紫云县猴场乡持续八年供应加碘盐防治地甲病监测结果分析

贵州省紫云县猴场乡,1980年通过调查,属于外环境缺碘引起的地甲病重病区。1980年9月开始供应1/5万加碘盐防治;1986和1987年两年又对全乡育龄妇女和地甲病患者服碘油胶丸治疗,现已基本得到控制并验收。现将防治调查结果分析报告如下。     

石家庄地区新生儿尿碘水平

本文报道了石家庄地区新生儿尿碘水平:非地甲病区正常新生儿尿碘的中位数是59.90μg/L;碘盐防治的地甲病区新生儿尿碘为136.30μg/L;非病区正常人尿碘为64.55μg/L;碘盐防治的地甲病区成人尿碘为149.08μg/L。表明地甲病区补碘后无论成人、正常新生儿或病儿都已获得充足的碘。结果提示测定新生儿尿碘,对于评价母体及新生儿碘营养状态是有价值的。     

辽宁省农村碘缺乏病病区和非病区儿童的亚临床损伤状况

目的了解辽宁省农村碘缺乏病病区和非病区7～14岁儿童的亚临床损伤状况.方法先用CRT-C2测定儿童智商(IQ),然后用JPB、测听仪、拍X线片、标准度衡器具检出IQ 50～69儿童的精神运动、听力障碍和骨龄、体格发育落后者.结果碘盐防治重、中、轻病区和碘盐碘油防治重病区、未补碘轻病区、非病区儿童人群轻度智力落后率分别为6.8%、5.0%、3.5%、2.3%、7.5%、2.3%;轻度智力落后儿童具有神经系统障碍和甲状腺功能障碍的亚临床损伤率分别为79.5%、77.0%、40.2%、50.0%、66.7%、37.5%.碘盐防治重、中、轻病区儿童亚克汀病患病率分别为5.4%、3.9%、1.4%,碘盐碘油防治重病区、未补碘轻病区儿重亚克汀病患病率分别为1.2%、5.0%.结论病区儿童亚临床损伤率和亚克汀病患病率以碘盐防治重病区和未补碘轻病区最高,次之为碘盐防治中度病区,碘盐碘油防治重病区和碘盐防治轻病区最低.碘盐碘油防治重病区和碘盐防治轻病区儿童与非病区儿童的亚临床损伤率无明显差异.     

碘油胶丸治疗地方性甲状腺肿疗效观察

我县为缺碘性地方性甲状腺肿病区,已在全县范围内实施了碘盐防治措施(碘盐浓度为二万分之一)在此基础上我们又对小庄公社二度以上的甲状腺肿病人采用碘油胶丸口服治疗并与单纯碘盐防治的二度以上病人进行对比观察,现将观察结果报告如下。材料与方法1.药物:碘油胶丸由武汉第四制药厂制造,剂量每丸为0.1克。     

娄底市碘缺乏病纵向监测结果分析

目的通过对碘缺乏病(IDD)患病情况的纵向监测,评价防治措施的效果和有待解决的问题.方法儿童甲状腺肿大(甲肿)率调查用触诊法或触诊+B超法;盐碘合格率调查采用直接滴定法;尿碘用碱灰化法和砷铈催化分光光度法;智商(IQ)测定用CRT-C2.结果①儿童甲肿率从1981年的27.9%下降至1985年的16.4%,至1995年又略有升高达21.2%.1996年起全民食盐加碘后儿童甲肿率持续下降,1997年降至5%以下,2002年降至零;②碘盐合格率在批发、零售两个层次上自1997年起即稳定在90%以上;③对目标人群的尿碘监测结果显示尿碘值在持续升高.未实施任何补碘措施时的本底值在6～78μg/gCr,至2002年8～10岁的儿童、妊娠、孕妇、哺乳期妇女的尿碘值已上升至85～1 091 μg/L,尿碘中位数407μg/L,＜100 μg/L的人数只有1%左右;④1997年至1999年共对256名新生儿脐带血做了TSH检测,其中＜10mU/L的245名,占95.7%;⑤对历史中等病区和历史非病区的8～10岁学生测定其智商,结果显示历史中等病区的儿童智商呈偏态分布,即中等智力及中等以下智力的人数明显多于中等及中等以上智力的人数.而历史非病区儿童的智商结构类似正态分布,即智商为中等的占较大的比例,而较差的和优秀的均呈递减趋势.结论补碘可以较快地降低儿童甲肿率并进而控制住甲肿的发生.全民普食碘盐以后居民的尿碘持续升高,至2002年测定时尿碘的最高值已超过1 000μg/L,尿碘太高对人体不良反应应该引起重视的.历史IDD病区儿童的智商测定得分低于历史的非病区,说明今后的防治工作应以历史IDD病区为主、同时建议消除IDD标准应当包括病区儿童与非病区儿童在经济、教育等其它相同条件下智商在同一水平.     

