摘要
目的调查河北省沧州市由内陆至沿海迁移人群的常见甲状腺疾病患病情况及尿碘水平，探讨迁移人群甲状腺疾病的流行趋势。方法采用回顾性调查分析方法，将沧州市及沧州市以西县市随工作单位的搬迁至黄骅港并长期定居的企事业单位职工及两地原有职工分为迁移组、内陆组和海港组，迁移组分为稳定居住者和间断居住者。收集所有调查对象2010-2016年在沧州市中心医院体检中心的体检资料，分析其慢性淋巴细胞性甲状腺炎（CLT）、甲状腺结节、毒性弥漫性甲状腺肿（GD）的患病情况。对迁移组中28例间断居住者进行了间断的尿碘测定，分别在黄骅港连续居住1个月以上来沧州当天，以及在沧州市、河间市等地连续居住半个月以上返回黄骅港前，采集尿样，进行尿碘测定，各进行3次，比较生活在两地后尿碘水平变化。结果2010-2016年，共调查7 180人，其中迁移组2 012人、内陆组2 858人、海港组2 310人。迁移组CLT和甲状腺结节的发病率[2.29%（46/2 012）、8.60%（173/2 012）]明显高于内陆组和海港组[1.05%（30/2 858）、5.42%（155/2 858），1.47%（34/2 310）、6.88%（159/2 310），P 〈 0.01或〈 0.05]；迁移组GD的发病率[0.45%（9/2 012）]高于内陆组[0.10%（3/2 858），P 〈 0.05]。迁移组中居住时间明确的为1 503人，其中，稳定居住者482人，间断居住者1 021人，间断居住者CLT和甲状腺结节的发病率[3.23%（33/1 021），9.89%（101/1 021）]明显高于稳定居住者[1.45%（7/482），6.64%（32/482），P均〈 0.05]。间断居住者于黄骅港居住后尿碘值明显高于沧州居住后[中位数（M，μg/L）：464.6比301.4，U = 4.648，P均〈 0.01]，6次测定间断居住者尿碘中位数分别为485.7、285.2、431.7、310.6、470.3、304.4 μg/L，呈明显大幅波动趋势。结论由内陆至沿海迁移人群多种甲状腺疾病的发病率增加，不仅高于内陆的迁出地，也高于沿海的迁入地；迁移人口的流动和居住的不稳定造成的碘摄入的大幅波动，可能是造成甲状腺疾病高发的部分原因。今后应多关注迁移人群的甲状腺疾病患病情况。
ObjectiveTo investigate the prevalence of common thyroid diseases and urinary iodine levels in the population migrated from inland to coastal areas and to evaluate the epidemiological trend of thyroid disease in Heibei Cangzhou.MethodsA retrospective analysis method was adopted. All the persons who were employees of enterprises and institutions, were divided into three groups： the migrated group, who migrated from Cangzhou City and the west counties of Cangzhou City to the Port of Huanghua where they had settled permanently because of the job; the inland group, who lived in Cangzhou City all the time and the seaport group, who lived in the Port of Huanghua for a long-term. Migrated groups were divided into stable occupants and intermittent occupants. During 2010-2016, a follow-up survey was conducted in the three groups at Examination Center of Cangzhou Central Hospital Physical. We compared the cumulative incidences of thyroid diseases including： chronic lymphocytic thyroiditis （CLT）, nodular thyroid disease and Graves＇s disease （GD）. In migrated group, 28 persons who occasionally lived in the Port of Huanghua were detected urinary iodine levels intermittently. We compared the two parts of urinary iodine level changes for three times by collecting a urine sample, including one part from people who lived in the Port of Huanghua continuously for more than a month, and another part of people who lived in Cangzhou or Hejian County for more than half a month then returned to Port of Huanghua.ResultsIn 2010-2016, a total of 7 180 residents were surveyed, of which 2 012 were in the migrated group, 2 858 were in the inland group and 2 310 in the seaport group. The incidences of CLT and nodular thyroid disease were 2.29% （46/2 012） and 8.60% （173/2 012） in the migrated group, which were much higher than that of the inland group and the seaport group [1.05% （30/2 858）, 5.42% （155/2 858）; 1.47% （34/2 310）, 6.88% （159/2 310）, P 〈 0.01 or 〈 0.05]. At the same time, the incidences of GD was 0.45% （9/2 012） in the migrated group, which was higher than that of the inland group [0.10% （3/2 858）, P 〈 0.05]. In migrated group, there were 1 503 residencies, including 482 stable occupants and 1 021 intermittent residents. The incidences of CLT and nodular thyroid disease in intermittent residents were 3.23% （33/1 021） and 9.89% （101/1 021）, which were much higher than that of stable occupants [1.45% （7/482）, 6.64% （32/482）, P 〈 0.05]. The urinary iodine levels in the persons who lived in the Port of Huanghua occasionally （464.6 μg/L） were much higher than that of the persons who lived in Cangzhou for a long time （301.4 μg/L, U = 4.648, P 〈 0.01）. There was a marked fluctuation of the median of urinary iodine determined 6 times which were 485.7, 285.2, 431.7, 310.6, 470.3 and 304.4 μg/L, respectively.ConclusionsThe incidence of many thyroid diseases of people migrated from inland to coastal areas has increased, which is not only higher than that of inland people, but also higher than that of coastal people. Large fluctuations in iodine intake due to migration flow and residential instability may be part of the reason for the high incidence of thyroid diseases. In the future, we should pay more attention to thyroid diseases of migratory population.
作者
王永森
白锡波
李平
黄福常
王宾
李蕾
刘敏
赵琳
Wang Yongsen, Bai Xibo, Li Ping, Huang Fuchang, Wang Bin, Li Lei, Liu Min, Zhao Lin(Medical Examination Center, Cangzhou Central Hospital of Heibei Province, Can@hou 061001, China （Wang YS, Bai XB, Wang B, Li L, Liu M, Zhao L）; Department of Endocrinology, Cangzhou Central Hospital, Cangzhou 061001, China （Li P, Huang FC）)
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2018年第3期230-234,共5页
Chinese Journal of Endemiology
