10166例南京市梅山社区居民尿碘水平与甲状腺结节患病情况分析

目的了解南京市梅山社区居民碘营养水平及甲状腺结节检出率。方法回顾性分析2019年1-12月在我院健康体检的10 166例南京市梅山社区居民资料,统计尿碘及甲状腺B超检查结果,分析尿碘水平与甲状腺结节检出情况。结果 10 166例南京梅山社区居民碘摄入不足(尿碘100μg/L)人群比为15.83%,碘适宜组(尿碘100～199μg/L)为39.03%,碘超过适宜组(尿碘200～299μg/L)为31.09%,碘过量组(尿碘≥300μg/L)为14.05%。社区居民尿碘中位数为181.5μg/L,男性尿碘中位数193.2μg/L,女性尿碘中位数128.7μg/L。男性尿碘中位数高于女性,差异有统计学意义(Z=17.39,P0.01);不同年龄组尿碘频数分布比较差异无统计学意义(P0.05)。10 166例居民检出甲状腺结节者3 926人,总检出率为38.62%。男、女性检出率分别为35.47%(2 709/7 637)、48.12%(1 217/2 529),男性低于女性(χ~2=128.25,P0.01)。碘不足和碘过量组甲状腺结节检出率[48.42%(779/1 609)、45.66%(652/1 428)]均高于碘适宜组和碘超过适宜组[34.45%(1 369/3 974)、35.69%(1 126/3 155),P均0.01]。不同年龄组甲状腺结节检出率比较差异有统计学意义(χ~2=518.05,P0.01),且检出率随年龄增大而增高(χ~2=492.50,P0.01)。结论南京市梅山社区居民总体碘营养状况理想,甲状腺结节检出率男性低于女性,随年龄增加检出率增高,碘不足和碘过量人群甲状腺结节检出率高,需根据尿碘结果调整碘营养水平。     

江苏高碘和适碘地区孕妇甲状腺疾病患病率的调查

目的 通过对江苏省高碘和适碘地区孕早期孕妇甲状腺疾病患病率的调查,初步建立不同水碘含量地区妊娠早期甲状腺疾病的流行病学数据库,为甲状腺疾病的有效防治提供依据.方法 选择徐州丰县和睢宁作为高碘和适碘地区,在两地抽取早孕妇女共439例,均为确认孕3月以内的当地常住妇女.设计并填写调查问卷,记录姓名、年龄、既往史、联系方式等一般资料,留取空腹静脉全血,现场离心血标本,分装血清,冰盒保存运输,实验室-86℃冰箱冷冻待检,以电化学发光法测定游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总甲状腺素(TT4)、促甲状腺激素(TSH)及甲状腺过氧化物酶抗体(TPOAb).调查问卷内容及检验结果全部录入Epidata数据库,筛除既往甲状腺疾病、肾脏疾病、心脏疾病、妊高症等对象后,对符合条件的396例对象之数据进行统计学分析.结果 396例调查孕妇中,有197例(49.7％)患甲状腺疾病,甲状腺功能亢进、亚临床甲亢、甲状腺功能减退、亚临床甲减、低T4血症和甲状腺自身免疫状态的患病率分别为0.5％、6.3％、3.3％、29.3％、9.3％和1.0％.其中,高碘地区孕妇的亚临床甲减患病率明显高于适碘地区,分别为32.4％和19.6％,其余类型甲状腺功能异常如甲减、甲亢、亚临床甲亢、低T4血症及甲状腺自身免疫状态的患病率均无差别.结论 江苏高碘与适碘地区孕妇甲状腺疾病谱以亚临床甲减、亚临床甲亢和低T4血症为主,高碘地区孕妇的亚临床甲减患病率高可能与碘摄入过量有关.     

