CAJ | 학술논문

目的调查我国碘缺乏病高危地区新发地方性克汀病(地克病)和地方性甲状腺肿(地甲肿)的流行现况,了解高危地区碘盐覆盖率较低的原因,有针对性地提出防治对策.方法以县为单位,在西藏、青海、新疆、甘肃、宁夏、四川、海南、重庆、云南、广西、内蒙古11个省份的碘盐监测盲区(高危县)采取单纯随机抽样方法选择调查乡,在其他高危县按照典型调查原则以乡为单位选取调查点,进行10岁以下新发地克病病例搜索;对8～10岁儿童采用B超法检测甲状腺大小,采用中国瑞文测验(农村修订版)检测智商;对育龄妇女开展人户调查和采集家中盐样,盐碘测定采用半定量法,统计居民户碘盐覆盖率;采集8～10岁儿童和育龄妇女尿样,尿碘测定采用砷铈催化分光光度法;全部结果采用Epi Iinfo 6.0软件进行分析.结果在101个高危县中搜索出地克病线索病例4122人,其中确诊地克病249例.儿童甲状腺肿大(甲肿)率为8.28%(4434/53 541),44个县儿童甲肿率在5%～20%,5个县儿童甲肿率在>20%～30%,3个县儿童甲肿率>30%.儿童智商均值为85.44,智商<70的儿童占16.52%(8713/52 745).儿童尿碘中位数为154.69;μg/L、尿碘<50μg/L的比例为17.26%(9069/52 558),有25个县的儿童尿碘中位数<100μg/L;育龄妇女尿碘中位数为107.14μg/L、尿碘<50μg/L的比例为27.50%(3722/13 534),有46个县家庭主妇尿碘中位数<100μg/L.居民户的碘盐覆盖率为77.85%(13 150/16 891),西藏、海南、青海碘盐覆盖率较低,分别为52.80%(1585/3002)、44.72%(631/1411)、72.82%(1850/2506).西藏、四川、海南、甘肃、青海居民户中>10%的人认为购买碘盐不方便,有71.39%(7652/10 719)的家庭食用土盐,土盐每公斤的平均价格(0.30～1.20元)低于碘盐(1.20～3.00元).结论碘缺乏病高危地区存在发生地克病和地甲肿的危险,应在这些地区开展碘缺乏病监测,降低碘盐价格,提高碘盐覆盖率,对特需人群要尽快实施应急补碘,建立消除碘缺乏病的长效机制. 目的調查我國碘缺乏病高危地區新髮地方性剋汀病(地剋病)和地方性甲狀腺腫(地甲腫)的流行現況,瞭解高危地區碘鹽覆蓋率較低的原因,有針對性地提齣防治對策.方法以縣為單位,在西藏、青海、新疆、甘肅、寧夏、四川、海南、重慶、雲南、廣西、內矇古11箇省份的碘鹽鑑測盲區(高危縣)採取單純隨機抽樣方法選擇調查鄉,在其他高危縣按照典型調查原則以鄉為單位選取調查點,進行10歲以下新髮地剋病病例搜索;對8～10歲兒童採用B超法檢測甲狀腺大小,採用中國瑞文測驗(農村脩訂版)檢測智商;對育齡婦女開展人戶調查和採集傢中鹽樣,鹽碘測定採用半定量法,統計居民戶碘鹽覆蓋率;採集8～10歲兒童和育齡婦女尿樣,尿碘測定採用砷鈰催化分光光度法;全部結果採用Epi Iinfo 6.0軟件進行分析.結果在101箇高危縣中搜索齣地剋病線索病例4122人,其中確診地剋病249例.兒童甲狀腺腫大(甲腫)率為8.28%(4434/53 541),44箇縣兒童甲腫率在5%～20%,5箇縣兒童甲腫率在>20%～30%,3箇縣兒童甲腫率>30%.兒童智商均值為85.44,智商<70的兒童佔16.52%(8713/52 745).兒童尿碘中位數為154.69;μg/L、尿碘<50μg/L的比例為17.26%(9069/52 558),有25箇縣的兒童尿碘中位數<100μg/L;育齡婦女尿碘中位數為107.14μg/L、尿碘<50μg/L的比例為27.50%(3722/13 534),有46箇縣傢庭主婦尿碘中位數<100μg/L.居民戶的碘鹽覆蓋率為77.85%(13 150/16 891),西藏、海南、青海碘鹽覆蓋率較低,分彆為52.80%(1585/3002)、44.72%(631/1411)、72.82%(1850/2506).西藏、四川、海南、甘肅、青海居民戶中>10%的人認為購買碘鹽不方便,有71.39%(7652/10 719)的傢庭食用土鹽,土鹽每公斤的平均價格(0.30～1.20元)低于碘鹽(1.20～3.00元).結論碘缺乏病高危地區存在髮生地剋病和地甲腫的危險,應在這些地區開展碘缺乏病鑑測,降低碘鹽價格,提高碘鹽覆蓋率,對特需人群要儘快實施應急補碘,建立消除碘缺乏病的長效機製.