口服碘油胶丸防治学生地甲肿效果观察

据文献报导,口服碘油胶丸防治地甲肿有满意的效果。我们于1987年10月至1989年4月在竹溪县水平镇黄龙中学,对住读学生作了口服碘油胶丸防治甲状腺肿的效果观察。现将结果报导如下:     

肌注不同剂量碘油与口服碘油胶丸对地甲病的疗效比较

肌注碘油与口服碘油胶丸防治地甲病国内外已有不少报导,为筛选适应我省病区疗效高,使用方便,经济实惠的治疗方法,1985～1987年在永丰乡进行了为期一年半的肌注不同剂量碘油与口服碘油胶丸的疗效观察,现报导如下。     

2002年四川省碘缺乏病监测结果分析

目的了解四川省碘缺乏病防治现状,评估防治效果,为完善消除碘缺乏病防制策略提供依据.方法在全省每个市(州)随机抽取1～2县共计30县的30所小学进行病情监测;每个市(州)随机抽取3个县共计63县进行盐碘监测.结果全省居民户合格碘盐食用率74.0%,加碘盐覆盖率91.9%;儿童尿碘中位数198.3μg/L,触诊和B超两种方法检查儿童甲状腺肿大(甲肿)率分别为5.8%和4.0%.结论我省碘缺乏病防治取得显著成效.与1999年相比,加碘盐覆盖率较提高了6个百分点,达到90%以上;甲肿率下降了63%,已接近国家碘缺乏病消除标准;儿童尿碘中位数达到WHO建议的理想水平.合格碘盐食用率距国家标准相差较远,碘盐问题仍是当前防治工作中的主要问题.非碘盐冲销病区现象依然存在,应引起政府部门的高度重视.健康教育仍是防治工作中的薄弱环节,力度必须加强.     

严重缺碘病区佟井村补碘10年后现况调查

本文对佟井村补碘10年后的防治现状进行了全面调查。结果表明该村为严重缺碘病区,经10年补碘防治后,仍存在不同程度缺碘。7～14岁儿童的甲状腺肿大率为22.68%,尚有少数儿童患有 I~0甲肿、有16.85%的学龄儿童发生轻度智力低下(IQ≤69)、8.5%的儿童骨龄落后(平均落后8.1个月)等。我们建议对严重缺碘病区,在供应碘盐基础上应坚持对育龄妇女肌注或口服碘油,并加强监测尤其碘盐质量的监测工作。     

陕西省汉阴县太平村碘盐防治地甲肿与地克病效果观察

在秦岭山区一个缺碘、地甲肿与地克病的高发村,采用了1/5万碘盐防治,使地甲肿患病率由防治前(1965年)的44.5%下降到(1987年)1.72%,治愈了94.89%的各型地甲肿病人,控制了地甲肿的新发和复发。地克病除了防治前出生现存的3例病人外,23年内未发生地克病,碘盐预防地克病切实有效,而治疗地克病的效果则不显著。随机抽取本村94人做甲状腺摄~(131)碘率测定,6小时与24小时指标均正常。儿童智商(IQ)均值为82.82±12.11,有14.28%的儿童智商低于69,表明在碘缺乏区,还有一定数量的亚临床克汀病存在。     

Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous,iron-deficient children: a randomized,double-blind,controlled trial

OBJECTIVE: In many developing countries, children are at high risk for both goiter and anemia. Iron (Fe) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter. The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia. DESIGN AND METHODS: In a 9-month, randomized, double-blind trial, 6-15 year-old children (n=377) were given iodized salt (25 microg iodine/g salt) or dual-fortified salt with iodine (25 microg iodine/g salt) and Fe (1 mg Fe/g salt, as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil). RESULTS: In the dual-fortified salt group, hemoglobin and Fe status improved significantly compared with the iodized salt group (P<0.05). At 40 weeks, the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group (-38%) was twice that of the iodized salt group (-18%) (P<0.01). Compared with the iodized salt group, serum thyroxine was significantly increased (P<0.05) and the prevalence of hypothyroidism and goiter decreased (P<0.01) in the dual-fortified salt group. CONCLUSION: Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia.     