沧州市水源性高碘分布及高碘病情调查分析

目的调查沧州市水源性高碘的分布及高碘对人体的危害,为划定高碘地区或病区并制定防治措施提供科学依据。方法在沧州市所辖的18个县（市、区）中,以乡（镇）为单位,按东、西、南、北、中5个方位选取5个村,测定每个村的饮用水碘含量,采样数量依水源数而定。在确定的高碘乡中随机抽取10个乡,对乡中心小学200名8～10岁学生进行甲状腺触诊,并采集其中100名学生的即时尿样测定其碘含量。结果180个乡中水碘中位数高于150μg/L的乡（镇）有64个,占总乡数的35.6%,分布于沧州市12个县（市、区）,高碘受威胁人口数为1 978 590。触诊检查了10个乡2 082名8～10岁学生甲状腺,甲状腺肿大率为9.46%。10个乡学生尿碘中位数范围为249.2～1 294.2μg/L。结论沧州市高碘分布广泛,应在高碘地区停止碘盐供应或寻找适碘水源以减少高碘的危害。     

高水碘地区甲状腺抗体阴性妊娠期妇女甲状腺功能分析

目的 探讨高水碘地区甲状腺抗体阴性妇女妊娠各期甲状腺功能的变化特征.方法 在高水碘地区选天津市静海县妇幼保健院(饮水水碘>200μg/L)和在适碘地区选天津市和平区妇幼保健院(饮水水碘<10μg/L,碘盐普及率>90%,居民尿碘中位数>100μg/L)作为调查地点.在妇幼保健院门诊,选取妊娠资料完整的妊娠早、中、晚期孕妇各50名,采集血样,用化学发光法检测甲状腺功能.同时收集日间随意一次尿样、家中饮用水样和食用盐样,尿碘测定采用砷铈催化分光光度法,水碘测定采用快速定量检测试剂盒,盐碘测定采用硫代硫酸钠滴定法.结果 ①甲状腺抗体阴性孕妇中,高水碘地区孕早期妇女血清TT_4、TT_3、FT_4明显低于适碘地区(111.97 nmol/L vs 140.46 nmol/L,Z=3.56,P<0.01;1.86 nmol/L vs 2.26 nmol/L,Z=2.35,P<0.05;14.13 pmol/L vs 16.32 pmol/L,Z=5.14,P<0.01);孕中期妇女血清FT_4、FT_3明显低于适碘地区(11.98 pmol/L vs 14.30 pmol/L,Z=5.75,P<0.01;4.04 pmol/L vs 4.32 pmol/L,Z=2.76,P<0.01);孕晚期妇女血清,TT_3、TSH明显高于适碘地区(2.88 nmol/L vs 2.70 nmol/L,Z=-2.27,P<0.05;2.37 mU/L vs 1.75mU/L,Z=-2.70,P<0.01).②高水碘地区孕妇家中饮水碘和孕妇尿碘明显高于适碘地区(205.57μg/L vs8.22μg/L,Z=-14.71,P<0.01;305.91μg/L vs 191.86μg/L,Z=-4.01,P<0.01),家中盐碘明显低于适碘地区(26.5 mg/kg vs 31.7 mg/kg,Z=5.68,P<0.01).③健康且没有甲状腺病史的被调查孕妇中,妊娠各期甲状腺抗体阳性率在高水碘和适碘地区之间比较差异无统计学意义(孕早期:10.20%vs 10.64%;孕中期:14.00%vs9.52%;孕晚期:4.00%vs 7.69%,P均>0.05).结论 高水碘地区甲状腺抗体阴性孕妇妊娠各期甲状腺功能不同于适碘地区,对高水碘地区孕妇应加强孕期(特别是孕早、中期)甲状腺功能监测.     

河北省居民饮用水高碘水源调查及其地理分布

目的 调查河北省居民饮用水高碘水源地理分布,划定河北省高碘区域.方法 在河北省11个市的173个县(市、区)中,以乡(镇)为单位,按东、西、南、北、中5个方位选取5个村,当每个村的水源数量超过5个时,再按东、西、南、北、中各采1份水样;当水源数量少于5个时,采集全部水样;如遇集中供水,每村仅采1份水样.水碘测定采用砷铈接触法.结果 全省共调查了2049个乡(镇),检测水样19 352份,查出高碘乡172个.水碘范围为0.1～2840.4μg/L,其中水碘中位数<150.0 μg/L的水样为18 358份,占94.86%;150.0～<300.0μg/L的水样为565份,占2.92%;≥300.μg/L的水样为429份,占2.22%.水碘中位数150.0～<300.0μg/L的乡(镇)110个,≥300.0 μg/L的乡(镇)62个.高碘乡分布在河北省6个市的33个县中,涉及人口5 854 960人.沧州市高碘水源大多为深井水,井深与水碘量呈正相关(r=0.430,P<0.01).邯郸、邢台、衡水市多为浅井水,井深与水碘无相关性(r值分别为-0.060、-0.119、-0.121,P>0.05).结论 河北省6个市有高碘水源,主要集中于邯郸、邢台、衡水和沧州市.高碘水源所在地均处于地势低平地区,水源全部是地下水,高碘乡(镇)多数呈片状,少数以点状分布.     

