中华地方病学杂志
中華地方病學雜誌
중화지방병학잡지
Chinese Journal of Endemiology
2014年
5期
540-544
,共5页
碘%过量%营养%甲状腺肿%甲状腺功能
碘%過量%營養%甲狀腺腫%甲狀腺功能
전%과량%영양%갑상선종%갑상선공능
Iodine%Excess%Nutrition,Goiter%Thyroid function
目的 调查水源性高碘地区儿童和妇女的碘营养状况及当地人群甲状腺容积和功能状态,探讨高碘地区划定的水碘界值问题.方法 在太原市小店区、清徐县的高碘乡镇,将所辖村按水碘含量50～＜100、100～＜150、150～＜300、≥300 μg/L划分为4组,分别为A、B、C、D组,每组选择2～3个村作为调查点.每组抽取200名8～10岁学龄儿童和60名妇女(包括孕妇、哺乳期妇女、育龄妇女各20名)作为调查对象.采集各调查对象家庭饮用水、食用盐和一次尿样,分别检测水碘、盐碘和尿碘.同时检测8～ 10岁儿童甲状腺容积.在知情同意情况下,采集妇女血样,检测游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH).结果 选择家中食用无碘盐的708名儿童和236名妇女作为调查对象.A、B、C、D组儿童饮用水水碘分别为73.8、144.7、258.5 501.0 μg/L,4组妇女饮用水水碘分别为73.8、144.7、242.7、485.9 μg/L.A、B、C、D组儿童尿碘分别为274.3、312.8、455.6、793.5 μg/L,4组妇女尿碘分别为238.3、235.2、371.6、641.6μg/L.儿童和妇女尿碘水平均随水碘值的升高而升高.A、B、C、D组儿童甲状腺肿大率分别为5.6％(11/196)、13.2％(25/189)、12.6％(20/158)、10.9％(18/165),甲状腺肿大率随着水碘水平升高而增高.在A、C、D组,孕妇FT3、FT4水平[pmol/L:(3.70±0.59),(14.01±2.44);(3.43±0.57),(12.87±2.12);(3.42±0.47),(12.66±1.78)]均低于哺乳期妇女[pmol/L:(4.26±0.57),(14.73±2.36);(4.28±0.40),(14.77±1.19);(4.36±0.65),(15.66±2.84)]、育龄妇女[pmol/L:(4.80±0.50),(17.47±2.11);(4.21±0.48),(15.83±1.64);(4.26±0.52),(15.53±1.81)],且随着各组调查点水碘水平的逐步升高,妇女的FT4激素水平逐渐下降,TSH水平逐渐上升.结论 水碘含量超过100 μg/L后,儿童甲状腺肿大率明显升高,儿童和妇女碘营养水平随水碘含量升高相继出现过量.妇女亚临床甲状腺功能减退症的发病危险性随水碘含量升高而增加,在水碘含量超过300μg/L,亚临床甲状腺功能减退症明显增高.建议将高碘地区划定标准的水碘含量切点值由150μg/L下调至100μg/L.
目的 調查水源性高碘地區兒童和婦女的碘營養狀況及噹地人群甲狀腺容積和功能狀態,探討高碘地區劃定的水碘界值問題.方法 在太原市小店區、清徐縣的高碘鄉鎮,將所轄村按水碘含量50～＜100、100～＜150、150～＜300、≥300 μg/L劃分為4組,分彆為A、B、C、D組,每組選擇2～3箇村作為調查點.每組抽取200名8～10歲學齡兒童和60名婦女(包括孕婦、哺乳期婦女、育齡婦女各20名)作為調查對象.採集各調查對象傢庭飲用水、食用鹽和一次尿樣,分彆檢測水碘、鹽碘和尿碘.同時檢測8～ 10歲兒童甲狀腺容積.在知情同意情況下,採集婦女血樣,檢測遊離三碘甲腺原氨痠(FT3)、遊離甲狀腺素(FT4)、促甲狀腺激素(TSH).結果 選擇傢中食用無碘鹽的708名兒童和236名婦女作為調查對象.A、B、C、D組兒童飲用水水碘分彆為73.8、144.7、258.5 501.0 μg/L,4組婦女飲用水水碘分彆為73.8、144.7、242.7、485.9 μg/L.A、B、C、D組兒童尿碘分彆為274.3、312.8、455.6、793.5 μg/L,4組婦女尿碘分彆為238.3、235.2、371.6、641.6μg/L.兒童和婦女尿碘水平均隨水碘值的升高而升高.A、B、C、D組兒童甲狀腺腫大率分彆為5.6％(11/196)、13.2％(25/189)、12.6％(20/158)、10.9％(18/165),甲狀腺腫大率隨著水碘水平升高而增高.在A、C、D組,孕婦FT3、FT4水平[pmol/L:(3.70±0.59),(14.01±2.44);(3.43±0.57),(12.87±2.12);(3.42±0.47),(12.66±1.78)]均低于哺乳期婦女[pmol/L:(4.26±0.57),(14.73±2.36);(4.28±0.40),(14.77±1.19);(4.36±0.65),(15.66±2.84)]、育齡婦女[pmol/L:(4.80±0.50),(17.47±2.11);(4.21±0.48),(15.83±1.64);(4.26±0.52),(15.53±1.81)],且隨著各組調查點水碘水平的逐步升高,婦女的FT4激素水平逐漸下降,TSH水平逐漸上升.結論 水碘含量超過100 μg/L後,兒童甲狀腺腫大率明顯升高,兒童和婦女碘營養水平隨水碘含量升高相繼齣現過量.婦女亞臨床甲狀腺功能減退癥的髮病危險性隨水碘含量升高而增加,在水碘含量超過300μg/L,亞臨床甲狀腺功能減退癥明顯增高.建議將高碘地區劃定標準的水碘含量切點值由150μg/L下調至100μg/L.
