碘缺乏病区儿童轻度智力落后及亚临床损伤的调查

目的 :评价农村不同程度碘缺乏病区学龄儿童轻度智力落后及亚临床损伤流行程度。方法 :用中国联合型瑞文测检图册 (CRT- RC2 )和农村儿童智商常模 (CRT- C2 )测验判定儿童智商 ,用天津医学院精神运动成套测验 (JPB)、测听仪、拍 X线片、标准度衡器具 ,判定学龄儿童精神运动、听力障碍者和骨龄、体格发育落后者。结果 :重、中、轻病区出生儿童的人群轻度智力落后率分别为 2 .34%、 4 .5 5 %、 0 .99%,亚临床损伤率分别为 2 9.30 %、 30 .32 %、 1 7.4 3%;重、中病区儿童轻度智力落后率和亚临床损伤率较轻病区为重。结论 :居民食用的碘盐合格率低、孕妇摄碘不足 ,可能是儿童轻度智力落后及亚临床损伤的原因。     

碘缺乏轻病区与非病区儿童的智力水平和精神运动功能状况调查

用CRT－C2和CRT－RC2测验、判定儿童智商,JPB和T分公式检测、计算确定儿童精神运动功能。智测IDD轻病区和非病区儿童智商均值分别为94．3和102．1,轻度智力落后率分别为7．5％和2．1％;轻病区儿童商均值显著低于非病区、轻度智力后率显著高于非病区（P＜0．005）。JPB检测两地儿童精神运动正常率显著低于非病区（P＜0．005）;两地轻度智力落后儿童精神运动障碍率分别为41．2％、25％,轻病区的轻度智力落后儿童精神运动障碍率明显高于非病区。表明轻度缺碘所造成的亚临床损伤程度明显重于非缺碘因素所致亚临床损伤程度,证实CRT－C2和JPB是临床同轻度脑发育障碍所致轻度智力落后和精神运动功能障碍的有效检测方法。     

浅谈亚临床型克汀病

亚临床型克汀病(简称亚克汀病),其本质是一种极轻型的充汀病,因此其发病机理和病因与克汀病是相同的,都是由于人体的碘缺乏造成的。亚克汀病的主要表现是智力落后,精神发育迟滞。经智商测定,四岁以下者采用丹佛发育筛选结果为异常;四岁以上者其智商为50——69,常伴有轻度听力障碍;极轻度言语障     

福建省城市学龄儿童智力发育水平现状研究

[目的]了解福建省城市学龄儿童的智力发育水平及影响因素。[方法]用中国联合型瑞文测验(CRT C2)测 定我省不同城市儿童智商(IQ)。[结果]我省城市儿童智商平均水平为102.4±14.6,轻度智力落后的患病率仅为1.7%; 不同城市之间儿童智力发育水平和轻度智力落后的患病率差异有显著性;沿海城市儿童的平均智商高于山区儿童,二者 轻度智力落后的患病率分别为1.1%和2.5%;不同年龄间儿童的智商差异有显著性,不同性别间儿童智商则类似;非碘 缺乏病区的城市儿童,平均智商高于碘缺乏病区,居住在碘缺乏重病区的儿童,轻度智力发育落后的患病率高于居住在 碘缺乏轻病区和非碘缺乏病区。[结论]我省儿童智力发育水平正常,影响城市儿童智力发育的主要因素是当地碘营养 状况和社会经济文化水平。     

绥中县农村碘缺乏病病区部分7～14岁儿童智商水平调查

[目的 ]了解碘缺乏对儿童智商的影响 ,指导碘缺乏病 (IDD)防治工作。 [方法 ] 2 0 0 1年用CRT C图册和CRT LNR进行测试、判定绥中县农村IDD重、中、轻病区 7～ 14岁儿童的智商 (IQ)。 [结果 ]重、中、轻IDD病区儿童智商值分别为 95 4± 15 7、96 1± 15 8、98 3± 15 5 ;IQ≤ 89儿童所占比例重病区 >中度病区 >轻病区 ,IQ≥ 110儿童所占比例重病区 <中度病区 <轻病区 ;重、中、轻病区儿童的轻度智力落后率分别为 6 7%、6 1%、4 1%。 [结论 ]碘缺乏对病区儿童智力发育有一定的不良影响 ,应引起重视     