全国居民户水平盐碘监测结果分析

目的　评估 1999年全民食盐加碘干预措施落实情况。方法　用 PPS法抽取 31个省 (自治区、直辖市 )各 12 0 0份居民食用盐 ,根据各省上报盐碘定量测定结果 ,利用 Epinfo6 .0软件进行资料汇总分析。结果　全国有 2 1个省碘盐覆盖率达到 90 %以上 ,而仅有 5个省的合格碘盐覆盖率达到 90 %以上。结论　适当降低加碘浓度 ,提高碘盐合格率 ,杜绝非碘盐冲击 ,才能确保居民食用合格碘盐 ,科学地防治碘缺乏病     

简化碘盐监测方案在碘盐普及地区的应用探讨

目的对目前碘盐覆盖率较高,普及碘盐的地区,探讨碘盐监测方案的简化办法。方法选取碘盐覆盖率和合格碘盐食用率均达标的吉林省的20个县(市),同时按照现行方案和简化方案开展碘盐监测。对两方案的结果进行比较,分析简化方案的可行性。结果20个县(市)2种方案监测结果间差异均不显著。结论简化方案具有较好的可操作性,在高碘盐覆盖率地区,其监测结果与现行方案间差异不显著。因此,对于全国大部分达标地区,简化方案具有良好的推广意义。     

实施食盐加碘新标准后重庆市碘盐质量评价

目的：了解重庆市实施食盐加碘新标准后的加碘盐质量，为制字碘缺乏病防制策略提供科学依据。方法：对生产，销售的碘盐和居民食用盐进行抽样调查。结果：检查生产和销售碘盐各14批，生产环节批质量不合格1批，其余均为合格批次，平均含碘量（－/x)显著高于手低于国家加碘标准35mg/kg的批次，生产占64．29％（9／14），销售占57．14％（8／14）；调查居民567户，碘盐覆盖率为97．2％，合格率89．8％，合格碘盐食用率为87．3％，结论：碘盐生产未严格按照国家标准进行加碘，影响了居民碘盐合格率和合格碘盐食用率达标。     

1/5万碘化钾和1/2万碘酸钾食盐防治碘缺乏病效果比较

目的比较不同碘含量食盐防治碘缺乏病的效果。方法对重病区麻江县河坝乡和轻病区凤岗县何坝乡的３８０２名学龄儿童的甲状腺肿大率、尿碘水平及盐碘含量进行对比调查分析。结果盐碘含量、尿碘水平和甲状腺肿大率呈负相关,食盐的含碘量和尿碘值呈正相关。结论１／２万碘酸钾食盐对ＩＤＤ的防治效果明显优于１／５万碘化钾食盐。     

内蒙古城镇和农牧区、病区和非病区碘盐及碘缺乏病病情分析

目的了解内蒙古城镇、农牧区、病区、非病区碘盐和碘缺乏病现状。方法对１９９７年全区碘缺乏病中期评估资料进行分析。结果精制盐的碘化效果较粉碎盐好,但在内蒙古由于生活习惯,有５０％以上居民食用粉碎盐。城镇碘盐合格率高于农牧区,但因为多数城镇为历史非病区,碘盐普及时间短,故儿童甲肿率仍偏高。结论经过多年防治,病区儿童甲肿率已下降到５％以下,可粗制碘盐的质量尚有待提高。非病区碘盐合格率达到了９０％以上,但需要有可持续性的保障机制     

2008年全国碘盐监测结果分析

目的 掌握我国居民层次碘盐食用情况,及时发现存在的问题,为政府制定碘缺乏病防治策略提供依据.方法 2008年,按照<全国碘缺乏病监测方案(试行)>要求,在全国31个省份以县为单位,新疆生产建设兵团以师为单位进行碘盐监测.每个县按所辖乡镇数量的不同,有9个以上乡镇的县,按东西南北中5个方位采用单纯随机抽样方法抽取9个乡、每个乡抽4个村、每个村抽8户居民;有9个和以下乡镇的县,按东西南北中5个方位各抽取1个乡、每个乡抽4个村、每个村抽15户居民.采集居民户家中的盐样进行碘盐测定,统计和分析各省居民碘盐覆盖率、碘盐合格率和合格碘盐食用率.碘盐测定采用直接滴定法,川盐及其他强化食用盐测定采用仲裁法.结果 全国共有2817个县(区、市、旗)及新疆生产建设兵团的14个师上报了监测结果,监测覆盖率99.96%(2831/2832).盐碘均数为31.51 mg/kg,有16个省份盐碘变异系数＞20.00%.共监测826 968户居民家中食用盐,其中碘盐798 725份,非碘盐28 243份,不合格碘盐20 270份.经人口加权,全国碘盐覆盖率97.48%,碘盐合格率为97.16%,合格碘盐食用率为94.79%.27个省(区、市)和新疆生产建设兵团的居民户合格碘盐食用率≥90.00%,海南、西藏、新疆、天津(省、区、市)的合格碘盐食用率＜90%.有2487个县(市、区、旗)的合格碘盐食用率≥90.00%,占实际监测县数的87.82%(2487/2831),104个县(市、区、旗)和新疆生产建设兵团的1个师碘盐覆盖率＜80.00%.结论 全国有16个省(区、市)的盐碘变异程度较高,碘盐质量有待提高.全国碘盐覆盖率和合格碘盐食用率总体较好,均≥90.00%,但海南、西藏、新疆等省(区)非碘盐情况仍然较为突出,碘盐覆盖水平较低.