吉林省不同孕期妇女尿碘水平与甲状腺功能关系的调查

目的为掌握全民食盐加碘后吉林省孕妇在不同孕期碘营养和甲状腺功能状况,为今后实施孕妇甲状腺功能监测的必要性和可能性提供依据。方法以省为单位,按"人口比例概率抽样方法"(PPS)抽取30个抽样单位(县)。用单纯随机抽样法从上述抽到的每个抽样单位中抽取3个乡(镇、街道办事处),每个乡(镇、街道办事处)抽取孕妇8人,每县(市、区、旗)孕妇24人。收集被调查对象尿样、血样及家中的食用盐、饮用水。采用化学发光法检测甲状腺功能(包括甲状腺抗体)指标,砷铈催化分光光度法检测尿、水碘含量,直接滴定法检测食盐碘含量。结果孕早、中、晚期妇女的尿碘中位数分别为188.6μg/L、201.9μg/L、175.7μg/L且不同孕期尿碘中位数及频数分布无显著性差异。孕早、中期妇女甲状腺功能异常主要为低FT4血症和亚临床甲状腺功能减退。孕晚期除低FT4血症和亚临床甲状腺功能减退外还有一定比例4.2%(10/240)甲状腺功能亢进(亚临床甲状腺功能亢进)存在。孕晚期妇女与孕早、中期相比甲状腺功能异常比率明显增加,孕妇抗体阳性率为10.2%(77/755)。抗体阳性者发生亚甲减3例占3.8%(3/77),低FT4血症1例占1.3%(1/77),甲亢(亚甲亢)3例占3.8%(3/77)。结论吉林省孕妇的碘营养处于适宜水平;建议在孕早期开展尿碘监测和甲功筛查。     

不同水碘地区孕妇碘营养状况及其影响因素研究

目的了解不同水碘地区孕妇碘营养状况,探索其影响因素,为孕妇孕期补碘提供科学依据。方法根据近年全国水源性高碘地区调查及全国碘缺乏病监测结果,适碘地区选择山西省汾阳市贾家庄乡和阳城乡(水碘50-100μg/L,对照组);高碘地区选择山西省汾阳市冀村镇和平遥县(水碘≥300μg/L),分别选择符合纳入条件(近半月内未服用富碘药物、无家族甲状腺疾病遗传史、排除先天性甲状腺疾病等)孕妇,其中适碘地区75例,高碘地区83例。对水碘、尿碘及游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离四碘甲状腺原氨酸(free thyroxin,FT_4)、促甲状腺素(thyroidstimulating hormone,TSH)、甲状腺球蛋白自身抗体(thyroglobulin antibody,TGAb)和甲状腺过氧化酶自身抗体(thyroid peroxidase antibody,TPOAb)等指标进行检测分析。结果调查显示水碘中位数分别为,适碘地区57.5μg/L、高碘地区464.8μg/L,高碘地区水碘含量高于适碘地区,差异有统计学意义(z=-2.852,P=0.004);适碘地区孕妇尿碘中位数(median urinary iodine,MUI)为223.38μg/L,总体处于适宜水平;高碘地区孕妇尿碘水平为814.05μg/L,总体偏高,且高碘地区孕妇尿碘水平高于适碘地区(z=-7.716,P=0.000);高碘地区孕妇TSH水平高于适碘地区(z=-10.416,P=0.000);甲状腺疾病患病率高于适碘地区孕妇,差异无统计学意义(χ~2=3.801,P=0.051)。Logistic回归分析显示,孕妇在孕期每周食用肉类2-3次发生碘营养不足的可能性较小(OR=0.092,95%CI=0.012-0.728,p=0.024);孕期每周食用牛奶4次以上的孕妇发生碘营养超过适宜量的可能性大(OR=8.624,95%CI=1.727-43.069,P=0.009);年龄较大的孕妇发生碘营养水平超适宜的可能性较小(OR=0.731,95%CI=0.558-0.958,P=0.023);居住在高水碘地区、在本地居住5年以上均是孕妇发生碘营养碘过量的危险因素(OR=50.650,95%CI=10.450-245.496,P=0.000;OR=9.296,95%CI=1.659-52.077,P=0.011)。结论适碘地区孕妇碘营养总体处于适宜水平,高碘地区孕妇甲状腺疾病发病率较高,应予以重视。     

