碘盐防治后新发地方性克汀病的病因探讨

在贵州省地克病流行区两个乡碘盐防治后出生的５２２名儿童中，临床检出４例新发地克病患者。对新发病患者３例和非地克病儿童４８人作尿碘、Ｔ３、Ｔ４、ＴＳＨ检验和头发硒、锌、铜、铁四种微量元素测定，并测两地的水和大米的四种微量元素含量。检测结果提示，新发地克病患者出现的原因，可能仍为碘供给量不足。     

碘与大骨节病的关系

通过对甘肃省大骨节病和碘缺乏病地理分布的调查,探讨了碘与大骨节病之间存在的关系。结果显示大内节病一般流行于碘缺乏病重病区,两病呈共存状况。病区补硒并实现持续性补碘后,大内节现情下降显。对病区水、粮硒和碘含量及７￣１２岁儿童发硒、尿碘、血清Ｔ３、Ｔ４、ＴＳＨ进行了测定,表明大骨节病病区为低硒、低碘环境,病区儿童甲状腺激素水平明显高于非病区,认为大骨节病与缺碘的关系值得进一步研究。     

安徽省全民普食磺盐前后新生儿TSH水平分析

目的 通过检测新生儿促甲状腺激素（ＴＳＨ）水平,比较安徽省全民普食碘盐前和普食磺上多后居民碘营养状况。方法 采用免疫放射法（ＩＲＭＡ）对新生儿脐带血ＴＳＨ水平进行了测定。结果 新生儿脐带血ＴＳＨ〉５ｍＵ／Ｌ者,１９９５年为３２．３％,１９９７年为２７．８％。结论 １９９７年安徽省居民碘缺乏危害程度料１９９５年减轻,但摄入的碘仍然不够,需要进一步加强全民普食碘盐防治措施。     

供碘盐地区与未供碘盐地区新生儿TSH值分布的对比观察

在苏南地区供碘盐八年以上的溧阳等四个县（市）和未供碘盐的无锡等四个县（市）对新生儿ＴＳＨ水平进行了研究。结果显示，不同尿碘水平的地区，新生儿ＴＳＨ水平分布呈现不同的分布特征，供应碘盐地区的新生儿ＴＳＨ水平分布出现了明显的左移；同时还发现用人群尿碘水平和用新生儿ＴＳＨ水平评价碘营养状况时出现了分离现象。     

硒对轻度缺碘大鼠甲状腺激素代谢影响的动态观察

轻度缺碘时随补硒和缺硒时间延长大鼠甲状腺重量和甲状腺过氧化物酶（ＴＰＯ）活力均逐渐增加，但缺硒（Ｓｅ↓）组增加幅度大；血清Ｔ４含量先降低后升高，Ｔ３含量逐渐增加，ｒＴ３含量呈逐渐降低的趋势。补硒（Ｓｅ↑）组肝脏、肾脏Ⅰ型脱碘酶（ＩＤＩ）活力先增加后降低，Ｓｅ↓组逐渐降低。甲状腺ＩＤＩ活力两硒组均有增加趋势，但Ｓｅ↓组低于Ｓｅ↑组的增加幅度。Ｓｅ↓组大脑Ⅱ型脱碘酶（ＩＤⅡ）活力有降低的趋势。提示低硒可降低肝脏和肾脏ＩＤＩ活力；硒缺乏可加重碘缺乏的效应；实验期间甲状腺代偿性增加Ｔ３分泌，这可能是甲状腺ＩＤＩ起主要作用。     

碘硒双补防治地方性甲状腺肿的研究

采用１／５万碘盐加亚硒酸钠，对云南省武定县碘硒缺乏地区的六个自然村进行地方性甲腺肿的防治研究。结果提示：１．缺硒是该地区地方性甲状腺肿流行因素之一；２．碘硒缺乏地区，碘硒双补法防治地方性甲状腺肿的效果优于单纯补碘法。     

