摘要
目的：通过对供应碘盐的缺碘地区与山西省停供碘盐的水源性高碘地区孕妇、哺乳妇女和育龄女性亚临床甲状腺疾病检出率的比较，分析2组人群在不同碘来源和碘营养水平下亚临床甲状腺疾病的患病情况，为碘相关甲状腺疾病敏感人群的筛检提供依据。方法：在我国6个省份选择缺碘补碘地区，调查当地孕妇、哺乳妇女、18～45岁育龄妇女3类人群，共991名；孕妇碘营养水平按＜150、150～249、250～499和≥500μg·L-1进行分组，哺乳妇女碘营养水平按＜100和≥100μg·L-1进行分组；在山西省选择高水碘地区，按水碘水平选择50～99、100～149、150～299和≥300μg·L-14个地区，每个地区选择孕妇、哺乳妇女和育龄妇女各20名，共计241名。分别采集上述调查对象的血样和尿样，采用化学发光免疫测定法或放射免疫法测定血清学甲状腺功能指标，采用砷铈催化分光光度方法测定尿碘水平。结果：在碘缺乏地区和高碘地区，女性人群亚临床甲状腺功能减退症（亚临床甲减）和甲状腺抗体阳性的并发率分别为2.32％和4.98％，亚临床甲减患者中甲状腺抗体阳性人群约占1／3～1／2。碘缺乏地区和高碘地区女性人群亚临床甲状腺疾病的患病率分别为27.55％和34.85％，约占总女性人群的1／3。高水碘地区孕妇、哺乳妇女、18～45岁育龄妇女亚临床甲减检出率明显高于碘缺乏地区（P＜0.05）；高水碘地区哺乳妇女甲状腺抗体阳性和亚临床甲减伴抗体阳性检出率明显高于碘缺乏地区（P＜0.05）。不同碘来源下，当摄碘量适宜时，女性亚临床甲状腺疾病检出率比较差异无统计学意义（P＞0.05）。随着碘暴露水平的增加，女性人群亚临床甲减和甲状腺抗体阳性患病率增加，二者的重合率也增加。孕妇碘营养＜100μg·L-1组低T4血症和总亚临床甲状腺疾病检出率均明显高于碘营养250～499μg·L-1组（P＜0.05），哺乳妇女碘营养＜100μg · L-1组低 T4血症和总亚临床甲状腺疾病检出率均明显高于碘营养≥100μg·L-1组（P＜0.05）。结论：在摄碘量适宜时，盐碘摄入碘与水碘摄入碘对亚临床甲状腺疾病的发生无影响；碘摄入量升高时，亚临床甲状腺疾病发病随之升高。
Objective By comparing the detection rates of subclinical thyroid diseases in women（pregnant,lactating＆amp;nbsp;and child-bearing age）between iodine deficient regions （supplied iodized salt）and water-borne iodine excess regions （consumed non-iodized salt）,and to find the different prevalence of subclinical thyroid disease between two regions under their different iodine source and iodine levels, and to provide reference for screening susceptible population with iodine-related thyroid diseases.Methods The iodine deficiency but salt iodine surpplying regions were selected from six provinces in our country,the local people who were pregnant women,lactating women and 18 to 45 years old women of child-bearing age,a total of 991 cases were investigated.The iodine nutrition levels of the pregnant women were grouped by 〈150,150-249,and ≥500μg·L-1;the iodine nutrition levels of the lactating women were grouped by 〈100 and ≥100μg·L-1 .The high water-iodine regions in Shanxi Province were selected,and according to the water-iodine levels 50-99,100-149,149-299,and more than 300μg·L-1 four regions were selected;20 cases of three kinds of people mentioned above were selected in each region,a total of 241 cases.The blood and urine samples were collected, and the serological thyroid function indexes were detected by chemiluminescence immunoassay method or radioimmunity method, and the urine-iodine was detected with cerium catalytic spectrophotometric method. Results In iodine deficient regions and water-borne iodine excess regions, the concurrence rates of subclinical hypothyroidism（hypothyroidism for short）and thyroid antibody positive of women were 2.32% and 4.98%,respectively;accounting to about 1/3 to 1/2 of those subclinical hypothyroidism population.The prevalence rates of subclinical thyroid diseases in the women population between the two regions were 27.55% and 34.85%,respectively;nearly accounting for 1/3 of the women population.The subclinical hypothyroidism detection rates of the three populations in high water iodine regions were significantly higher than those in iodine deficient regions（P〈0.05）.The lactating women’s detection rates of thyroid antibody positive and subclinical hypothyroidism with antibody positive in high water iodine regions were significantly higher than those in iodine deficient regions（P〈0.05）.With different iodine sources,when took appropriate iodine,there was no statistical difference of the detection rates of subclinical thyroid diseases among three kinds of women（P〉0.05）. With the increase of iodine exposure levels,the prevalence of women who suffered from subclinical hypothyroidism and thyroid antibody positive was increased,the coincidence rate was also increased.The detection rates of low T4 concentration and total subclinical thyroid disease of pregnant women in iodine nutrition〈100μg·L-1 group were significantly higher than those in iodine nutrition 250-499μg·L-1 group （P〈0.05）.The detection rates of low T4 concentration and total subclinical thyroid disease of lactating women in iodine nutrition 〈100μg· L-1 group were significantly higher than those in iodine nutrition ＆gt;100μg·L-1 group （P〈0.05）.Conclusion When the iodine intake is appropriate, iodine intakes from salt or from water have no effect on subclinical thyroid diseases. When the iodine intake increases,the prevalence of subclinical thyroid diseases will increase too.
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2014年第3期668-674,共7页
Journal of Jilin University：Medicine Edition
基金
国家自然科学基金青年基金资助课题(81001224)
科技部"十一五"国家科技支撑计划项目资助课题(2006BAI06B05)
联合国儿童基金会基金资助课题(2011H&NIR1Act17)
国际营养改善联盟基金资助课题(104641)
关键词
碘缺乏
高水碘
女性
亚临床甲状腺疾病
检出率
iodine deficiency
high water-iodine
women
subclinical thyroid diseases
detection rate