社区居民高TSH水平下甲状腺结节与碘营养状况调查

目的调查兰州市社区居民高促甲状腺激素(TSH)水平下甲状腺结节患病率与碘营养状况。方法对兰州市社区常住居民整群分层抽样,按照高TSH组与正常TSH组进行甲状腺结节患病情况和碘营养状况调查。结果①男性甲状腺结节患病率为17.98%,男性高TSH率占16.85%。女性分别为23.43%和25.31%。甲状腺结节患病率、TSH水平具有性别差异(P0.05)。②加碘盐政策施行后,相较于37岁以上人群,37岁以下人群的尿碘水平升高,TSH数值降低(P0.05)。高TSH水平下甲状腺结节患病率与年龄,性别显著相关(P0.05),但正常水平没有此相关性(P0.05)。③年龄是发生甲状腺结节的危险因素。TSH水平与收缩压、低密度脂蛋白、空腹血糖、总胆固醇、年龄相关。④尿碘中位数为197.00μg/L,高于其他地区,施行加碘盐政策后尿碘水平显著升高(P0.05)。尿碘水平与TSH、甲状腺结节的患病率没有相关性;高TSH下单发结节与多发结节患病率不受尿碘影响。结论高TSH可增加甲状腺结节的患病率,同时年龄、性别影响甲状腺结节患病率。目前状态下,居民尿碘和TSH、甲状腺结节患病率均没有相关性。     

天津市三条石社区≥50岁居民高血压、冠心病、脑卒中现患调查报告

本文报告了1988年12月天津市红桥区三条石社区开展老年保健,对≥50岁居民5735人进行了心脑血管病调查。结果表明,高血压患病率为59.98‰,标化率为85.27‰,男女高血压患病率随增龄而增加(r=0.816,P<0.05),女性高于男性(u=4.64,     

高碘地区儿童碘营养影响因素和甲状腺肿大及结节的流行特征

目的了解高碘地区停供碘盐前儿童碘营养的影响因素和甲状腺肿大和结节的状况。方法采用单纯随机法在河北省衡水市水碘中位数在200～300μg/L高碘乡(镇)中随机抽取3个进行调查。结果在3个乡(镇)共采集测定8～10岁儿童1次即时尿样326份,尿碘中位数在478.4～571.3μg/L之间,尿碘含量>300μg/L尿样所占比例在77.9%～86.6%之间。12个村儿童的尿碘中位数与其所在村的水碘中位数成正相关(Spearsman,R=0.79,P=0.002),而与盐碘中位数不相关(Spearsman,R=-0.17,P=0.6)。儿童尿碘中位数与水碘中位数成直线相关(R=0.83,F=22.0,P=0.001),直线回归方程为:尿碘=318.1+0.829*水碘。在3个乡(镇)共用B超检测8～10岁儿童452名,甲状腺肿大37例,肿大率为8.2%;不同性别和年龄组甲状腺肿大率无显著差异。在其中2个乡共发现甲状腺结节15例,平均检出率为5.6%,不同性别和年龄组甲状腺结节检出率无显著差异。结论高碘地区儿童碘营养过剩主要由高水碘造成,碘盐加重了这种状况;存在甲状腺肿大流行,甲状腺结节的检出率也较高。甲状腺结节的成因和发生强度有待于进一步研究。     