碘硒联合缺乏对大鼠甲状腺重量血清激素及酶活性的影响

应用２×２析因实验设计将Ｗｉｓｔａｒ大鼠随机分为四组：Ｉ＋Ｓｅ＋、Ｉ＋Ｓｅ－、Ｉ－Ｓｅ＋、Ｉ－Ｓｅ－。观察了喂养１２周和３２周大鼠甲状腺重量，血清总Ｔ４、Ｔ３水平和血清碱性磷酸酶（ＡＫＰ）活性。结果表明，低碘组（Ｉ－Ｓｅ＋，Ｉ－Ｓｅ－）甲状腺重量明显增高，血清Ｔ４下降，Ｔ３变化不明显或代偿性升高。在低碘条件下低硒，１２周时甲状腺重量增加快于低碘加硒组，但是在３２周时，甲状腺重量虽然继续增加，其速度却明显慢于低碘加硒组。血清ＡＫＰ无论１２周还是３２周时，酶活性明显下降仅发生在低碘同时伴有低硒时（Ｉ－Ｓｅ－），当低碘加硒时（Ｉ－Ｓｅ＋），ＡＫＰ活性明显增加且与加碘组（Ｉ＋Ｓｅ＋，Ｉ＋Ｓｅ－）无显著性差别。上述结果提示，缺碘是造成甲状腺肿大的主要原因，缺硒１２周时具有加重甲状腺肿大的辅助作用。     

低硒低维生素E人工饲料喂养大鼠甲状腺激素代谢的变化

用低硒、低ＶＥ的人工半合成料饲养大鼠８周，引起甲状腺激素（ＴＨ）和自由基代谢紊乱（与补硒补ＶＥ鼠比较）：１．肝、肾Ｔ４５’－脱碘酶（ＩＤ－Ｉ）活性分别降低６０％和５０％，血清Ｔ３减少３６％，Ｔ４增加３２％，联合补ＶＥ和硒肝ＩＤ－Ｉ活性和血清Ｔ３浓度较单纯补硒组显著增加。２．全血和肝脏ＧＳＨ－Ｐｘ活力分别降低７０％和８２％，血清和肝脏ＬＰＯ浓度分别增加５３％和４０％。硒含量相同时，变更ＶＥ量对ＧＳＨ     

生后24小时内新生儿尿碘与先天性甲低症筛查之间的关系

为了阐明新生儿尿碘与先天性甲低症筛查之间的关系，我们测定了碘缺乏病病区与非病区分娩２４小时之内的母婴尿碘及新生儿脐血滤纸Ｔ４、ＴＳＨ水平。在用碘盐防治的碘缺乏病病区的母婴尿碘分别为２１１．８８μｇ／Ｌ（ｎ＝６７）和１７１．３３μｇ／Ｌ（ｎ＝６２）（Ｐ＞０．０５）。而在非碘缺乏病病区则分别为６４．００μｇ／Ｌ（ｎ＝６０）和５８．１９μｇ／Ｌ（ｎ＝６０）（Ｐ＞０．０５）。我们发现在同一地区母婴的尿碘无显著性差异，而碘预防区的母婴尿碘要比非病区大约高３倍。两个地区的Ｔ４、ＴＳＨ值都在正常范围之内。新生儿尿碘和Ｔ４、ＴＳＨ之间无明显关系。关键词     

补硒对低硒克山病病区居民血浆甲状腺激素水平的影响

给低硒克山病病区居民每日口服２００μｇ亚硒酸钠１２周，测定红细胞硒含量，谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）活性的血浆Ｔ３、Ｔ４及ｒＴ３水平，探讨硒对甲状腺激光水平的影响。结果表明：补硒显提高红细胞硒含量和ＧＳＨ－Ｐｘ活性；补硒组血浆Ｔ３明显升高，ｒＴ２明显降低，而Ｔ４无明显改变。红细胞硒含量与血浆Ｔ３呈明显正相关（ｒ＝０．５４７，ｎ＝３８，Ｐ〈０．００１）和血浆ｒＴ３呈显负相关（ｒ＝－０．４２     

Immunoradiometric measurement of serum thyrotropin levels in inhabitants who used iodized salt for 25 years in an endemic goiter area]

Recently we surveyed the thyroid function and TSH concentration of villagers in an endemic goiter area where iodized salt had been supplied for 25 years. We found that the serum FT3 and TSH (IRMA) level of villagers were higher and the FT4 level was lower than those of the controls, comparing with the RIA, which suggested that the inhabitants of the endemic goiter area had subclinical hypothyroidism based on the IRMA method for TSH assay. Therefore, we suggest that the best biochemical technique for monitoring the iodized salt prophylaxis program and the physiological response of villagers to iodine is measurement of serum TSH level with the ultrasensitive assay and FT4 level periodically.     