목적 조사수원성고전지구인동화부녀적전영양상황급당지인군갑상선용적화공능상태,탐토고전지구화정적수전계치문제.방법 재태원시소점구、청서현적고전향진,장소할촌안수전함량50～＜100、100～＜150、150～＜300、≥300 μg/L화분위4조,분별위A、B、C、D조,매조선택2～3개촌작위조사점.매조추취200명8～10세학령인동화60명부녀(포괄잉부、포유기부녀、육령부녀각20명)작위조사대상.채집각조사대상가정음용수、식용염화일차뇨양,분별검측수전、염전화뇨전.동시검측8～ 10세인동갑상선용적.재지정동의정황하,채집부녀혈양,검측유리삼전갑선원안산(FT3)、유리갑상선소(FT4)、촉갑상선격소(TSH).결과 선택가중식용무전염적708명인동화236명부녀작위조사대상.A、B、C、D조인동음용수수전분별위73.8、144.7、258.5 501.0 μg/L,4조부녀음용수수전분별위73.8、144.7、242.7、485.9 μg/L.A、B、C、D조인동뇨전분별위274.3、312.8、455.6、793.5 μg/L,4조부녀뇨전분별위238.3、235.2、371.6、641.6μg/L.인동화부녀뇨전수평균수수전치적승고이승고.A、B、C、D조인동갑상선종대솔분별위5.6％(11/196)、13.2％(25/189)、12.6％(20/158)、10.9％(18/165),갑상선종대솔수착수전수평승고이증고.재A、C、D조,잉부FT3、FT4수평[pmol/L:(3.70±0.59),(14.01±2.44);(3.43±0.57),(12.87±2.12);(3.42±0.47),(12.66±1.78)]균저우포유기부녀[pmol/L:(4.26±0.57),(14.73±2.36);(4.28±0.40),(14.77±1.19);(4.36±0.65),(15.66±2.84)]、육령부녀[pmol/L:(4.80±0.50),(17.47±2.11);(4.21±0.48),(15.83±1.64);(4.26±0.52),(15.53±1.81)],차수착각조조사점수전수평적축보승고,부녀적FT4격소수평축점하강,TSH수평축점상승.결론 수전함량초과100 μg/L후,인동갑상선종대솔명현승고,인동화부녀전영양수평수수전함량승고상계출현과량.부녀아림상갑상선공능감퇴증적발병위험성수수전함량승고이증가,재수전함량초과300μg/L,아림상갑상선공능감퇴증명현증고.건의장고전지구화정표준적수전함량절점치유150μg/L하조지100μg/L.
Objective Toinvestigate iodine nutrition,thyroid volume and function of children and women in high water iodine areas,and to discuss the cut-off point of water iodine level where should be defined as iodine excessive areas.Methods In iodine excessive townships in Xiaodian and Qingxu Counties of Taiyuan City,all villages were divided to 4 groups according to the concentration of iodine in drinking water:50 ～ ＜ 100 μg/L (Group A),100 ～ ＜ 150 μg/L(Group B),150 ～ ＜ 300 μg/L(Group C) and ≥300 μg/L(Group D),and 2-3 villages were randomly selected from each group as investigation sites.Two hundred children aged 8-10 and 60 women (20 pregnant women,20 breasffeeding women and 20 women of childbearing age,respectively) were sampled.Drinking water,edible salt and once random urine samples for each studying object were collected,and the iodine content was measured.The goiter volume of children aged 8-10 and triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH) of women were determined.Results Totally 708 children and 236 women were selected as respondents who ate non-iodized salt.Iodine content in drinking water of children in groups A,B,C and D was 73.8,144.7,258.5 and 501.0 μg/L,respectively,and that of women was 73.8,144.7,242.7 and 485.9 μg/L,respectively.Median urinary iodine of children in groups A,B,C and D was 274.3,312.8,455.6 and 793.5 μg/L,respectively,and that of women was 238.3,235.2,371.6 and 641.6 μg/L,respectively.The median urinary iodine of children and women increased with increasing water content of iodine.The goiter rate of children was 5.6％ (11/196),13.2％ (25/189),12.6％ (20/158) and 10.9％ (18/165) for each group,respectively,which also increased with increasing water content of iodine.In groups A,C and D,the FT3 and FT4 levels[pmol/L:(3.70 ± 0.59),(14.01 ± 2.44); (3.43 ± 0.57),(12.87 ± 2.12); (3.42 ± 0.47),(12.66 ±1.78)] in pregnant woman were lower than those in breasffeeding women[pmol/L:(4.26 ± ±0.57),(14.73 ± 2.36;(4.28 ± 0.40),(14.77 ± 1.19); (4.36 ± 0.65),(15.66 ± 2.84)] and women of childbearing age[pmol/L:(4.80 ±0.50),(17.47 ± 2.11); (4.21 ± 0.48),(15.83 ± 1.64); (4.26 ± 0.52),(15.53 ± 1.81)].With increasing water content of iodine,FT4 level was decreasing and TSH level was increasing gradually in women.Conclusions When water iodine exceeds 100 μg/L,goiter rate of children has increased significantly.Iodine excessive women and children have appeared one after another with increasing water content of iodine.Women incidence of subclinical hypothyroidism risk has increased with increasing water content of iodine,and the detection rate of subclinical hypothyroidism is significantly higher when water iodine is higher than 300 μg/L.The cut-off point of iodine excessive areas should be descend from 150 μg/L to 100 μg/L.
