higher incidence of thyroid hypofunction in Huangpo town （ P 〈 0. 05 ）. Conclusion USI in minor iodine deficiency area could effectively prevent the prevalence of iodine deficiency disorders （ IDD ） and caused short-elapsed increase in the incidence of hyperthyroidism which disappeared as the iodine deficiency was eliminated and should concern adverse consequences.
出处
《华南预防医学》
2007年第4期1-6,共6页
South China Journal of Preventive Medicine
基金
广东省医学科学技术研究基金(编号:82001004)
