摘要
目的 了解山西省缺碘地区普遍食盐加碘20年后不同人群碘营养状况和甲状腺功能水平,为因地制宜科学补碘提供数据支持。 方法 2014年,以山西省缺碘地区临汾市襄汾县6个乡镇(城关镇、大邓乡、邓庄镇、古城镇、襄陵镇、汾城镇)为调查地点。采用两阶段抽样方法,抽取6 -12岁学龄儿童(学龄儿童)、18 - 44岁育龄期妇女(育龄期妇女)、孕妇、哺乳期妇女及其0 -6个月的母乳喂养婴儿(母乳喂养婴儿)、7 -24个月的幼儿(幼儿)各400名作为调查对象。采集学龄儿童家中生活饮用水水样和食用盐盐样,分别采用水碘砷铈催化分光光度法(国家碘缺乏病参照实验室推荐方法)、《制盐工业通用试验方法 碘的测定》(GB/T 13025.7-2012)检测水碘、盐碘;采集全部调查对象随意1次尿样,采用《尿碘的砷铈催化分光光度测定方法》(WS/T 107-2006)检测尿碘;采集学龄儿童、育龄期妇女、孕妇、哺乳期妇女及其母乳喂养婴儿血样,制备滤纸片干血斑(DBS)样本,采用时间分辨荧光免疫法检测血清总甲状腺素(TT4)、促甲状腺激素(TSH)水平。 结果 共采集水样290份,水碘中位数为9.37 μg/L。共采集盐样406份,盐碘中位数为25.0 mg/kg,碘盐覆盖率为98.52%(400/406),合格碘盐食用率为92.61%(376/406)。采集学龄儿童、育龄期妇女、孕妇、哺乳期妇女、母乳喂养婴儿、幼儿尿样各389、379、363、365、366、366份,尿碘中位数分别为200.7、175.0、186.0、113.2、285.8、204.8 μg/L,其中学龄儿童、母乳喂养婴儿、幼儿为碘超适宜量水平,其余人群为碘适宜水平。采集学龄儿童、育龄期妇女、孕妇、哺乳期妇女、母乳喂养婴儿血样各402、397、398、390、386份,TT4中位数分别为127.2、110.2、141.7、95.8、139.0 nmol/L,TSH中位数分别为1.2、0.9、0.8、0.9、0.9 mU/L,均在参考值范围内。哺乳期妇女TT4异常率(8.46%,33/390)和TSH异常率(7.95%,31/390)高于学龄儿童、育龄期妇女、孕妇、母乳喂养婴儿[TT4异常率分别为0.25%(1/402)、1.26%(5/397)、0.50%(2/398)、1.04%(4/386),TSH异常率分别为1.24%(5/402)、1.51%(6/397)、1.51%(6/398)、0.78%(3/386),P均< 0.05]。哺乳期妇女甲状腺功能异常率(7.95%,31/390)高于其余人群[1.24%(5/402)、1.51%(6/397)、1.51%(6/398)、0.78%(3/386),P均< 0.05]。 结论 调查地区不同人群的碘摄入量总体上充足,现行盐碘含量标准能够满足不同人群的碘营养需求。哺乳期妇女甲状腺功能异常率较高,建议在缺碘地区坚持普遍食盐加碘防治碘缺乏危害策略,进一步加强对孕妇和哺乳期妇女等重点人群的碘营养及甲状腺功能监测。
Objective To understand the iodine nutritional status and thyroid function of different populations after 20 years of universal salt iodization in iodine deficiency area of Shanxi Province, and to provide data support for scientific iodine supplementation according to local conditions. Methods In 2014, six townships (Chengguan, Dadeng, Dengzhuang, Gucheng, Xiangling and Fencheng townships) in Xiangfen County, Linfen City, Shanxi Province, were selected as the place of investigation. Four hundred school-age children aged 6 - 12 years (school-age children), 400 child-bearing women aged 18 - 44 (child-bearing women), 400 pregnant women, 400 lactating women and their 0 - 6 months breast-feeding infants (breast-feeding infants), and 400 children aged 7 - 24 months were selected by two-stage sampling method. Water samples of school-age children′s domestic drinking water and salt samples for domestic consumption were collected, and the water iodine and salt iodine were detected by arsenic and cerium catalytic spectrophotometry (recommended by the National Iodine Deficiency Disorders Reference Laboratory) and "General Test Method in Salt Industry-Determination of Iodine" (GB/T 13025.7-2012). Random urine samples of all subjects were collected, urine iodine was detected by "Method for Determination of Iodine in Urine by As3+-Ce4+ Catalytic Spectrophotometry" (WS/T 107-2006). Samples of filter paper dried blood spots (DBS) of school-age children, child-bearing women, pregnant women, lactating women and breast-feeding infants were collected, and serum total thyroxine (TT4) and thyroid stimulating hormone (TSH) levels were detected by time-resolved fluorescence