孕妇口服碘油预防子代亚临床损伤效果的研究

目的了解和比较重度缺碘地区口服碘油孕妇的子代与重度缺碘地区仅食用碘盐孕妇的子代和轻度缺碘地区未补碘孕妇的子代亚临床损伤状况.方法采取CRT-C2、JPB、测听仪、拍X线片、标准度衡器具检测同期出生的3组7～13岁儿童的智商、精神运动功能、听力、骨龄和身高、体重.结果碘油预防组、碘盐预防组、未补碘组儿童的智商均值分别为98.2±15.3,93.5±15.7,94.2±16.2,IQ50～69者分别占2.3%,7.1%,7.5%;3组儿童JPB异常率为1.0%,4.5%,4.4%,听力减退率为1.9%,5.4%,5.6%,骨龄落后率为4.4%,7.4%,7.8%,身高落后率为4.2%,7.1%,7.3%,体重落后率为2.4%,4.3%,4.4%.统计碘油预防组儿童智商均值显著高于碘盐预防组和未补碘组儿童(P＜0.001),碘油预防组儿童的轻度智力落后率、JPB异常率、听力减退率、骨龄和身高落后率则显著低于另两组儿童(P＜0.05),而碘盐预防组与末补碘组儿童各项亚临床损伤率差异无显著性意义(P＞0.1).结论孕妇服用碘油预防子代亚临床损伤的效果为佳,在尚未普及合格碘盐的重度缺碘地区对孕妇投服碘油是必要和可行的.     

广东龙川县碘盐防治地甲病对儿童智力的影响

碘缺乏病可造成不同程度的脑发育落后,在国内外已得到证实,同时人们逐渐注意到碘缺乏地区在得到充分补碘后,仍有相当一部分存在着与地方性甲状腺病(简称地甲病)流行病学有关的非克汀病样损伤的智力落后的“正常人”。Fierro报告了厄瓜多尔碘缺乏地区轻度智力落后者高达35.4％;我国碘缺乏地区轻度智力落后的儿童占同年龄组15～30％。为探讨我省缺碘地区儿童的智力情况,我们调查了地甲病重病区龙川县上坪镇,现将结果报告如下: 一般材料:上坪镇地甲病患病率为29.7％,1984年使用碘盐(碘化钾:食盐为1:2万)防治,碘盐供应基本落实。该地区1987年底经考核已达到基本控制地甲病的标准。本次调查     

云南省8个少数民族聚居地亚克汀病流行情况调查

目的　调查云南省 8个少数民族聚居地亚克汀病的患病率 ,研究其流行规律、特点 ,为今后的防治工作提供科学依据。方法　用《中国联合型瑞文测验 (CRT C2 )》测定智商 ;用《津医精神运动成套测验 (JPB)》进行精神运动测验。结果　调查 8～ 12岁少数民族儿童 42 2 2名 ,平均智商 (IQ)91± 19,其中IQ 5 5～ 69者 2 77人 ,查出精神运动障碍 119例 ;儿童甲状腺B超平均肿大率为 5 .4% ,尿碘中位数 466.9μg L ,盐碘合格率为94.9%。结论　 42 2 2名少数民族儿童中 ,轻度智力落后兼有精神运动障碍者 119例 ,由此估算亚克汀病患病率为 2 .8%。     

包头市地方性砷中毒对儿童智力发育影响的调查

目的研究包头市地方性砷中毒对病区儿童智力发育的影响。方法通过对我市地方性砷中毒病区儿童测试智商。结果病区儿童智商（IQ）均值95．12，比全国农村儿童智商理论分布值低4．88。儿童智力落后率7．57％，比理论分布值高5％。结论病区儿童的智力发育障碍明显，智力发育受到了不同程度的损伤，证实我市地方性砷中毒对病区儿童的智力发育有不同程度的影响。     

碘缺乏对农村地区儿童骨龄和体格发育影响

骨龄是评价儿童骨发育的指标，身高和体重是评价儿童体格发育的指标。为了解和比较农村非缺碘地区、碘盐防治碘缺乏病（IDD）轻病区和未补碘IDD轻病区同时期出生儿童骨龄、身高、体重发育状况，我们于2001年对辽宁省部分农村地区儿童进行了手腕骨X线拍片和身高、体重测量。结果报告如下。     

沿海产盐区与非产盐区8～10岁儿童碘营养与智力水平分析

目的 了解和比较沿海产盐区和非产盐区8～10岁儿童碘营养状况与智力水平,为采取针对性防治措施提供依据.方法 选择产盐区翔安区和非产盐区集美区的小学为调查点,8～10岁儿童为调查对象,调查其家中碘盐食用情况、尿碘含量、甲状腺肿大情况和智商水平.结果 产盐区和非产盐区儿童合格碘盐食用率分别为81.5%和98.6%;甲状腺肿大率分别为3.0%和0.7%,尿碘中位数分别为202.8 μg/L和238.4 μg/L,＜50 μg/L的比例分别为3.5%和1.0%.产盐区8～10岁儿童智商均明显低于非产盐区儿童;产盐区8岁儿童智商明显高于9岁和10岁儿童;非产盐区8岁儿童智商明显高于9岁和10岁儿童,9岁儿童智商明显高于10岁儿童.结论 补碘能提高儿童智商,降低智力损害.要坚持食用碘盐,开展对孕妇、哺乳妇的碘营养监测.     