Abstract：

Objective To study the national surveillance results and learn the current situation of iodized salt consumption at household level in 2008, and to find out the remaining problems and to provide scientific basis for developing control strategies against iedine deficiency disorders. Methods In 2008, in accordance with the requirements of the "National Iodine Deficiency Disorders Surveillance Program (Trial)", the surveillance was conducted at county level in 31 provinces and at division level in Xinjiang Production and Construction Corps. In each county 9 townships were randomly selected according to their sub-area positions of east, west, south, north and center;4 villages were randomly sampled in each chosen township;8 households were randomly selected in each chosen village. In every county with 9 or less townships, 1 township was randomly selected respectively in the east, west, south,north and center sub-areas;4 villages were randomly sampled in each chosen township;15 households were randomly selected in each chosen village. Edible salt from these households was collected. Iodized salt coverage rate, proportion of qualified iodized salt and consumption rate of the qualified iodized salt of the households in each province were counted and analyzed. Iodized salt was determined by direct titration;the salt samples from Sichuan and other enhanced salt were detected by arbitration. Results Totally 2817 counties (districts, cities, banners) and 14 divisions of the Xinjiang Production and Construction Corps reported the monitoring results, monitoring coverage reached 99.96%(2831/2832). Mean of iodine content was 31.51 mg/kg.Sixteen provinces had a variation coefficient of iodine content for more than 20%. A total of 826 968 households were tested of their edible salt, in which iodized salt 798 725 copies, non-iodized salt 28 243 copies, and unqualified iodized salt 20 270 copies. Weighted by population,at national level, the coverage rate of iodized salt was 97.48%, qualified rate of iodized salt 97.16%, and consumption rate of qualified iodized salt was 94.79%.Twenty seven provinces (autonomous regions and municipalities) and Xinjiang Production and Construction Corps had a qualified iodized salt coverage rate of above or equal 90.00%. Tibet, Hainan, Xinjiang and Tianjin provinces (regions) had a qualified iodized salt coverage rate lower than 90.00%. Further, 2487 counties had the rate high or equal 90.00% accounting for 87.82% (2487/2831) of complementing monitoring counties. One hundred and four counties and 1 division of the Xinjiang Production and Construction Corps had the coverage rate of iodized salt below 80.00%. Conclusions Sixteen provinces(autonomous regions and municipalities) have relatively a high degree of variation coefficient in salt iodine content. The quality of iodized salt needs to be improved. The coverage rate of iodized salt and the qualified iodized salt at national level are both above or equal 90.00%. However, the non-iodized salt problem is still serious and have a relatively lower coverage of iodized salt in Tibet, Hainan and Xinjiang.     

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.     

Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg l/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 microg/dl 85.1% had urinary iodine > or =10 microg/dl. Median urinary iodine was above 13 microg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 microg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 microg/dl; urinary iodine of their schoolchildren was <5 microg/dl in 10.8% and <2 microg/dl in 6-9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.     

Risks of iodine-induced hyperthyroidism after correction of iodine deficiency by iodized salt.

Biochemical signs of hyperthyroidism, or even overt and possibly lethal clinical hyperthyroidism were reported in 2 severely iodine-deficient African countries (Zimbabwe and Democratic Republic of Congo, RDC) soon after the introduction of iodized salt. The 2 countries had access to iodized salt produced in Botswana, as well as 5 other countries in the region, namely Cameroon, Nigeria, Kenya, Tanzania, and Zambia. Therefore, a multicenter study was conducted in these 7 countries to evaluate whether the occurrence of iodine-induced hyperthyroidism (IIH) after the introduction of iodized salt was a general phenomenon or corresponded to specific local situations in the 2 affected countries. Two or 3 areas with a past history of severe iodine deficiency that had recently been supplemented with iodized salt were selected in each of the 7 countries. The prevalence of goiter was determined in 4423 schoolchildren in these areas and the concentration of urinary iodine in 2258. Salt factories and health structures were visited for the evaluation of the quality of iodized salt and the possible occurrence of IIH. The study showed that iodine deficiency had been eliminated in all areas investigated, and that the prevalence of goiter had markedly decreased since the introduction of iodized salt. This is a remarkable achievement in terms of public health. However, some areas were now exposed to iodine excess due mostly to a poor monitoring of the quality of the iodized salt and of the iodine intake of the population. In these areas or countries, IIH occurred only when the introduction of iodized salt had been of recent onset (<2 years), namely in Zimbabwe and RDC. In conclusion, the risk of IIH after correction of iodine deficiency is closely related to a recent excessive increment of iodine supply.