摘要
目的调查湖南省碘营养现状,分析碘盐与甲状腺疾病的关系。方法采用整群、分层抽样法对湖南省2 650例成人及120例8~10岁儿童进行横断面调查,成人及儿童均行尿碘检测和甲状腺超声检查,成人采集血液进行甲状腺功能测定,统计碘营养状况、甲状腺疾病患病情况,并进行性别、地区间比较。结果2 650例成人中6例样本缺失,余2 644例尿碘浓度为173.85(118.63,249.28)μg/L,其中重度碘缺乏14例(0.53%),中度碘缺乏91例(3.44%),轻度碘缺乏360例(13.62%),碘足量1 132例(42.81%),碘超足量635例(24.02%),碘过量412例(15.58%);女性中度、轻度碘缺乏比率(4.48%、15.70%)高于男性(2.44%、11.62%)(P<0.05);城市人群重度、中度、轻度碘缺乏比率(0.86%、4.81%、16.81%)高于农村(0.16%、1.92%、10.06%)(P<0.05),碘过量比率(9.77%)低于农村(22.04%)(P<0.05);2 644例成人中临床甲状腺功能亢进(甲亢)检出率为1.51%,亚临床甲亢为0.49%,临床甲状腺功能减退(甲减)为0.83%,亚临床甲减为17.89%;超声对单纯性甲状腺肿、结节性甲状腺肿及甲状腺结节检出率分别为1.55%、0.91%和13.80%;抗甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性率为12.82%,甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)阳性率为15.20%;女性亚临床甲亢、亚临床甲减检出率(0.77%、21.96%)高于男性(0.22%、13.99%)(P<0.05),单纯性甲状腺肿、结节性甲状腺肿检出率(2.32%、1.55%)高于男性(0.81%、0.30%)(P<0.05),TPOAb、TgAb阳性率(17.63%、22.58%)高于男性(8.22%、8.14%)(P<0.05);城市结节性甲状腺肿、甲状腺结节检出率(1.36%、15.80%)高于农村(0.40%、11.58%)(P<0.05);不同碘营养状况者临床甲亢、亚临床甲亢、临床甲减、亚临床甲减检出率,单纯性甲状腺肿、结节性甲状腺肿、甲状腺结节检出率及TPOAb阳性率比较差异无统计学意义(P>0.05);碘缺乏人群TgAb阳性率高于其他碘营养状况者(P<0.05);120例儿童尿碘浓度为268.35(207.53,351.58)μg/L,其中中度碘缺乏1例(0.83%),轻度碘缺乏7例(5.83%),碘足量17例(14.17%),碘超足量48例(40.00%),碘过量47例(39.17%);城市儿童碘超足量比率(50.00%)高于农村(30.00%)(P<0.05);农村儿童甲状腺肿检出率(15.00%)高于城市(1.67%)(P<0.05)。结论目前湖南省成人碘营养状况为碘足量,女性、城市人群碘缺乏情况多见,农村碘过量多见,女性人群亚临床甲亢/甲减、甲状腺肿检出率及TPOAb、TgAb阳性率较高,城市人群结节性甲状腺肿、甲状腺结节检出率较高,成人TgAb阳性率升高与碘缺乏有关;儿童碘营养状况为碘超足量,城市碘超足量情况多见。
Objective To investigate the iodine nutrient status and the relationship between iodized salt and thyroid disease in Hunan province.Methods Totally 2 650 adults and 120 children aged 8 to 10 years selected by stratified and cluster random sampling method in Hunan province received thyroid ultrasonography and urinary iodine level detection,and the adults were collected blood for thyroid function test.The iodine nutrition status and thyroid diseases were collected to compare the differences between urban and rural populations and between males and females.Results In2 650 adults,excluding 6 missing samples,the urinary iodine concentration of 2 644 samples was 173.85（118.63,249.28）μg/L,and there were 14 cases（0.53%）of severe iodine deficiency,91 cases of moderate iodine deficiency（3.44%）,360 cases of mild iodine deficiency（13.62%）,1 132 cases of adequate iodine intake（42.81%）,635 cases of super excessive iodine intake（24.02%）and 412 cases of excessive iodine intake（15.58%）.The rates of moderate and mild iodine deficiency in females（4.48%,15.70%）were significantly higher than those in males（2.44%,11.62%）（P〈0.05）,the rates of severe,moderate and mild iodine deficiency in urban populations（0.86%,4.81%,16.81%）were significantly higher than those in rural populations（0.16%,1.92%,10.06%）（P〈0.05）,and the rate of excessive iodine intake in urban populations（9.77%）was significantly lower than that in rural populations（22.04%）（P〈0.05）.Among these 2 644 adults,the detection rates of clinical hyperthyroidism,subclinical hyperthyroidism,clinical hypothyroidism