碘缺乏致智力损伤36篇文献的Neta分析

目的 探讨碘缺乏病区中缺碘的智力落后病因学中的意义和补碘对儿童智力的保护作用。方法 严格按照纲入标准,利用插集到的献研究进行Ｍｅｔａ分析,２０项用联合型瑞测验,３９项用中国比内量表测试智力。结果 分析发现用联合瑞测验和中国比内量有相似结果,缺磺病区儿童比非缺碘地区儿童损失８．９４～１０．８０个智商（ＩＱ分）,在脑发育关键期进行有效补碘能比同病区未补碘儿童提高１１．８５～１１．６４个ＩＱ。统计     

碘缺乏病区胚胎至婴幼儿期碘状况对儿童智力发育的影响

使用Ｓｔａｎｔｏｒｄ－Ｂｉｒｅｄ量表，对地方性克汀病及地方性甲状腺肿病区补碘前处于胚胎至婴幼期的儿童和碘盐稳定供应３～４年后出生的儿童进行智力测验，结果表明碘缺乏地区确实存在众多的智力低下儿童，主要集中在补碘前出生的儿童。为观察稳定供碘后儿童智力发育的变化情况，我们对地方性克汀病区的受试儿童追踪观察了两年。结果表明未能进一步改善儿童的智力水平，说明胚胎至婴幼期缺碘对儿童智力发育的损害是不可逆性的。     

Appropriate iodine nutrition in Iran: 20 years of success

Iodine is a trace element in the human body, its only known function is the synthesis of thyroid hormones. Effects of iodine deficiency, termed iodine deficiency disorders (IDD), include endemic goiter, hypothyroidism, cretinism, decreased fertility rate, increased infant mortality and mental retardation. 2.2 billion people worldwide are at risk for IDD. Of these, 30-70% have goiter and 1-10% have cretinism. Two decades ago the I.R. Iran was among the countries most severely affected by iodine deficiency, but during the last two decades has made much progress in the development of universal salt iodization strategies and IDD prevention, and since 1996 meets all WHO/UNICEF/ICCIDD criteria for the sustainable elimination of iodine deficiency.     

The effects of iodine deficiency in pregnancy and infancy

Iodine requirements are increased ≥ 50% during pregnancy. Iodine deficiency during pregnancy can cause maternal and fetal hypothyroidism and impair neurological development of the fetus. The consequences depend upon the timing and severity of the hypothyroidism; the most severe manifestation is cretinism. In moderate-to-severely iodine-deficient areas, controlled studies have demonstrated that iodine supplementation before or during early pregnancy eliminates new cases of cretinism, increases birthweight, reduces rates of perinatal and infant mortality and generally increases developmental scores in young children by 10-20%. Mild maternal iodine deficiency can cause thyroid dysfunction but whether it impairs cognitive and/or neurologic function in the offspring remains uncertain. Two meta-analyses have estimated that iodine-deficient populations experience a mean reduction in IQ of 12-13.5 points. In nearly all regions affected by iodine deficiency, salt iodisation is the most cost-effective way of delivering iodine and improving maternal and infant health.     

我国碘缺乏病防治研究的成就与展望

本文论述了我国碘缺乏病的防治成就和科研成果。在防治成就方面,我国8～10岁儿童的甲状腺肿大率由1995年的20%下降至2005年的5%,全国高危地区的8～10岁儿童甲状腺肿大率已经降至2009年的2.9%;在科研成果方面,复制出了接近于人类地方性克汀病的实验性大鼠模型,发现了尿碘与甲状腺肿大率之间呈现"U"形曲线关系。文章还对今后的防治前景进行了展望,认为我国的国策应由全民食盐加碘向科学补碘方向转化,并提出了科学补碘的具体内涵。     

Population living in the Red Sea State of Sudan may need urgent intervention to correct the excess dietary iodine intake

