宁安市碘缺乏病监测报告

为了解宁安市人群碘营养现况 ,评价干预措施落实情况及效果 ,我们于1998— 1999年对儿童甲状腺容积 ,尿碘 ,食用加碘盐进行抽样调查 ,现将结果报告如下 :1　监测结果1.1　甲状腺肿大　经 PPS法抽取 30所学校 ,对全部 8～ 10岁学生 ,用 7.5MHz探头 B超仪进行甲状腺容积测定 [1 ] 。 1998、 1999年甲肿率分别为13.82 %和 10 .0 6 % ,二者之间差异有显著意义 (P <0 .0 0 1)。其中 1998年 8、9、10岁儿童甲状腺容积中位数为 3.6、4.0、 4.1m l,甲肿率为 8.96 %、15 .47%、17% ;1999年 8、9、10岁儿童甲状腺容积中位数分别为 3.8、4.0、4.2ml,…     

B超法和触诊法同步诊断儿童甲状腺容积分析

目的比较B超法和触诊法诊断8～10岁儿童甲状腺容积的差异.方法用B超法和触诊法同步诊断包头市9个旗、县、区内642例8～10岁儿童甲状腺容积.结果 B超法阳性18例,肿大率为2 80%,触诊法阳性34例,肿大率为5.30%.2者吻合率为95.17%,灵敏度和特异度分别为61.11%和95.09%.结论在甲肿率较低(5%左右)时,B超法和触诊法诊断一致性较高,所以触诊法也可作为大面积评估的主要方法,尤其适用于基层.     

2005年唐山市城、乡居民碘缺乏病监测结果分析

目的评价全民食盐加碘实施10年来唐山市碘缺乏病的预防效果,了解唐山市城、乡居民碘营养状况。方法 PPS 抽样方法与实际情况相结合确定监测对象;触诊法检测8～10岁小学生甲状腺大小;尿碘检测用改进的酸消化砷-铈法;盐碘检测按 GB/T13025.7-1999直接滴定法;水碘检测按砷-铈分光光度法。结果城、乡儿童尿碘中位数分别为205、155μg/L,尿碘<50μg/L 的分别占3.64%、5.71%;盐碘合格率分别为91.09%、62.38%;8～10岁小学生甲肿率分别为2.73%、4.76%。结论唐山市属于缺碘地区,通过食盐加碘,学龄儿童和育龄妇女碘营养状况达到适宜水平。     

2007年西藏自治区碘缺乏病高危地区重点人群调查分析

目的 掌握西藏自治区碘缺乏病防治工作现况,提出有针对性的防治对策,杜绝新发地方性克汀病(简称地克病)的发生.方法 2007年4-8月在拉萨、山南、林芝、昌都、日喀则5个地区的16个县,搜索所有1997年1月1日以后出生的疑似克汀病患者,在每个乡选择2个村,每个村选取60名8～10岁儿童,采用触诊法和B超法进行甲状腺检查、尿碘测定、智商测查;每个村选择30户育龄妇女进行尿碘测定,并对其家中食盐进行半定量检测.结果 调查未发现新发克汀病患者.触诊法检查,8～10岁儿童甲状腺肿大(简称甲肿)率为4.5%(257/5680);B超法检查,甲肿率为4.7%(258/5433).8～10岁儿童尿碘中位数为159.4μg/L,智商为78.3±14.5;育龄妇女的尿碘中位数为70.2μg/L;碘盐覆盖率为52.8%.结论 儿童甲肿率、尿碘水平达到了消除碘缺乏病标准;但是儿童智商偏低,育龄妇女尿碘水平较低,碘盐覆盖率较低,碘缺乏病的防治工作需要加强.     