2008年山东省地方性水源性高碘病区成人颈动脉粥样硬化调查

目的 调查2008年山东省地方性水源性高碘病区成人颈动脉粥样硬化患病情况,探讨水源性高碘与颈动脉粥样硬化发生的关系.方法选择山东省郓城县和巨野县作为高碘病区和对照区,以郓城县的大陈楼村、魏垓村、刘一村和二十里铺村为高碘病村,以巨野县的章西村、毕海南村、夏官屯和祁集村为对照村.利用彩超对40岁以上的高碘病区居民299人和对照区居民323人进行颈动脉粥样硬化检查、诊断和记分.结果大陈楼村、魏垓村、刘一村和二十里铺村4个高碘病村成人颈动脉粥样硬化检出率分别为47.1%(33/70)、62.2%(51/82)、67.5%(52/77)和58.6%(41/70);章西村、毕海南村、夏官屯和祁集村4个对照村成人颈动脉粥样硬化检出率分别为40.7%(35/86)、40.8%(31/76)、38.2%(34/89)和37.5%(27/72).高碘病村和对照村成人颈动脉粥样硬化检出率按年龄标准化后分别为45.81%、58.18%、61.63%、55.34%和34.66%、36.25%、43.01%、41.30%,高碘病村的检出率高于对照村(T=26,P＜0.05).高碘病区299人中,检出阳性163人、阴性136人,0分136人、1～3分120人、4～7分43人;对照区323人中,检出阳性122人、阴性201人,0分201人、1～3分87人、4～7分35人.高碘病区与对照区成人颈动脉粥样硬化阳性检出情况及病变严重程度比较,差异有统计学意义(x2值分别为17.54、18.42,P均＜0.01).结论高碘病区成人动脉粥样硬化检出率增高、病变严重程度增大.

Abstract：

Objective To survey the prevalence rates of adult carotid atherosclerosis in water-sourceoriginated high iodine area in Shandong province in 2008 and discuss the relationship between water-sourceoriginated high iodine and carotid atherosclerosis occurrence. Methods Yuncheng county was chosen as observation area which included Dachenlou, Weigai, Liuyi and Ershilipu villages. Juye county was chosen as control that included Zhangxi, Bihainan, Xiaguan and Qiji villages. Two hundred and ninety-nine participants aged over 40 from water-source-originated high iodine areas and 323 residents aged over 40 from normal iodine areas were investigated.Portable-type B mode color Doppler was performed to examine the carotid artery of all participants. The adult carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of adult carotid atherosclerosis in the 4 water-source-originated high iodine villages of Dachenlou, Weigai, Liuyi and Ershilipu were 47.1% (33/70) ,62.2% (51/82) ,67.5% (52/77) and 58.6% (41/70), respectively and the prevalence rates of adult carotid atherosclerosis in the 4 normal iodine villages of Zhangxi, Bihainan, Xiaguan and Qiji were 40.7%(35/86),40.8% (31/76),38.2% (34/89) and 37.5% (27/72), respectively. The prevalence rates of adult carotid atherosclerosis standardized by age in the 4 high iodine villages and the 4 normal iodine villages were 45.81% ,58.18% ,61.63%,55.34% and 34.66%,36.25%,43.01% ,41.30%, respectively. The prevalence rates were higher in high iodine villages than that in control villages(T = 26, P ＜ 0.05 ). There were 136 people scored "0", 120 people scored "1 -3",43 people scored "4 - 7", and total 299 people. There were 201 people scored "0", 87 people scored "1 - 3", 35 people scored "4 - 7", and total 323 people. The expected prevalence rates and severity of adult carotid atherosclerosis was significantly different between high iodine area and normal iodine area (x2 = 17.54,18.42, all P ＜ 0.01).Conclusion The prevalence rate and severity of adult atherosclerosis in water-source-originatod high iodine area is higher than that in normal iodine area.     

Epidemiological survey on the relationship between different iodine intakes and the prevalence of hyperthyroidism

OBJECTIVE: To investigate the effect of different levels of iodine intake on the prevalence of hyperthyroidism and the impact of universal salt iodization on the incidence of hyperthyroidism. DESIGN: A comparative cross-sectional and longitudinal survey was conducted in three areas with borderline iodine deficiency, mild iodine excess (previously mild iodine deficiency) and severe iodine excess. Universal salt iodization had been introduced 3 years previously except in the area with borderline iodine deficiency. METHODS: In total 16 287 inhabitants from three areas answered a questionnaire concerning the history of thyroid disease. Among them 3761 unselected subjects received further investigations including thyroid function, thyroid autoantibodies, thyroid ultrasonography and urinary iodine excretion. RESULTS: Among areas with median urinary iodine excretion of 103 microg/l, 375 microg/l and 615 microg/l (P<0.05), the prevalence of hyperthyroidism did not differ significantly (1.6%, 2% and 1.2%). The prevalence of subclinical hyperthyroidism was higher in areas with borderline iodine deficiency and mild iodine excess than in the area with severe excess iodine intake (3.7%, 3.9% and 1.1%, P<0.001). The prevalence of Graves' disease and its proportion in hyperthyroidism did not differ among areas. The incidence of hyperthyroidism did not significantly increase after the introduction of universal salt iodization. CONCLUSION: Different iodine intakes under a certain range do not affect the prevalence and type of hyperthyroidism. Subclinical hyperthyroidism is more prevalent in the iodine deficient area than in the severe iodine excessive area. In the area with mild iodine deficiency, the introduction of universal salt iodization may not be accompanied by an increased incidence of hyperthyroidism.     

