碘摄入量与甲状腺功能障碍关系的多因素分析

目的探讨碘摄入量和甲状腺功能障碍之间的关系.方法对轻度碘缺乏、碘超足量、碘过量三个碘摄入水平地区14岁以上成年人的流行病学调查资料进行多因素分析.结果Logistic回归显示,碘超足量、碘过量是亚临床甲减和临床甲减的独立危险因素(P＜0.05).碘过量时亚临床甲亢的患病危险减少,OR值为0.218(P＜0.05).引入碘摄入量与甲状腺自身抗体的交互作用后,碘过量仍然是亚临床甲减和临床甲减的独立危险因素(P＜0.01);碘超足量对临床甲减无显著影响,但使亚临床甲减的患病危险性显著升高(P＜0.01),并且其与TgAb的联合作用显著升高亚临床甲减和临床甲减的患病危险性(P＜0.05).结论碘摄入量增加有抑制甲状腺功能的趋势,碘超足量和碘过量使甲状腺功能减退症患病危险增加.     

青岛地区妊娠期妇女碘营养状况与甲状腺功能减退症的相关性研究

目的 研究青岛地区妊娠期妇女碘营养状况及其与甲状腺功能减退症的相关性.方法 随机选取妊娠妇女663例,检测空腹尿碘、血清TSH、FT4、甲状腺过氧化物酶抗体(TPOAb).结果 妊娠期妇女尿碘在2.50～3 366.00μg/L,尿碘中位数(MUI)为161.59μg/L,碘缺乏、碘足量、碘超足量、碘过量的比例分别为44.95％、34.09％、15.69％、5.28％;妊娠T2、T3期尿碘水平以及轻度碘缺乏的比例均明显高于T1期,差异有统计学意义(均P＜0.05);妊娠T2、T3期碘足量的比例低于T1期妇女,差异也有统计学意义(均P＜0.05);妊娠期临床甲减、亚临床甲减、低T4血症的患病率分别为0.60％、3.77％、6.49％,妊娠各期之间的患病率差异均无统计学意义(均P＞0.05);妊娠期TPOAb总阳性率为9.80％,碘缺乏组中亚临床甲减患者TPOAb的阳性率明显高于甲功正常组(P＜0.01),且TPOAb阳性组亚临床甲减的患病率明显高于TPOAb阴性组(P＜0.01).结论 青岛地区妊娠期妇女群体不存在碘缺乏,但有44.95％的妊娠妇女个体存在碘缺乏,随着妊娠期的延长,碘缺乏呈加重趋势;TPOAb阳性与妊娠妇女发生亚临床甲减相关.     

妊娠早期孕妇尿碘水平与甲状腺功能的相关性研究

目的 研究孕早期母体碘营养状况对甲状腺功能的影响。方法 选取199 例孕早期妇女作为研究对象，采用生化比色法测定尿碘，电化学发光法检测促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）及游离甲状腺素（FT4），研究母体碘营养状况与甲状腺功能的关系。结果 ①尿碘缺乏组、尿碘适量组、尿碘超足量组及尿碘过量组的构成比依次为59.3%、21.1%、9.5% 及10.1% ；②不同尿碘营养水平组甲状腺功能减退症（甲减）、亚临床甲减、甲状腺功能亢进症（甲亢）及亚临床甲亢的患病率比较，差异无统计学意义（P >0.05）；碘过量组低甲状腺素血症（低T4 血症）的患病率较高，差异有统计学意义（χ2=11.593，P =0.009）；③碘营养水平>500 μg/L 时，尿碘水平与TSH 呈正相关；④碘适量组FT3 水平高于碘过量组，差异有统计学意义（P <0.05），碘缺乏组、碘超足量组及碘过量组间差异无统计学意义（P >0.05）；不同碘营养水平组FT4 比较，差异无统计学意义（F =2.454，P =0.064）；碘过量组TSH 水平高于碘缺乏组、碘适量组及碘超足量组，差异有统计学意义（P <0.05）。碘缺乏组、碘适量组与碘超足量组间比较，差异无统计学意义（P >0.05）。结论 大部分孕早期妇女存在碘缺乏，应适量补碘，但应避免碘过量及碘缺乏。     