福建省家庭户盐碘含量与学龄儿童甲状腺容积关系的横断面研究

目的评价2011年、2014年和2016年福建省碘缺乏病监测中不同盐碘含量对学龄儿童甲状腺容积分布的影响。方法 2011年和2014年福建省碘缺乏病监测采用以人口比例概率抽样法(PPS)分别抽取了1 219名和1 507名8-10岁儿童,而2016年以县级为单位采用分层抽样法抽取了6 312名8-10岁儿童;对抽中的儿童进行家庭户食用盐样和尿样采集以及甲状腺B超的测量。采用直方图和箱式图对甲状腺容积分布进行分析,计算偏度和峰度进行甲状腺容积正态性检验。结果家庭户食用盐碘中位数从2011年的29.30 mg/kg降低到2016年的23.20 mg/kg;2011年、2014年和2016年8-10岁儿童尿碘中位数分别为223.00、154.30和187.20μg/L;2011年、2014年和2016年甲状腺容积中位数(M)和四分数间距(IQR)分别为3.09 ml和1.21 ml、2.80 ml和1.10 ml、3.10 ml和1.20 ml;2011年、2014年、2016年甲状腺容积峰度和偏度分别为8.37和125.94、1.19和3.41、1.64和6.25。结论随着盐碘含量下降,学龄儿童尿碘中位数降低到适宜状态,同时甲状腺容积分布对称性提高。     

杭州市淳安县山区儿童甲状腺肿大率回升原因调查

目的调查杭州市淳安县儿童碘营养状况,分析山区儿童甲状腺肿大率(甲肿率)回升的原因。方法采用随机整群抽样的方法抽取8～10岁儿童642名。用触诊法对每个儿童检查甲状腺,部分儿童检测尿碘、盐碘、智商、血清总蛋白及调查其膳食情况。结果山区学生甲肿率为10．28%,明显高于城镇学生(3．32%),两组比较差异有统计学意义(P＜0．05)；山区住校生甲肿率(13．81%)与山区未住校生(6．90%)差异有统计学意义(P＜0．05)；城镇学生与山区未住校生甲肿率差异无统计学意义(P＞0．05)；山区住校生的食物种类和每日碘摄入量平均分别为4．9种和26．01μg/d,均低于城镇学生(11．5种、38．05μg/d)。结论山区儿童特别是山区住校生碘摄入量低且不持续及食物中蛋白质较少是导致甲肿率回升的主要原因,应采取措施改善其营养状况。     

江苏省6～12岁儿童甲状腺容积正常值

目的：探讨江苏省6－12岁儿童甲状腺容积正常值,方法：在江苏省人群尿碘中位数大于100ug/L碘营养状况正常的地区选择6－12岁儿童用B超作甲状腺容积测量。同时测其身高和体,计算体重表面积,结果：检查6－12岁学龄儿童2100例,甲状腺容积随年龄和体表面积增加而增加,据此提出了江苏省儿童6－12岁各年龄组甲状腺容积正常值范围和按体表面积计算的甲状腺容积正常范围;结论：该正常值范围对江苏省碘缺乏病监测及全国修订儿童甲状腺容积正常值具有一定的参考价值。     

WHO甲状腺容积标准判定高碘甲状腺肿大适用性的探讨

目的探讨WHO甲状腺容积标准对我国儿童高碘甲状腺肿大的适用性。方法在河北省衡水市随机选取3个水碘中位数在150-300μg/L的高碘乡和1个水碘中位数为105.4μg/L的对照乡,采用单纯随机抽样方法,分别在3个高碘乡和对照乡选取452名和120名8~10岁儿童,用B超测量其甲状腺容积,用WHO和我国甲状腺容积标准判定其甲状腺肿大情况。结果 WHO和我国甲状腺容积标准判定的3个高碘乡儿童甲状腺肿大率为24.6%(111/452)和8.2%(37/452),有显著统计学差异(χ2=44.19,P=0)。两个标准判定的8、9、10岁年龄组肿大率分别为33.7%(31/92)、23.3%(45/193)、21.0%(35/167)和14.1%(13/92)、6.2%(12/193)、7.2%(12/167);男孩和女孩的肿大率分别为27.1%(66/244)、21.6%(45/208)和7.4%(18/244)、9.1%(19/208);均有显著统计学差异。对照乡儿童甲状腺肿大率分别为14.0%(17/120)和4.2%(5/120),有显著差异(χ2=7.18,P=0.007)。结论判定高碘甲状腺肿大时,WHO甲状腺容积标准对我国儿童偏低。     