碘油和碘盐对碘缺乏病区孕妇碘代谢影响的动态研究

观察了长期供应１／４万－１／２万碘盐的ＩＤＤ病区妊娠妇女在孕前服与未服碘油丸对纠正体内碘代谢动态变化的影响。发现服碘油的孕妇血清ＴＳＨ，Ｔｇ值在孕３，５个月时降低，然后升高，Ｔ４，ＦＴ４升高持续到怀孕７个月，Ｔ３与ＦＴ３在３，５个月时恒定在孕前水平，然后下降，ｒＴ３在孕５个月时明显升高，提示碘油仅能保护孕妇在妊娠期的前５个月不缺碘，在此时应再服一次小剂量碘油丸。     

Maternal thyroid function in different conditions of iodine nutrition in pregnant women exposed to mild-moderate iodine deficiency: an observational study

Objective We examined the effect of different conditions of nutritional iodine intake on maternal thyroid function throughout gestation in a cohort of healthy, anti‐thyroid antibody‐negative women from a mild‐moderately iodine‐deficient (ID) area. Design Observational cohort study. Patients The study included 168 women receiving prenatal preparations containing 150 μg of iodine from early pregnancy (150‐I group); 105 women who had regularly used (>2 years) iodized salt prior to becoming pregnant (I‐salt group); 160 women neither taking iodine supplements nor using iodized salt (no‐I group). Measurements Maternal TSH, FT3 and FT4 were determined throughout gestation. Results Mean TSH concentrations were higher among the 150‐I women than in the remaining two groups, and in a high proportion of them, TSH values were found to exceed the upper limit for gestational age. Conversely, the prevalence of low free‐thyroxine levels in the 150‐I women was similar to that observed in the I‐salt women and markedly lower than that recorded for the no‐I group. Conclusions The regular use of iodine‐containing supplements proved effective in reducing the risk of inappropriately low FT4 levels during pregnancy. The observed TSH increase in 150‐I women may be because of a transient stunning effect on the thyroid gland, occurring as a result of the abrupt increase in daily iodine intake. Whilst the importance of gestational iodine supplementation is undisputed, we believe that in mild‐moderately ID areas, women considering conception should be advised to take iodine supplementation for several months prior to pregnancy.     

对我国现行碘盐干预措施的实施研究与效果评价

为探讨我国制定的新的碘盐浓度标准能否纠正病区居民的碘营养缺乏，在保证碘盐质量的前提下，对从未采取过磺盐防治的郑州市进行了碘盐干预措施实施研究。     

郑州市农村不同经济收入水平8～10岁学生IDD调查

目的观察、研究郑州市碘盐浓度调整后IDD消长情况和碘缺乏病可持续发展,探讨农村不同经济收入水平对IDD的影响,评价不同地理类型地区IDD现状.方法用国家规定的技术标准和检验方法对郑州市6个农业县不同经济收入水平、不同地理类型地区8～10岁学生IDD进行调查.结果 8～10岁学生甲肿率和尿碘水平维持在国家消除标准以内,不同经济水平、不同地理类型地区之间甲肿率无显著差异(P＞0.05).结论碘盐浓度适当调整没有影响8～10岁学生甲肿率,在当前碘盐浓度范围和农民生活水平条件下,经济因素、地区因素对IDD的影响已不明显.     

不同碘营养水平对育龄妇女甲状腺功能的影响

目的 研究不同碘营养水平对育龄妇女甲状腺功能的影响.方法 选择新疆巩留县和伊宁县各50名育龄妇女(非孕)作为碘充足组和碘缺乏组,按统一设计的调查项目表,逐项询问、检查、填写;内容包括家庭食用盐和饮用水的种类,个人甲状腺疾病史和甲状腺肿大情况.采集调查对象饮用水、食盐、尿液,分别用直接滴定法、砷铈催化分光光度法检测含碘量;采集并用化学发光免疫法检测静脉血清中的TSH、FT4、FT3水平.结果 碘缺乏组和碘充足组碘盐覆盖率分别为72%和100%,前者低于后者(χ2=16.28,P<0.01);尿碘中位数分别为95.5μg/L[四分位间距(QR)=50.0μg/L]和167.4μg/L(QR=186.4μg/L),前者低于后者(U=632.00,P<0.01);血清TSH中位数分别为2.56、1.88 mU/L,前者有高于后者的趋势,但差异无统计学意义(U=990.50,P>0.05);血清FT4分别为(14.7±2.0)、(17.0±3.8)pmoI/L,前者明显低于后者(t=3.76,P<0.01);血清FT3分别为(5.1±1.4)、(4.8±0.5)pmoI/L,二者比较差异无统计学意义(t=1.59,P>0.05);FT3/FT4比值分别为0.33±0.04、0.30±0.04,二者比较差异有统计学意义(t=3.13,P<0.01);甲状腺功能异常检出率分别为20.0%(10/50)、8.0%(4/50),二者比较差异无统计学意义(χ2=2.99,P>0.05).结论 育龄妇女的碘营养缺乏是导致自身甲状腺功能低下的主要原因,坚持长期食用碘盐是彻底纠正机体缺碘状况的最有效方法.     