목적 조사아국전결핍병고위지구신발지방성극정병(지극병)화지방성갑상선종(지갑종)적류행현황,료해고위지구전염복개솔교저적원인,유침대성지제출방치대책.방법 이현위단위,재서장、청해、신강、감숙、저하、사천、해남、중경、운남、엄서、내몽고11개성빈적전염감측맹구(고위현)채취단순수궤추양방법선택조사향,재기타고위현안조전형조사원칙이향위단위선취조사점,진행10세이하신발지극병병례수색;대8～10세인동채용B초법검측갑상선대소,채용중국서문측험(농촌수정판)검측지상;대육령부녀개전인호조사화채집가중염양,염전측정채용반정량법,통계거민호전염복개솔;채집8～10세인동화육령부녀뇨양,뇨전측정채용신시최화분광광도법;전부결과채용Epi Iinfo 6.0연건진행분석.결과 재101개고위현중수색출지극병선색병례4122인,기중학진지극병249례.인동갑상선종대(갑종)솔위8.28%(4434/53 541),44개현인동갑종솔재5%～20%,5개현인동갑종솔재>20%～30%,3개현인동갑종솔>30%.인동지상균치위85.44,지상<70적인동점16.52%(8713/52 745).인동뇨전중위수위154.69;μg/L、뇨전<50μg/L적비례위17.26%(9069/52 558),유25개현적인동뇨전중위수<100μg/L;육령부녀뇨전중위수위107.14μg/L、뇨전<50μg/L적비례위27.50%(3722/13 534),유46개현가정주부뇨전중위수<100μg/L.거민호적전염복개솔위77.85%(13 150/16 891),서장、해남、청해전염복개솔교저,분별위52.80%(1585/3002)、44.72%(631/1411)、72.82%(1850/2506).서장、사천、해남、감숙、청해거민호중>10%적인인위구매전염불방편,유71.39%(7652/10 719)적가정식용토염,토염매공근적평균개격(0.30～1.20원)저우전염(1.20～3.00원).결론 전결핍병고위지구존재발생지극병화지갑종적위험,응재저사지구개전전결핍병감측,강저전염개격,제고전염복개솔,대특수인군요진쾌실시응급보전,건립소제전결핍병적장효궤제.
Objective To investigate the occurrence of new cretinism cases and the prevalence of endemic goiter, and the reason of lower coverage rate of iodized salt in the iodine deficiency disorders(IDD) high-risk areas of China, so as to put forward target prevention measures for these areas. Methods A hundred and one counties from 11 provinces(autonomous regions, municipality), such as Tibet, Qinghai, Xinjiang, Gansu, Ningxia, Sichuan, Hainan, Chongqing, Yunnan, Guangxi, Inner Mongolia, were chosen into the survey by simple random sampling. In the counties of high risk, typical sampling principle was used. In the selected townships, searching for new cretinism cases were carried out in the children under 10 years old, the thyroid volume of children aged 8-10 years old were determined by B-ultrasonography methods and their urinary iodine (UI) were determined by As3-Ce<'4+> catalytic spectrophotometry, the intelligence quotient(IQ) values of children aged 8-10 years old were measured by the combined Raven Test in China. In the household survey, the housewives were asked to fill in the questionnaire, the iodized salt coverage rates and the UI levels of child-bearing age women were investigated, the salt iodine content was determined using self-quantitative kit. Epi Info software was used to analyze the determination results. Results In the 101 high-risk counties, 249 were diagnosed as new cretinism cases from 4122 suspected cases searched. The goiter rate of children aged 8-10 years old by B-ultrasound was 8.28% (4434/53 541), 44 counties had goiter rates in the range of 5%-20%, 5 counties had goiter rates in the range of 20%-30%, and 3 counties had goiter rates of 30%. The mean IQ of children was 85.44, and the percentage of IQ value less than 70 was 16.52%(8713/52 745). The median urinary iodine(MUI) of children was 154.69 μg/L, the percentage of UI less than 50 μg/L was 17.26% (9069/52 558). Twenty-five counties had a MUI of children less than 100 μg/L. The MUI of housewives was 107.14 μg/L, the percentage of UI less than 50 μg/L was 27.50% (3722/13 534). MUI of housewives in 46 counties were less than 100.0 μg/L. The coverage rate of iodized salt at household level was 77.85%(13 150/16 891). The coverage rate of iodized salt was 52.80%(1585/3002), 44.72% (631/1411) and 72.82% (1850/2506) in Tibet, Hainan and Qinghai, respectively. More than 10% residents of Tibet, Sichuan, Hainan, Gansu and Qinghai complained that iodized salt was not convenient to buy. There were 71.39%(7652/10 719) of observed people ate crude salt. The average price of crude salt price(0.30-1.20 Yuan/kg) was lower than iodized salt(1.20-3.00 Yuan/kg). Conclusions In these IDD high-risk areas, the risk of endemic goiter and cretinism prevalence is threatening. The IDD monitoring should be carried out successively in these high-risk areas. The prevention measures, increasing iodized salt coverage rate and establishing the sustainable mechanism for eliminating IDD should be strengthened. Emergent iodine fortification measure for high risk region people should be implemented as soon as possible, a long term effective mechanism of eliminating IDD should be established.