摘要
目的评估甘肃省不同儿童碘营养水平地区哺乳期妇女碘营养和甲状腺功能状况。方法依据2009年甘肃省8~10岁儿童尿碘监测结果,分别选择尿碘中位数≥300μg/L的武威市凉州区、200~299μg/L的张掖市临泽县和100~199μg/L的平凉市华亭县作为研究地点,并结合2014年8~10岁儿童尿碘调查结果,华亭县为碘过量地区、凉州区为碘适宜1地区、临泽县为碘适宜2地区。2014年对每个点按东、南、西、北、中随机选择1个乡,每个乡选择哺乳期妇女10名,进行尿碘和甲状腺功能检测,采集家中食盐进行盐碘检测。选择其中3个乡的60名8~10岁儿童开展家庭食盐摄入量调查。采集集中式供水出厂水2份,在其覆盖内按东、西、南、北、中五个方位采集末梢水各1份;分散式供水每个乡东、南、西、北、中五个方位各采集水样1份进行水碘检测。结果碘过量地区、碘适宜1地区和碘适宜2地区水碘中位数分别为2.32、0.70和6.18μg/L(P<0.05);盐碘中位数分别为25.3、25.0和28.6 mg/kg(P>0.05);人均日摄盐量分别为15.0、11.3和4.7 g,日摄盐量差异有统计学意义(P<0.05)。碘过量地区、碘适宜1地区和碘适宜2地区哺乳期妇女尿碘中位数分别为181.8、143.1和104.9μg/L,差异有统计学意义(P<0.05)。碘过量地区、碘适宜1地区和碘适宜2地区哺乳期妇女促甲状腺激素(TSH)中位数分别为2.3、2.2和1.9 mIU/L,游离甲状腺素(FT4)均数分别为15.0、13.9和14.6 pmol/L,游离三碘甲状腺原氨酸(FT3)均数分别为5.0、4.8和4.6 pmol/L;TSH、FT4和FT3差异均无统计学意义。碘过量地区、碘适宜1地区和碘适宜2地区哺乳期妇女甲状腺球蛋白抗体(Tg Ab)阳性率分别为3.6%、11.3%和13.2%,甲状腺微粒体抗体(Tm Ab)阳性率分别为3.6%、11.3%和11.3%,差异均无统计学意义;甲状腺功能异常发生率分别为14.3%、21.0%和9.4%(P>0.05),其中低FT4血症患病率分别为7.1%、4.8%和1.9%(P>0.05),亚甲减患病率分别为3.6%、11.3%和3.8%(P>0.05)。结论甘肃省三个地区哺乳期妇女碘营养总体适宜,但均有部分个体存在碘营养不足或碘过量;三个地区均有部分哺乳期妇女发生甲状腺功能异常;应开展哺乳期妇女碘营养和甲状腺功能监测并建立哺乳期妇女正常甲状腺功能参考值。
Objective To assess the iodine nutrition and thyroid function of lactatingwomen in different iodine nutrition level of children in Gansu Province,and provide a scientific basis for iodine supplementation. Methods Liangzhou district（ the median urinary iodine was greater than or equal to 300 g/L）,Linze county（ the median urinary iodine was from 200 to 299 g/L） and Huating county（ the median urinary iodine was from100 to 199 g/L） were selected according to 8-10 years old children urinary iodine in2009. Huating county,Liangzhou district and Linze county were as iodine excessive area,iodine suitable area 1 and iodine suitable area 2,respectively in 2014. One township was randomly selected from the east,west,south,north and middle parts of each research point,10 lactating women were randomly collected in each township,who was tested urine samples and thyroid function. Salt intake was surveyed in 3 townships. 2 samples were collected in centralized water supplies,1 sample was collected in its coverage by the east,west,south,north and middle parts; 1 sample was collected by the east,west,south,north and middle parts in decentralized water supplies, which were tested of water iodine. Results The medians of water iodine were 2. 32,0. 70 and 6. 18 μg/L and the medians of salt iodine were 25. 3,25. 0 and 28. 6 mg/kg for iodine excessive area,iodine suitable area 1 and iodine suitable area 2,respectively. Per capita daily intake of salt were 15. 0,11. 3 and 4. 7 g for iodine excessive area,iodine suitable area 1 and iodine suitable area 2 respectively,there were statisticant differences. The median urinary iodine of lactating women were 181. 8,143. 1 and 104. 9 μg/L for iodine excessive area,iodine suitable area 1 and iodine suitable area 2,respectively. The medians of thyroidstimulating hormone（ TSH） were 2. 3,2. 2 and 1. 9 mIU/L, mean values of free thyroxine（ FT4） were 15. 0,13. 9 and 14. 6 pmol/L,mean values of free triidothyronine（ FT3） were 5. 0,4. 8 and 4. 6 pmol/L for iodine excessive area,iodine suitable area 1 and iodine suitable area 2 respectively, there were not statistically differences. The positive rate of thyromicrosomal antibody（ Tm Ab） were 3. 6 %,11. 3 % and 13. 2 % and the positive rate of thyroglobulin antibody（ Tg Ab） were 3. 6 %,11. 3 % and 11. 3 % for iodine excessive area,iodine suitable area 1 and iodine suitable area 2 respectively（ P〉0. 05）. Prevalence of thyroid function disorders were 14. 3 %,21. 0 % and 9. 4 % and prevalence of low-FT4 syndrome were 7. 1 %,4. 8 % and 1. 9 %, prevalence of subclinical hypothyroidism were 3. 6 %,11. 3 % and 3. 8 % for iodine excessive area,iodine suitable area 1 and iodine suitable area 2 respectively（ P〉0. 05）. Conclusion Iodine nutrition level was appropriate for lactating women in 3 areas,but some lactating women were iodine deficiency or iodine excess. There were occurred thyroid function disorders in some lactating women in 3 areas. The lactating women＇s iodine nutrition and thyroid function should be monitored and the normal reference value of thyroid function on lactating women should be established also.
作者
窦瑜贵
王燕玲
孙玮
曹永琴
朱小南
郑菁
Dou Yugui;Wang Yanling;Sun Wei;Cao Yongqin;Zhu Xiaonan;Zheng Jing(Gansu Center for Disease Prevention and Control, Lanzhou 730020, Chin)
出处
《卫生研究》
CAS
CSCD
北大核心
2018年第1期56-61,共6页
Journal of Hygiene Research
基金
甘肃省卫生行业科研计划管理项目(No.GWGL2013-38)
关键词
哺乳期妇女
碘营养
甲状腺功能
甲状腺自身免疫
lactating women, iodine nutrition, thyroid function,thyroid autoimmunity