辽宁省碘缺乏病病区不同补碘时期出生儿童智力水平调查

目的 了解和比较辽宁省碘缺乏病病区不同补碘时期出生儿童智力水平.方法 1900-2007年,在辽宁省的6个碘缺乏病病区县(市、区)各选出1个乡,其中轻中重病区乡各2个.在6个乡的10所学校中,以病区供应碘盐初期(1978-1980年)、非碘盐充销期(1981-1990年)、恢复普及碘盐期(1991-1995年)、全民食盐加碘期(1996-2000年)出生的7～14岁儿童为凋查对象,用中国联合型瑞文测验(CRT-C)和第二版农村儿童智商(intelligence quotient,IQ)常模测试(CRT-RC2)检查儿童IQ.结果 病区儿童IQ在非碘盐充销期(91.9±14.3)明显低于供应碘盐初期(95.8±14.6,q=8.60,P<0.01),恢复普及碘盐期(99.7 ±14.7)明显高于供应碘盐初期、非碘盐充销期(q值分别为9.53、18.13,P均<0.01),全民食盐加碘期(104.3±14.9)明显高于供应碘盐初期、非碘盐充销期、恢复普及碘盐期(q值分别为20.00、28.00、10.46,P均<0.01).儿童智力落后率(IQ≤69)在非碘盐充销期(6.7%,88/1314)高于供应碘盐初期(4.4%,21/471,χ2=3.85,P<0.05),恢复普及碘盐期(3.3%,48/1470)明显低于非碘盐充销期(χ2=15.37,P<0.01),全民食盐加碘期(2.7%,36/1344)低于供应碘盐初期(χ2=4.41,P<0.05)和非碘盐充销期(χ2=26.34,P<0.01).供应碘盐初期各年度出生儿童IQ及智力落后率未有明显变化;非碘盐充销期的10年间,出生儿童IQ呈"∪"形降升,智力落后率则呈"∩"形升降;恢复普及碘盐时期出生儿童IQ逐年提高,智力落后率逐年降低;全民食盐加碘期各年度儿童IQ继续上升,智力落后率降到历史最低程度.结论 碘缺乏病病区非碘盐充销时期出生儿童智力水平明显低于供应碘盐初期儿童,全民食盐加碘期病区出生儿童智力水平较供应碘盐初期和恢复普及碘盐时期出生儿童有明显提高.     

2009年甘肃省碘缺乏病调查结果分析

目的 掌握甘肃省碘缺乏病防治现状,为制订碘缺乏病的防治措施提供依据.方法 2009年,在甘肃省14个市(州),每个市(州)抽取1个达标县(市、区、旗),并按东、西、南、北、中5个方位各抽取1个乡(镇、街道),不足5个乡时全部抽取;在所抽取的每个乡(镇、街道),各抽取1个村,进行居民户碘盐情况及碘盐销售网络调查.同时在每个村抽取1所小学,进行儿童尿碘、甲状腺、智商检查及碘缺乏病知晓状况调查.结果 共检测1420份食用盐,加权碘盐覆盖率为99.53%,加权合格碘盐食用率为98.15%.共对1761名8～10岁儿童检测尿碘,中位数为225.87μg/L,在14个县中,有5个县儿童尿碘处于适宜水平,7个县超过了碘适宜水平.2个县处于碘过量水平.共对3051名8～10岁儿童进行甲状腺检查,加权甲状腺肿大率为1.9%,只有红古区儿童加权甲状腺肿大率大于5%,为5.3%.共对2815名8～10岁儿童进行智商检测,平均智商为105.3,除卓尼县和康乐县之外,其余各县儿童智商均在100以上.碘缺乏病知晓调查平均分为3.2分.知道缺碘不聪明的占57.08%(1229/2153),知道缺碘致甲状腺肿大的占71.76%(1544/2153),知道碘盐是最好的防治方法的占68.04%(1465/2153),向家人讲述碘盐好处的占61.82%(1331/2153).共凋查了87个乡(镇)102个村的食盐销售情况,每个乡(镇)都有一个碘盐代销点,每个村至少有1个碘盐零售店,但73.5%(75/102)的零售店无销售许可证.结论 甘肃省碘缺乏病防治取得了显著进展,合格碘盐食用率达到国家消除标准,甲状腺肿大率明显下降,大多数县儿童尿碘处于"大于适宜水平",碘盐销售网络基本健全,但各县碘缺乏病健康教育工作进展不平衡.