Effect of iodine supplementation on a pediatric population with mild iodine deficiency.

A cross-sectional study in two stages consisted of healthy children to assess the effect of iodine supplementation on a pediatric population with mild iodine deficiency in an ongoing program in the Province of Pontevedra, northwestern Spain. In the first survey (1984), 1565 schoolchildren and in the second survey (1995) 907 schoolchildren were randomly selected from the population. In January 1985, a mandatory consumption of iodized salt in our region was begun. In both surveys we studied prevalence of goiter, urinary iodine excretion, and prevalence of thyroid dysfunction. Similar prevalences of goiter were observed in both surveys, 3.7% versus 3.9%; however, significantly lower prevalence of Ib and II degree goiters were observed in the second survey. The mean iodine excretion was 88.6 +/- 73 microg/L (median 66.3) and 146.4 +/- 99 microg/L (median 115.7), p < 0.01 for the first and second surveys, respectively. Finally, the overall prevalence of thyroid dysfunction was similar in both surveys, 9.2% versus 7.0%; however, significantly lower prevalence of suppressed serum thyrotropin (TSH), considered as a marker of subclinical hyperthyroidism, was observed in the second survey when compared to the first, 0.1% versus 2%, p < 0.01. Our results are in agreement with the recent data from Denmark, where the prevention of subclinical hyperthyroidism occurring in the elderly as a consequence of longstanding mild iodine deficiency is the reason that the Danish finally started iodine supplementation on a national basis. In conclusion, long-term correction of mild iodine deficiency in a pediatric population has beneficial effects on the prevalence of high-degree goiters, and this correction reduces significantly the prevalence of subclinical hyperthyroidism. The present observation constitutes a strong argument for correcting even mild iodine deficiency.     

2008年浙江省舟山市海岛地区甲状腺疾病流行病学调查

目的 调查浙江省舟山市海岛地区食用非加碘盐的居民患甲状腺疾病状况及致甲状腺疾病的相关影响因素.方法 2008年在浙江省舟山市岱山县对737名食用非加碘盐的居民进行流行病学问卷调查、甲状腺B超检查、甲状腺功能及尿碘测定;同时抽查了183名8～10岁儿童(均为食用非加碘盐居民的子女)的尿碘.结果 舟山市岱山县食用非加碘盐的居民尿碘中位数(MUI)为122.2 μg/L,8～10岁儿童MUI为123.7μg/L;甲状腺肿、甲状腺癌、甲状腺功能亢进(简称甲亢)、亚临床甲状腺功能亢进(简称亚临床甲亢)和亚临床甲状腺功能减退(简称亚临床甲减)的患病率分别为39.9%、0.4%、0.4%、0.7%和0.8%.logistic回归分析显示,甲状腺肿患病率无性别差异(P>0.05),而年龄是甲状腺肿发生的危险因素(P<0.05);甲状腺肿、甲亢患病情况与饮食史、吸烟史、饮酒史、饮茶史、尿碘水平均无明显相关关系(P均>0.05).结论 舟山市海岛地区食用非碘盐居民碘摄入适量,但甲状腺肿和甲亢患病率较高.     

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.     