BACKGROUND: Both inadequate and high intakes of iodine are associated with thyroid disease and associated abnormalities. Consumption of foods deficient in iodine induces hypothyroidism. Conversely, excessive intake of the nutrient precipitates hyperthyroidism. Iodine deficiency causes impairment of thyroid hormonogenesis resulting in goiter (struma), cretinism which is associated with increased prenatal and infant mortality, deafness, motor disabilities and mental retardation due to damage during fetal and neonatal brain development. We have assessed the iodine status of school children from the locality of Port Sudan, Red Sea State of Eastern Sudan. The primary sources of iodine of the children are mainly iodized salt and rations supplied by local donors and various aid agencies operating in the Sudan. METHODS: Male and female children (n=141), aged 6 to 12 years (median age 9.8 years), were selected for the survey using a multistage random sampling technique, between May 22 and August 25, 2006. All the children were assessed for urinary iodine and visible goiter. In addition, the iodine content of twenty salt samples was determined using the lodometric titration method and spot test kits. The components of other foods that are routinely consumed by the children and households were noted using a questionnaire form. FINDINGS: Urinary iodine concentration exceeded 300 microg/l and 1000 microg/l in 65% and 9.9% of the children, respectively. The highest urinary iodine level was 1470 microg/l. The prevalence of visible goiter was 17%. All the salt samples collected from the schools had more than 150mg potassium iodate per kg of salt. CONCLUSIONS: The results of this pilot survey reveal that excessive intake of iodine in children exists in Port Sudan. Inappropriate and unregulated local fortification of salt and lack of monitoring of the imported and donated salt is the primary reason for the excessive intake. There is an urgent need for a regulatory mechanism during the process of iodine fortification and at the point of entry of imported and donated iodized salt as well as the mode of delivery in order to avoid hyperthyroidism and associated disorders. In addition, independent professionals should critically evaluate the health impact of excessive consumption of the nutrient.     

Validity of spot testing kit for estimation of iodine content of salt under field conditions in National Capital Territory of Delhi

Iodine is an essential element for normal human growth and development. The daily per capita requirement is 150 mcg. Deficiency of iodine in the daily diet may lead to the development of goiter and other iodine deficiency disorders, including mental and physical retardation and endemic cretinism. Salt samples from the families of 252 children were taken from 3 randomly selected government primary schools in Nand Nagri, an urban resettlement colony of East Delhi. The iodine content of the samples was then analyzed by one researcher using the Spot Testing Kit (STK), while another researcher analyzed the samples using the Standard Iodometric Titration (SIT) method at the Department of Human Nutrition in AIIMS, New Delhi. Test results were then analyzed using a 2 x 2 table. Specificity, sensitivity, and predictive values of the STK were calculated using the SIT method as the gold standard. The STK was found to be 97.14% sensitive, 80.76% specific, and with a negative predictive value of 98.65%. The STK is therefore a highly useful tool with which to estimate the iodine content of salt in community settings.     

鲁西南滨湖居民碘营养状况综合评价

目的　综合评价鲁西南滨湖地区居民的碘营养状况。方法　按整群批质量保证抽样法 (LQAS)对山东省微山湖、东平湖周围碘营养状况性质未定的滨湖 4县 (微山、金乡、鱼台、梁山 ) 1 9个乡镇 4 2 81例 8～ 1 0岁学龄儿童甲状腺肿大率、智商、尿碘、水碘及盐碘等指标进行抽样调查。结果　 4县以乡镇为单位 ,儿童甲状腺肿大率差别较大 ;外环境水碘含量高低不一 ;内环境尿碘水平较高 ,体内碘除来自当地饮水和粮食外 ,可能不同程度地受到居民食用碘盐的影响 ;金乡、鱼台 2县儿童智商基本呈正态分布 ,与对照组相比无显著性差异 ;微山县儿童智商水平略向低值偏移 ,与对照组进行U检验P <0 0 1。结论　鲁西南滨湖地区同时存在缺碘区、适碘区和高碘区 ,几种情况交错存在 ,呈片状、灶状或点状分布     

碘缺乏、补碘、高碘对儿童智力影响的Meta分析

目的 量化分析碘缺乏，补碘，高碘对儿童智力的影响。方法 采用Meta分析，利用检索工具收集尽可能多的文献。纳入研究的标准是：研究来自碘缺乏病区或高碘地区，文献采取对照实验设计，提及研究组与对照组的社会经济文化发展水平相近。纳入研究归入碘缺乏，补碘和高碘三个组。结果 纳入碘缺乏，补碘和高碘三组的研究分别为62，36，30项，三组内各单项研究的Hunter齐性检验没有显著的统计学意义（P＞0．05），合并计算的平均效应值依次是0．69（10．4个智商分，95％CI＝9．9－10．9），0．81（12．2个智商分，95％CI＝11．5－12．9）和0．21（3．2个智商分，95％CI＝2．5－4．0）。结论 碘缺乏和补碘对病区儿童智力干扰明显或极为明显；碘缺乏造成儿童智商损失约10分，在脑发育关键期补碘出生的儿童智商比未补碘儿童高约12分；目前尚不能肯定高碘对儿童智力有影响。