immunoassay. Results A total of 290 water samples were collected, and the median of water iodine was 9.37 μg/L. A total of 406 salt samples were collected, the median of salt iodine was 25.0 mg/kg, the coverage rate of iodized salt was 98.52% (400/406), and the consumption rate of qualified iodized salt was 92.61% (376/406). Urine samples of 389 school-age children, 379 child-bearing women, 363 pregnant women, 365 lactating women, 366 breast-feeding infants, and 366 children aged 7 - 24 months were collected, and the medians of urine iodine were 200.7, 175.0, 186.0, 113.2, 285.8 and 204.8 μg/L, respectively. Among them, school-age children, breast-feeding infants, and children aged 7 - 24 months were over the appropriate level, while the rest populations were at the iodine appropriate levels. Blood samples of 402 school-age children, 397 child-bearing women, 398 pregnant women, 390 lactating women, and 386 breast-feeding infants were collected, and the medians of TT4 were 127.2, 110.2, 141.7, 95.8 and 139.0 nmol/L, respectively;the medians of TSH were 1.2, 0.9, 0.8, 0.9 and 0.9 mU/L, respectively, and they were all within the reference ranges. The abnormal rates of TT4 (8.46%, 33/390) and TSH (7.95%, 31/390) in lactating women were higher than those in school-age children, child-bearing women, pregnant women and breast-feeding infants [TT4 abnormal rates were 0.25% (1/402), 1.26% (5/397), 0.50% (2/398), 1.04% (4/386), respectively;TSH abnormal rates were 1.24% (5/402), 1.51% (6/397), 1.51% (6/398) and 0.78% (3/386), respectively, P < 0.05]. The rate of thyroid dysfunction in lactating women (7.95%, 31/390) was higher than those in the rest populations [1.24% (5/402), 1.51% (6/397), 1.51% (6/398), 0.78% (3/386), P < 0.05]. Conclusions The iodine intake of different populations in the survey area is generally sufficient, and the current salt iodine content standard can meet the iodine nutrition needs of different populations. Lactating women have a high rate of thyroid dysfunction. It is suggested to stick to the strategy of universal salt iodization to prevent iodine deficiency hazards in iodine deficiency areas, and further strengthen the monitoring of iodine nutrition and thyroid function of pregnant women and lactating women.
作者
贾清珍
张向东
任艳婷
王正辉
郭百锁
张峰峰
吴赵明
Jia Qingzhen;Zhang Xiangdong;Ren Yanting;Wang Zhenghui;Guo Baisuo;Zhang Fengfen;Wu Zhaoming(Department of Iodine Deficiency Disorders,Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China;Clinical Laboratory,Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China;Department of Fluoride and A rsenic Diseases,Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China)
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2019年第7期541-546,共6页
Chinese Journal of Endemiology
基金
联合国儿童基金会/全球营养改善联盟/苏黎世联邦理工学院合作研究项目(2014-2015)
中国人类遗传资源国际合作项目(国科遗办[2015]36号)
关键词
碘
普遍食盐加碘
甲状腺功能
调查
Iodine
Universal salt iodization
Thyroid function
Investigation