2006年和2007年浙江省淳安县碘缺乏病病情调查报告

目的 了解浙江省淳安县碘缺乏病病情,为因地制宜,科学补碘提供科学依据.方法 2006,2007年在淳安县选掸病情最重的3所小学(汪宅乡,屏门乡和文昌镇各1所小学),每所小学抽取90名8-10岁学生进行甲状腺B超检查,采集学生尿样测定尿碘,采集学生家庭食用盐样,定量检测盐碘.结果 2006年B超检查8-10岁儿童267人,甲状腺肿大(简称甲肿)率为7.5%(20/267),尿碘中位数为247.5μg/L,盐碘均数为32.7 mg/kg,2007年B超检查8-10岁儿童271人,甲肿率为3.7%(10/271),尿碘中位数为383.4μg/L,盐碘均数为33.5 mg/kg.2006年汪宅乡,屏门乡和文昌镇甲肿率分别为15.2%(14/92),6.0%(5/83)和2.2%(2/92).尿碘中位数分别为360.1,211.3,189.3μg/L,2007年汪宅乡,屏门乡和文昌镇甲肿率分别为6.6%(6/91),3.3%(3/90)和1.1%(1/90),尿碘中位数分别为388.6,411.5,327.8μg/L.2006年调查汪宅乡,屏门乡和文昌镇的人均年收入分别为1000,2000,3000元.结论 病情严重程度与经济状况,尿碘有关,营养因素在甲肿发生中的作用不容忽视,在营养水平较低的基础上,尿碘过高导致了较高的甲肿率.     

2002年河北省碘缺乏病监测报告

目的掌握河北省碘缺乏病病情与碘营养状况,发现可能存在的问题.方法监测点的选择采用单纯随机抽样方法.结果 1 200名学生的甲状腺肿大(甲肿)率为4.9%,按学生数加权后的甲肿率为5.15%,剔除2个高水碘监测点数据,加权后的甲肿率为4.7%;儿童尿碘中位数为246.2μg/L,＜100μg/L的样本数占16.9%,各年龄组儿童尿碘水平及频数分布差异均无显著意义.全省居民户碘盐覆盖率和合格碘盐食用率分别为97.3%,92.2%.水碘含量＜10μg/L的样本数占52.9%,＞300μg/L的样本数占5.7%.结论河北省8～10岁儿童碘营养状况良好,碘缺乏病病情稳定.     

1999年全国8～10岁儿童甲状腺容积调查

目的 分析1999年全国8～10岁儿童甲状腺容积的频数分布及其统计值,为建立有效的地方性甲状腺肿防治策略服务。方法 收集全国安例用B超法测定甲状腺容积,在中国地方病防治研究中心处理。结果 ①全国8～10岁儿童甲状腺容积统计值（ml）为,均数3.6、中位数3.4、众数3.0、95%分位数5.9、99%分位数7.9。②全国8～10岁儿童甲状腺容积95%分位数,男性依次为4.8,5.6,6.3ml,女性依次为5.2,5.8,6.5ml。③甲状腺容积地区差明显,按中位数计算最低上海1.2ml,居中安徽、山西3.7ml,居高重庆、贵州、新疆4.0ml。④对触诊法的适用性问题做了详细讨论,认为可用。结论 全国8～10岁儿童甲状腺容积地区差非常明显,原因未详。     

Thyroid volumes in schoolchildren of the Emirates

Iodine deficiency is a major public health problem, an enlarged goiter being its most apparent manifestation. Recent studies have used US as an accurate and precise method of measuring thyroid size. The aim of this study was to describe thyroid volumes measured by US among school-aged children in the United Arab Emirates. Cross-sectional studies were performed in 4,381 school children, aged 6-17 yr in three locations in the Emirates. Data were collected on age, sex, weight, thyroid size by palpation and US, and urinary iodine. Age/sex and body surface area (BSA) upper limits of thyroid volume were derived. Median urinary iodine in Abu Dhabi, Al Ain and in rural areas of Dubai were 9.9, 12.0 and 9.6 mg/dl respectively. The goiter prevalence by palpation was 28.1%, 26.4% grade 1 and 1.7% grade 2. There was significant difference in median and upper limit of thyroid volumes between boys and girls (p < 0.001). The thyroid volumes of subjects, as assessed by US, progressively increased with age for both sexes (r = 0.53, p < 0.001). In schoolchildren in the Emirates, the best predictors of thyroid volume were BSA, height and weight. The thyroid volumes of the children in this study appear comparable with those reported in a European survey in 1997.     