不同碘营养状况与亚临床甲状腺病的相关性研究

目的：分析不同碘营养状况与亚临床甲状腺疾病的相关性,以便掌握对该类疾病的临床特点与诊治方法。方法选取该院2011年4月-2012年4月期间于门诊接受健康体检的人群共69例,对其饮食习惯与膳食情况进行问卷调查。根据该地区的碘摄入量设置碘摄入正常范围,采用中位数法将其分为碘足量亚组和碘适量亚组,记录所有人每日碘摄入量与血清中甲状腺激素的水平,采用超声对其甲状腺进行检查,了解其碘营养情况与甲状腺超声改变、亚临床甲状腺疾病的关联。结果碘足量亚组TSH指标为(4.63±1.22)pmol/L,高于碘适量亚组差异有统计学意义(P<0.05);碘足量亚组FT3指标为(4.72±0.89)pmol/L,少于碘适量亚组差异有统计学意义(P<0.05);两组FT4指标差异无统计学意义(P>0.05);碘摄入量足量组平均结节数量为(3.0±1.5)个,甲状腺体积为(21.8±6.8)mL,均显著高于碘摄入量适中组差异有统计学意义(P<.05);碘足量组亚临床加减发生率为12.1%,亚临床甲亢发生率为2.0%,加工正常率为88.5%,均高于碘适量亚组差异有统计学意义(P<0.05)。结论碘的摄入超出正常范围,会抑制甲状腺功能,出现以亚临床甲状腺功能减退为主的功能异常症状,使甲状腺功能减退的患病率明显增加,碘过量时亚临床甲亢的患病危险减少。碘过量是亚临床甲减和临床甲减的独立危险因素。     

碘伏皮肤消毒对医护人员甲状腺功能影响的研究

目的　探讨长期应用碘伏做术前皮肤消毒对医护人员甲状腺功能和自身免疫状态的影响。方法　选择 119名长期应用碘伏做术前皮肤消毒的女性医务人员 ,以 12 3名同医院年龄配对的无碘伏接触史的女性医护人员作为对照。测定尿碘、促甲状腺激素 (TSH)、游离甲状腺素 (FT4 )、游离三碘甲状腺原氨酸 (FT3)、甲状腺球蛋白抗体 (TPO Ab)和甲状腺球蛋白抗体 (TG Ab) ,B超检查其甲状腺。结果　暴露组、非暴露组的尿碘中位数 (MUI)分别为 30 0 4μg/L和 2 6 9 1μg/L(P >0 0 5 ) ;甲状腺肿患病率分别为 3 4%和 2 4%(P >0 0 5 ) ;暴露组甲状腺疾病的总患病率显著高于非暴露组( 11 8%比 4 1%,P =0 0 2 6 ) ,各种甲状腺疾病的患病率与非暴露组相比都有增加的趋势 ,并尤以临床甲状腺功能亢进症 (甲亢 )和亚临床甲状腺功能减退症 (甲减 )为著。暴露组的临床甲亢患者多在应用碘伏 2～ 4年发病。暴露组的TPO Ab滴度均值显著高于非暴露组 ( 2 9 5IU/L比 2 2 4IU/L ,P =0 0 48)。结论　碘伏应用于术前皮肤消毒可能引起女性医护人员甲状腺疾病发病率增加。有碘伏暴露史的医护人员应当定期进行甲状腺功能和甲状腺自身抗体的检测。     

碘摄入量与甲状腺功能减退症调查研究

目的对确定甲减多发家系成员研究碘过量与甲状腺功能减退症的影响。方法57个甲状腺功能减退的多发家系,每个家系中要求两代中至少5人参加,受试者测定血清TSH、FT3、FT4和尿碘。结果甲减的发病率在尿碘水平500μg/L以下的各组间差异无显著性。尿碘水平500-599μg/L甲减的发病率显著升高与尿碘水平100-499μg/L间各组比较差异显著性。结论碘过量可引起临床、亚临床甲减的患病率增加。     

广州番禺地区妊娠早期妇女的碘营养与甲状腺功能

目的 研究广州番禺地区妊娠早期妇女碘营养情况与甲状腺功能的变化,为今后是否需广泛开展孕妇尿碘和甲状腺功能监测提供依据.方法 选择常住番禺地区的妊娠早期妇女2 794例,测定尿碘浓度(UIC)、血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb).结果 2 794例妊娠早期孕妇中,重度碘缺乏5.26%,中度碘缺乏12.67%,轻度碘缺乏20.15%,碘充足39.30%,碘过量22.98%,UIC的中位数为155 μg/L.临床甲状腺功能减退和亚临床甲状腺功能减退的患病率为0.93%和7.27%,TPOAb和TgAb的阳性率分别为9.62%和10.10%.碘缺乏者和碘过量者与碘充足者比较,TSH升高、甲状腺功能减退患病率、TPOAb阳性率增高,差异有统计学意义(P<0.05).TPOAb阳性率和亚临床甲状腺功能减退(甲减)的患病率与UIC减少和增多呈U型趋势.结论 广州番禺地区妊娠早期妇女仍有碘营养异常情况,碘缺乏及碘过量均增加发生亚临床甲状腺功能减退、甲状腺自身抗体阳性概率.应在妊娠早期广泛开展尿碘和甲状腺功能、甲状腺抗体的监测,早期发现、早期干预以保障孕妇和胎儿健康.     