Abstract：

Objective To master the status in control of iodine deficiency disorders (IDD) in Gansu province and to provide the basis for development of control strategies. Methods One county which reached the national standardization of IDD elimination was selected randomly from each of 14 cities of Gansu province in 2009, then one town was selected respectively from five directions (east, south, west, north, and central) of the above selected counties. One village was chosen from every town which was selected for investigating household iodized salt and iodized salt sales network. At the same time the thyroid of children was examined, their urinary iodine (UI) was determined, the intelligence quotient(IQ) values of children were measured and health education was surveyed in one primary school which was chosen in each of the selected town. Results A total of 1420 edible salt samples were tested;the weighted iodized salt coverage rate and the weighted qualified iodized salt rate were 99.53% and 98.15 respectively. Urine samples were collected from 1761 children included in the study. The urinary iodine median was 225.87 μg/L. The urinary iodine medians were at optimal levels in five counties, over the optimal levels in seven counties and at excessive levels in two counties. A total of 3051 children aged 8 - 10 were randomly selected for thyroid examination. The weighted thyroid goiter rate(TGR) of children was 1.9%, and TGR was higher than 5% only in Hoaggu county. IQ of 2815 children was tested and the mean IQ was 105.3, except for the country of Zhuoni and Kangle, the mean IQ of other counties were over 100. The average score of health education was 3.2.Children of 57.08% (1229/2153) knew that iodine deficiency could lead to mental retardation, 71.76% (1544/2153) knew that iodine deficiency could cause thyroid goiter, 68.04%( 1465/2153 ) knew that eating iodized salt was the best method for IDD prevention and control and 61.82%(1331/2153) informed their families of the benefits of eating iodized salt. Each town had one agency selling iodized salt and each village had one more retail store with iodized salt, but 73.5%(75/102) of the stores without license for the sales. Conclusions Great progress has been made on the prevention and control of IDD in Gansu province. The qualified iodized salt consumption rate has reached the national standard for IDD elimination, TGR has decreased markedly, the urinary iodine levels in more counties are over the optimal levels and iodized salt distribution network is basically sound. But progress in health education is uneven.     

沿海产盐区与非产盐区哺乳期妇女碘营养水平和甲状腺功能调查

目的了解福建沿海产盐区与非产盐区哺乳期妇女碘营养状况及其甲状腺功能水平,为科学防治碘缺乏病提供依据。方法选择产盐区翔安区和非产盐区集美区为调查点,调查居民饮用水水碘含量,哺乳期妇女家中的碘盐覆盖率、合格碘盐食用率及其尿碘水平和血清甲状腺激素水平。结果产盐区、非产盐区哺乳期妇女家中合格碘盐食用率分别为91.18%和96.67%,尿碘中位数分别为131.20μg/L和104.35μg/L,尿碘<100μg/L的比例分别为35.29%和46.66%;产盐区与非产盐区哺乳期妇女的甲状腺激素TPOAb、TGA、TT3、TT4、FT3、FT4、TSH、Tg的中位数均在正常范围,两区均有部份哺乳期妇女存在甲状腺功能减退倾向,产盐区较非产盐区更为严重。结论目前的盐碘浓度对产盐区和非产盐区哺乳期妇女总体是适宜的,产盐区和非产盐区均有部分哺乳期妇女存在碘营养不足和甲状腺功能减退倾向。应对哺乳期妇女开展常规碘营养和甲状腺功能监测,采取针对性补碘措施,以控制碘缺乏病的发生。     

Endemic goitre in Senegal--thyroid function etiological factors and treatment with oral iodized oil.

Endemic goitre and its response to orally administered iodized oil has been studied in seven villages 25-30 km south of Velingara, Eastern Casamance, Senegal. In 502 adults aged greater than 15 years goitre prevalence was 62% with 18.2% having goitre grade 2 or 3. Mean free T4 (FT4) was 11.9 +/- 3.5 (SD) pmol/l and iodine deficiency was confirmed by noting median urinary I of 0.079 mumol/l (14.9 mumol I/mol creatinine) with elevated free T3 (FT3)/FT4 ratios. Serum selenium concentrations were normal. The response to 480 mg of oral iodized oil assessed at 6 and 12 months was characterized by a 35.8% increase in FT4, a 25% decrease in FT3 and a 50% decrease in TSH (all p less than 0.01) at 12 months associated with a significant decrease in goitre size measured in 70 persons when compared to 65 controls not receiving iodine. Urinary iodine rose from 0.071 mumol/l to 0.189 mumol/l (p less than 0.01) during this time and no adverse effects on thyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) were observed. A variation in goitre prevalence between villages was noted which, in such a small geographical area, suggests that etiological factors in addition to iodine deficiency may be important in goitre pathogenesis. Oral iodized oil administration is an effective treatment for iodine deficiency goitre in the short term.