海岛居民甲状腺疾病和碘营养状况的关系

目的 调查舟山海岛地区居民甲状腺疾病和碘营养状况,分析二者的相互关系.方法 通过整群随机抽样的方法选取了3284名舟山成年居民进行了尿碘检测,并进行流行病学问卷调查、甲状腺B超检查、甲状腺功能测定.结果 舟山海岛地区成年居民尿碘中位数为226.0μg/L,其中城镇居民320.7 μg/L、盐民122.2 μg/L、农民188.9 μg/L、渔民193.6 μg/L、僧侣271.7 μg/L.舟山地区3284名居民弥漫性甲状腺肿、结节性甲状腺肿、胶质性甲状腺肿、甲状腺腺瘤、甲状腺癌、甲状腺功能亢进(甲亢)、亚临床甲亢、甲状腺功能减退(甲减)、亚临床甲减的患病率分别为1.7%、25.3%、8.7%、0.2%、0.4%、0.5%、0.8%、0.03%和1.0%,甲状腺过氧化物酶抗体(TPOAb)阳性率为9.5%.甲状腺疾病患病率女性明显高于男性(P＜0.05),且随年龄的增长而增高(P＜0.05).经logistic回归模型分析甲状腺疾病患病率与年收入、食用海产品、吸烟史、饮酒史、饮茶史、尿碘值等均无明显相关性(P＞0.05).结论 舟山地区居民碘摄入充足,是否实施全民食盐加碘值得商榷;舟山海岛地区甲状腺疾病的患病率较高可能与碘过量有关.

Abstract：

Objective To investigate iodine nutrition and thyroid health status among residents in Zhoushan archipelago, and to analyse their relationship.Methods A total of 3 284 residents in Zhoushan archipelago were surveyed by questionnaire and their thyroids were examined by B-mode ultrasound.The levels of urinary iodine and thyroid function were detected.Results The median level of urinary iodine in 3 284 residents was 226.0 μg/L, being 320.7 μg/L in citizens, 188.9 μg/L in farmers, 122.2 μg/L in salt-makers, 193.6 μg/L in fishers, and 271.7 μg/L in buddhist.The prevalence of diffuse goiter, nodular goiter, colloid goiter, thyroid adenoma, thyroid carcinoma, hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, and positve rate of TPOAb were 1.7% ,25.3% ,8.7% ,0.2% ,0.4% ,0.5% ,0.8% ,0.03%,1.0% ,and 9.5% repectively.The prevalence of thyroid diseases was increasing with aging, and higher in women than in men (P＜0.05).There was no significant relationship of the thyroid diseases with seafood, smoking,drinking, and tea (P＞0.05).Conclusions The citizens of Zhoushan archipelago have adequate iodine intake.It is pertinent to discuss Universal Salt Iodization.Excessive iodine intake may contribute to the high prevalence rate of thyroid diseases in Zhoushan.     

2008年福建省厦门市水源性高碘村及相邻村流行病学调查

目的 了解福建省厦门市水源性高碘村及相邻村水碘、学生碘营养状况及家中食用盐含碘量,为制订科学防治措施提供依据.方法 2008年,在厦门市选择水源性高碘村翔安区洪前行政村前边村及相邻的东莲村、东山村、大中村共4个自然村为调查点,4个自然村每村各采集1份自来水厂末梢水样和村民家中的所有井水水样.测定水碘,按统一设计的登记表在采水样时同时记录采样点基本情况;对4个村7～13岁所有在校学生进行甲状腺触诊检查,并采集尿样和家中盐样,采用砷铈催化分光光度法测定尿碘,采用直接滴定法测定盐碘.结果 在4个调查村,共采集4份自来水厂末梢水,水碘均为1.5μg/L;共有水井237 口,水碘范围为0.1～506.0μg/L;水碘<10μg/L的井占18.6%(44/237);水碘在10～150μg/L的井占73.4%(174/237);水碘>150μg/L的井占8%(19/237).共检测学生尿样79份,尿碘中位数为153.3μg/L.尿碘>200～<300 μg/L 的占11.4%(9/79),300～<500μg/L的占12.7%(10/79),500～<800μg/L的占7.6%(6/79).触诊法检查学生79名,甲状腺肿大率为11.4%(9/79);检测学生家中盐样71份,碘盐覆盖率为77.5%(55/71).结论 调查村井水水碘分布范围大;要针对不同人群分别采取宣传高碘危害和碘缺乏危害的知识,不断提高其健康意识.     