Assessment of goiter in an area of endemic iodine deficiency.

Urinary iodone (UI) excretion and sonographically measured thyroid volume were investigated in 195 subjects living in 6 separate villages in the Casamance region of southeastern Senegal, West Africa. A comparison of goiter prevalence using thyroid palpation and volume measurement and of iodine excretion expressed as micrograms per gram (microg/g) creatinine or micrograms per deciliter (microg/dl) urine was undertaken, and possible pathogenetic factors were investigated. Ultrasound measured thyroid volumes were above the recommended upper limit of the reference range for an area replete in iodine in 83.1% or females, 52.3% of males, and 80.0% of children aged 13 years or younger. Overall sensitivity and specificity for palpation compared to sonographically demonstrated thyroid enlargement was 51.7% and 91.5%, respectively. Thyroid enlargement was not associated with ethnic origin, thiocyanate ingestion, HLA DR/DQ phenotype frequency, or thyroid growth-stimulating immunoglobulin (TGI) positivity. Median UI was 32 microg/g creatinine with 65.0% having values consistent with iodine deficiency (< 50 microg/g). When results were expressed as micrograms per deciliter, the percentage having values consistent with iodine deficiency (< 5.0 microg/dl) increased to 95.7%. The findings suggest a primary role for iodine deficiency in goitrogenesis in the study population. They demonstrate that classification of the severity of the endemia in this or other study populations in areas of iodine deficiency is dependent on the methods used to determine goiter prevalence (palpation or ultrasound measured thyroid enlargement), or dietary iodine status (iodine excretion expressed as micrograms per gram creatinine or micrograms per deciliter urine).     

2007年重庆市璧山县与云阳县8～10岁儿童碘缺乏病病情分析

目的 了解重庆市璧山县与云阳县8～10岁儿童碘缺乏病病情.方法 选择重庆市璧山县、云阳县为调查县,采用多级整群随机抽样方法.每个县各抽取3所小学,检测8～10岁学龄儿童甲状腺肿大情况及尿碘、家庭食用盐含碘量,分析甲状腺肿大率与尿碘、盐碘的关系.结果 共调查556名儿童,触诊与B超法检查的甲状腺肿大率分别为10.79%(60/556)、9.53%(53/556),尿碘中位数为261.24 μg/L,盐碘中位数为34.11mg/kg;不同尿碘、盐碘水平下,儿童甲状腺肿大率比较差异无统计学意义(X~2值分别为0.9145、1.3453,P均>0.05).结论 重庆市璧山县与云阳县儿童尿碘水平偏高,可以考虑下调食盐加碘量.     

重庆市碘缺乏病高危地区重点人群碘营养状况调查与分析

目的 了解重庆市碘缺乏病高危地区重点人群碘营养状况,有针对性地提出防治对策.方法 2007年4-5月,在重庆市城口、巫溪县的6个乡(镇),搜索所有的1997年1月1日以后出生的疑似地方性克汀病(地克病)儿童;在每个乡分别抽取8～10岁儿童200人,进行甲状腺检查、智商测定和采集尿样测定尿碘;在每乡抽取妇女(孕妇和哺乳期)40人,进行家庭食用盐碘测定和调查居民碘盐覆盖率及采集尿样测定尿碘.儿童甲状腺检查采用诊法和B超法,智商测定采用<中国瑞文联合型测验>(CRT-RC2)农村版,尿碘测定采用酸消化砷铈分光光度法,盐碘测定采用直接滴定法.结果 城口、巫溪县乡镇医院报告疑似地克病6例,排除5例,另外1例为外地出生;8～10岁儿童甲状腺触诊法肿大率为9.58%(92/960),B超法肿大率为8.89%(65/731);儿童平均智商(IQ)为103.32,尿碘中位数为319.15 μg/L;妇女尿碘中位数为248.42 μg/L,居民碘盐覆盖率为98.82%(336/340).结论 重庆市城口、巫溪县儿童碘营养状况良好,未发现当地出生的新发地克病患儿;8～10岁儿童甲状腺肿大率和尿碘,妇女尿碘和居民碘盐覆盖率达到基本消除碘缺乏病标准.     

