碘代谢检测指标评估甲状腺疾病手术治疗患者碘营养状况的价值

目的探讨碘代谢检测指标在甲状腺疾病手术治疗患者碘营养状况评估中的应用价值。方法收集31名健康志愿者和30例甲状腺疾病手术患者术前、术后血清、晨尿和24 h尿标本,应用电感耦合等离子体质谱法检测样本中的碘浓度,比较健康者和患者术前、术后血清碘、晨尿碘、晨尿碘/晨尿肌酐、24 h尿碘和24 h尿碘排泄量的差异,并分析健康者碘代谢检测指标的测定值对世界卫生组织、美国梅奥医学中心和奎斯特诊断公司提供的参考范围的验证率。结果甲状腺疾病术前组的晨尿碘/晨尿肌酐比值显著低于健康对照组(P<0.05),两组其他指标的差异无统计学意义(P均>0.05);患者经手术治疗后血清碘、晨尿碘和24 h尿碘水平均显著高于术前水平(P<0.05);健康对照组各项碘代谢指标的中位数均在3个实验室提供的参考范围内,但仅有血清碘、晨尿碘及41~70岁人群的晨尿碘/晨尿肌酐比值与美国梅奥医学中心提供的参考范围的验证率大于90%;晨尿碘/晨尿肌酐比值的受试者工作特征曲线下面积最大,为0.737。结论晨尿碘/晨尿肌酐比值可能用于甲状腺疾病手术治疗患者碘营养状况的评估。

Values of Iodine Metabolism Biomarkers in Assessing the Iodine Nutrition Status in Surgically Treated Patients with Thyroid Disease

Objective To assess the clinical application value of iodine metabolism biomarkers in assessing iodine nutrition status in surgically treated patients with thyroid disease.Methods Blood,morning urine and 24-hour urine samples were collected in 31 healthy volunteers and in 30 surgically treated patients with thyroid disease before and after surgery.Iodine concentration was analyzed by inductively coupled plasma mass spectrometry.The iodine metabolism biomarkers including serum iodine(SI),morning urine iodine(UI),morning urine iodine/urine creatinine ratio(UI/UCr),24-hour urine iodine(24 h UI),and 24-hour urine iodine excretion(24 h UIE)were evaluated in these two groups.In addition,the validation coincidence rate of iodine metabolism biomarkers in healthy volunteers to different reference ranges including World Health Organization,Mayo Clinic,and Quest Diagnostics were calculated.Results The UI/UCr ratio of pre-operative thyroid disease patients was significantly lower than that of healthy volunteers(P＜0.05),while the other biomarkers showed no significant differences(all P＞0.05)between these two groups.The SI,UI,and 24 h UI in postoperative thyroid disease patients were significantly higher than those of the pre-operative patients(all P＜0.05).Though the medians of all biomarkers in healthy volunteers were within the reference ranges,only the validation coincidence rates of SI,UI,and UI/UCr in the 41-70-year populations were over than 90% according to Mayo Clinic;furthermore,the area under the receiver operating characteristic curve about UI/UCr ratio(0.737)was the biggest within the iodine metabolism biomarkers.Conclusion The UI/UCr ratio may be used for iodine nutrition evaluation in surgically treated patients with thyroid disease.