and subclinical hypothyroidism were 1.51%,0.49%,0.83% and 17.89%,while the ultrasonic detection rates of goiter,nodular goiter and thyroid nodule were 1.55%,0.91% and 13.80%.The positive rates of thyroid peroxidase antibody（TPOAb）and thyroglobulin antibody（TgAb）were 12.82% and 15.20%.The detection rates of subclinical hyperthyroidism,subclinical hypothyroidism,goiter and nodular goiter were significantly higher in females（0.77%,21.96%,2.32%,1.55%）than those in males（0.22%,13.99%,0.81%,0.30%）（P〈0.05）,and the positive rates of TPOAb and TgAb were significantly higher in females（17.63%,22.58%）than those in males（8.22%,8.14%）（P〈0.05）.The detection rates of nodular goiter and thyroid nodule were significantly higher in urban populations（1.36%,15.80%）than those in rural populations（0.40%,11.58%）（P〈0.05）.There were no significant differences in the detection rates of clinical hyperthyroidism,subclinical hyperthyroidism,clinical hypothyroidism,subclinical hypothyroidism,goiter,nodular goiter and thyroid nodule,as well as the positive rate of TPOAb among populations with different iodine nutrient status（P〈0.05）.The positive rate of TgAb in iodine deficiency populations was significantly higher than that in the others（P〈0.05）.The urinary iodine concentration in 120 children was 268.35（207.53,351.58）μg/L.There were no children of severe iodine deficiency,and 1 case（0.83%）of moderate iodine deficiency,7 cases（5.83%）of mild iodine deficiency,17 cases（14.17%）of iodine sufficient intake,48 cases（40.00%）of super excessive iodine intake and 47 cases（39.17%）of excessive iodine intake.The rate of super excessive iodine intake in urban populations（50.00%）was significantly higher than that in rural populations（30.00%）（P〈0.05）.The detection rate of goiter in rural populations（15.00%）was significantly higher than that in urban populations（1.67%）（P〈0.05）.Conclusion Hunan province is currently in the state of iodine sufficiency,and the iodine deficiency is more common in females and urban populations,while excessive iodine intake is more common in rural populations.The detections rates of subclinical hyperthyroidism,subclinical hypothyroidism and goiter as well as the positive rates of TPOAb and TgAb are high in females,and the detections rates of nodular goiter and thyroid nodule are high in urban populations.The increased positive rate of TgAb is correlated with iodine deficiency in the adults.Super excessive iodine intake is more common in children and urban populations.
作者
胡婉钰
曾志斌
张红
HU Wan-yu;ZENG Zhi-bin;ZHANG Hong(Department of Endocrinology and Metabolism, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, the Second Xiangya Hospital of Central South University, Changsha 410011, China)
出处
《中华实用诊断与治疗杂志》
2018年第5期440-444,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家卫生和计划生育委员会公益性科研专项(201402005)
中华医学会临床医学科研专项资金(15010010589)
关键词
甲状腺疾病
食盐加碘
碘摄入量
流行病学
Thyroid disease
salt iodization
iodization intake
epidemiology