Thyroid volumes in schoolchildren of Tehran: comparison with European schoolchildren.

Since the normative values of thyroid volume ultrasonography results from European schoolchildren were endorsed by the World Health Organization (WHO), few studies have addressed the limitation of the recommended references as universal normative values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehranian schoolchildren and compare them with the WHO normative values. Cross-sectional studies were performed in 2016 schoolchildren, aged 6-15 yr, in Tehran 10 yr after distribution of iodized salt. Data were collected on age, sex, weight, height, thyroid size by palpation and ultrasonography, and urinary iodine. Age/sex and body surface area (BSA) upper limits (97th percentile) of thyroid volume were derived. The goiter prevalence was 42% by palpation, 31% grade 1 and 11% grade 2. Median urinary iodine was 21.2 microg/dl. The 97th percentiles were comparable in girls and boys of all ages. Applying the WHO thyroid volume references to the Tehranian children, they did not show any enlarged thyroid based on BSA and on age, even in 11% of children with grade 2 (visible) goiter. In the Tehranian children, the best predictors of thyroid volume were BSA, height and weight. Using linear regression, the 97th percentile of thyroid volume from Tehranian children were lower than the corresponding references from the WHO normative values. The results indicate that a thyroid volume reference based on weight alone would perform as well as the one based on BSA. In addition, until the adoption of a new applicable international reference for thyroid volume, the use of local reference in the screening of children for thyroid enlargement is recommended.     

Epidemiological survey of thyroid volume and iodine intake in schoolchildren,postpartum women and neonates living in Ulaan Baatar

OBJECTIVE: Although endemic goiter had been recognized in most parts of the country, there are few available data on iodine-deficiency disorders (IDDs) in Mongolia. This study aimed to characterize the current status of iodine deficiency in Ulaan Baatar, Mongolia's capital city. DESIGN: Cross-sectional, observational study designed and performed according to the surveillance methods for IDD prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS: A total of 505 schoolchildren aged 9-14 years (237 girls and 268 boys) and 138 mothers and their neonatal infants were selected to clinical and biochemical examination of the thyroid in 1996 and 1999. MEASUREMENTS: The anthropometric measurements, thyroid volume determined by ultrasound, blood TSH and FT4 concentrations, urinary iodine concentration and iodine content of salt consumed in households. RESULTS: Median thyroid volumes based on age were generally higher than those in iodine-sufficient areas and comparative to those reported in mild iodine-deficiency areas. Application of the updated WHO/ICCIDD reference values in iodine-replete European schoolchildren to the Mongolian children aged 10-12 years resulted in a goiter prevalence of 43.3%. The median value of urinary iodine concentration was 152.5 micro g/l (1.20 micro mol/l) and 40.3% of children excreted iodine below 100 micro g/l. Iodized salt (> 40 ppm) was consumed in 63.1% of households and in the children using noniodized salt their urinary iodine concentration was lower than those using ionized salt. In postpartum women, median thyroid volume and urinary iodine concentration were 11.3 ml and 107 micro g/l (0.84 micro mol/l), respectively, and 46% of women excreted less than 100 micro g/l (0.79 micro mol/l) of iodine. Of their neonates, 17.8% had elevated blood TSH levels (> 5 mU/l). In a 1999 survey, the goiter prevalence and ratio of low iodine excretion in schoolchildren decreased to 29.8% and 31.3%, respectively, while median urinary iodine concentration remain unchanged (160 micro g/l; 1.26 micro mol/l). CONCLUSION: The present study clearly indicates the presence of mild iodine deficiency in Mongolia. Enlarged thyroid gland and normal iodine excretion observed in schoolchildren living in Ulaan Baatar may result from the residual effects of iodine deficiency previously and presumably still exist in the city. Slight reduction in the rate of children with enlarged thyroid and low urinary iodine excretion after the onset of national iodinization programme suggests incomplete normalization of thyroid volume in children and that the correction of iodine deficiency is now in progress in Ulaan Baatar. Further nationwide surveys together with monitoring the progress of the national programme eliminating IDD are required in suburban areas surrounding the city and also in rural areas.     