2007年云南省梁河县鼠疫疫源地室内鼠密度和蚤指数调查

目的 调查与分析云南省梁河县鼠疫疫源地室内鼠密度和蚤指数,评估鼠疫发生的潜在危险.方法 根据历史鼠疫监测资料,2007年8-9月在云南省梁河县选择30个鼠疫疫源村,对每个村的全部住户进行编号后,随机抽取20户,放置鼠笼和粘蚤纸用于捕获鼠和蚤,计算鼠密度、染蚤率、蚤指数、中位数.结果 黄胸鼠和臭鼷鼱分别捕获133和33只,平均每村捕鼠5只,平均鼠密度为2.8%(166/6000).染蚤鼠101只,染蚤率为60.8%(101/166).收集鼠体蚤344匹,其中印鼠客蚤296匹.缓慢细蚤48匹.鼠体蚤指数为2.1(344/166).捕获地面游离蚤315匹,地面游离蚤指数为0.026(315/11 888).平均每村5.5匹.其中,猫栉首蚤指明亚种和印鼠客蚤占了地面游离蚤总数的97.8%(308/315).地面游离蚤和鼠体蚤的蚤种构成不一致(精确概率法,P<0.01),鼠体蚤和鼠密度呈现正相关(r=0.68,P<0.01),地面游离蚤与鼠密度和鼠体蚤间均无相关关系(r=-0.17、0.32,P均>0.05).使用诱饵油炸猪皮3600个笼·夜,共捕获105只鼠,使用诱饵油条2400个笼·夜,捕获46只鼠,油炸猪皮的捕鼠效果明显优于油条(χ2=5.59,P<0.05).结论 梁河县鼠疫疫源村室内鼠以黄胸鼠为主,印鼠客蚤和猫栉首蚤指明亚种分别是鼠体蚤和地面游离蚤的优势种.勐宋、邦读村和汤加屯仍有发生鼠疫的可能性.     

Lower prevalence of mild hyperthyroidism related to a higher iodine intake in the population: prospective study of a mandatory iodization programme

Objective  Marked differences in pattern of thyroid dysfunction are seen in populations with different iodine intakes. We evaluated the influence of a higher iodine intake on thyroid hormone levels and the prevalence of thyroid dysfunction in the Danish population.
Design  Two cross-sectional studies matched on a group level according to sex and age.
Participants  In all, 8219 individuals were examined before ( n  = 4649) or after ( n  = 3570) the introduction of a mandatory iodization programme in 2000 in two regions with established mild and moderate iodine deficiency. Serum TSH, fT₄ and fT₃ were measured. An ultrasonography of the thyroid was performed.
Results  We found a higher median serum TSH after the introduction of mandatory iodization of salt: 1·51 mU/l (10–90th percentiles: 0·72–3·00) vs. 1·30 mU/l (10–90th percentiles: 0·59–2·66) before iodization. The difference was found in both regions and across age groups. There was a lower prevalence of mild hyperthyroidism and a tendency towards a lower prevalence of overt hyperthyroidism. The prevalence of mild hypothyroidism increased, most pronounced among young women after iodization. Conversely, there was a lower prevalence of undiagnosed overt hypothyroidism. However, when currently treated participants were included, the prevalence of hypothyroidism increased after iodization in the area with formerly mild iodine deficiency.
Conclusion  A change in pattern of thyroid dysfunction was seen in relation to mandatory iodization of salt. There was no rise in the prevalence of hyperthyroidism and the prevalence of mild hyperthyroidism was halved. Conversely, prevalence of hypothyroidism increased.     

血吸虫病防控技术集成研究与示范 Ⅰ项目实施前基线调查

目的为评价和分析血吸虫病防控技术集成研究与示范的效果提供基线调查资料。方法选择2个湖沼型血吸虫病流行村,一个为试点村,实施控制血吸虫病流行的综合措施;另一个作为对照村,实施常规防治措施。在2个村同时开展血吸虫病疫情调查以及相关问卷调查。结果试点村和对照村居民血吸虫感染率分别为3.57%和4.29%(χ2=1.10,P=0.294),耕牛血吸虫感染率分别为17.14%和14.62%(χ2=0.14,P=0.711)。试点村最高活螺密度为1.5446只/0.1m2,最高阳性螺密度0.0213只/0.1m2;对照村最高活螺密度为0.7036只/0.1m2,最高阳性螺密度0.0284只/0.1m2。居民防病意识2个村差异无统计学意义,但试点村居民接受综合治理的程度高于对照村。结论 2个行政村从自然环境、流行程度以及居民生产生活方式均相近,符合实施对比研究的要求。