贵州省黔南州供碘20年后8～10岁儿童碘营养状况和智力调查

目的 了解贵州省黔南州供碘20年后8～10岁儿童碘营养状况和智力水平.方法 对黔南州8～10岁儿童421名采用触诊法进行甲状腺检查,用酸消化砷铈接触法检测尿碘,用<中国联合型瑞文测验>进行智商(IQ)测定.结果 8～10岁儿童甲状腺肿大率为5.0%(21/421),尿碘中位数为331.2μg/L,8～10岁儿童IQ均值为93.32±18.68,不同碘营养水平的儿童IQ值比较,差异有统计学意义(P＜0.05).结论 食盐加碘后黔南州儿童的碘营养缺乏状况已得到纠正,8～10岁儿童尿碘水平、甲状腺肿大率已达到国家消除碘缺乏病标准,智力水平发育基本正常.     

重庆市普供碘盐5年防治碘缺乏病效果观察

目的 评价重庆市碘盐防治碘缺乏病的效果。方法 用直接滴定法检测居民户盐碘含量；用B超法和触诊法检查8～10岁儿童甲状腺，同时检查儿童尿碘含量。结果 5年碘盐覆盖率为90．08％～98．17％，合格碘盐食用率为83．00％～89．58％；触诊法和B超法检查8～10岁儿童甲状腺肿大率，1999年(23．75％和23．58％)均较1997年(18．33％和17．42％)显著升高，但甲状腺容积呈下降趋势；2002年8～10岁儿童甲状腺肿大率(14．18％和13．50％)和甲状腺容积均显著下降。结论 重庆市普供碘盐防治碘缺乏病2年病情无显著变化，5年效果显著。     

Normal values for thyroid ultrasonography, goiter prevalence and urinary iodine concentration in schoolchildren of the Veneto Region, Italy

Goiter prevalence in school-age children and median urinary iodine concentration (UIC) are the main indicators of iodine deficiency in a population. In areas of mild iodine deficiency, where goiters are small, ultrasound is preferable to physical examination to estimate goiter prevalence. The World Health Organization (WHO) has adopted thyroid volume ultrasonography results from a survey of European schoolchildren as an international reference, but these values have recently been questioned. The aims of the study were: a) to determine regional normal echographic reference values of thyroid volume in children aged between 11 and 14 yr in the Veneto Region, in North-East Italy; b) to determine goiter prevalence by physical and ultrasonographic examination; c) to determine UIC in this section of the population. A cross-sectional study was carried out on 1730 schoolchildren, aged between 11 and 14, living in towns in low-lying areas, in the valleys of the pre-Alps and in the mountains between 600 and 1200 m. Thyroid volume was evaluated by inspection and palpation using the WHO criteria. In 560 children thyroid volume was determined by ultrasound. UIC was measured in 1368 children. On physical examination a grade I goiter was found in 7.5% of children. No goiter grade II or grade III was found. The regional thyroid volume reference values by ultrasonography were similar, or slightly lower (5-20%), to the corresponding WHO reference values. Mean UIC was 148 +/- 110 microg/l, with no difference between lowlands and uplands; UIC values less than 100 microg/l were found in about 30-35% of the children. UIC was higher in children using iodized salt than in non-users. No correlation was found between thyroid volume by ultrasonography and UIC. Thyroid volume was found to be bigger in upland children than in those in low-lying areas, probably because of low iodine intake in people living in the mountains in previous generations. This data show that Veneto is not a iodine-deficient area, with no presence of endemic goiter. However, the great number of children with a UIC of less than 100 microg/l also suggests the use of iodized salt in the Veneto Region.