妊娠妇女尿碘与甲状腺功能异常的初步研究

目的研究妊娠早期妇女碘营养及甲状腺功能,为指导孕期妇女补碘提供依据。方法选取2013年6月至2014年1月在南方医科大学附属小榄医院产科门诊行常规产前检查的1 851例妊娠早期妇女作为研究对象,收集尿液和采集空腹静脉血,采用砷铈催化分光光度法测定尿标本中碘含量,利用化学发光法测定促甲状腺激素(TSH)、游离甲状腺素(FT4)和过氧化物酶抗体(TPOAb)。结果 1 851例妊娠早期孕妇尿碘中位数为129μg/L,其中60.72%的孕妇处于碘缺乏状态,28.09%的孕妇处于碘适量,2.32%的孕妇碘过量。本组孕妇甲状腺异常总患病率为29.39%,其中低甲状腺素血症、甲减、亚临床甲减、甲亢、亚临床甲亢、甲状腺TPOAb阳性的患病率分别为24.37%、0.70%、0.81%、0.92%、2.59%、11.02%。尿碘水平异常与碘足量水平的甲状腺功能异常总患病率分别为30.73%和25.96%,差异有统计学意义(χ2=4.095,P=0.043),而二者的甲状腺功能异常个体患病率差异无统计学意义(P0.05)。尿碘水平异常与尿碘足量水平孕妇的TPOAb阳性率分别为10.74%和11.73%,差异无统计学意义(P0.05)。结论妊娠早期妇女60%以上存在碘摄入不足,尿碘水平异常孕妇的甲状腺功能异常的总患病率明显高于碘足量水平孕妇。     

妊娠合并甲状腺功能减退症的碘营养状态分析

目的:分析妊娠合并甲状腺功能减退症患者碘营养状态。方法:选取妊娠合并甲状腺功能减退症者268例,尿碘砷铈催化分光光度法检测空腹尿碘水平。结果:妊娠合并甲减患者尿碘水平为8.92~3125.45μg/L,尿碘MUI为179.46μg/L,其中碘重度、中度及轻度缺乏者分别占1.12%、3.36%、42.54%,碘缺乏者共占47.02%。碘适量、超足量及过量分别占比35.07%、11.94%、5.97%。T1、T2、T3期尿碘MUI分别为179.13、158.64及142.75μg/L。T3期中、轻度碘缺乏比例显著高于T1、T2期,T1、T2期碘适量比例显著高于T3期,T1期碘过量率显著高于T3期,差异均有统计学意义(P0.05)。妊娠合并临床甲减组高尿碘比例显著低于亚临床甲减组及低T4血症组,临床甲减组正常尿碘比例显著高于低T4血症组,差异均有统计学意义(P0.05)。结论:妊娠合并甲状腺功能减退症患者碘缺乏者较多,T3期碘营养水平较T1、T2期低,孕妇应定期进行碘水平检测,并依据其具体情况合理给予补碘。     

2型糖尿病患者中亚临床甲状腺功能减退症与慢性肾脏病的相关性分析

目的 探讨2型糖尿病患者中亚临床甲状腺功能减退症(SCH)与慢性肾脏病(CKD)之间的关系。方法 回顾性分析重庆医科大学附属第二医院内分泌科2012-01~2013-01间收治的991例2型糖尿病患者的病例资料。以促甲状腺激素(TSH)>5 m U/L(正常参考值为0.35-5 m U/L)并且游离三碘甲状腺原氨酸(FT3)与游离甲状腺素(FT4)在正常范围内定义为亚临床甲状腺功能减退症。比较亚临床甲状腺功能减退组与甲状腺功能正常组之间慢性肾脏病的患病率,行多因素回归分析来评估亚临床甲状腺功能减退症与慢性肾脏病的相关性。结果 991例2型糖尿病患者中,有126例(12.7%)患者存在亚临床甲减。亚临床甲减组与甲状腺功能正常组之间慢性肾脏病的患病率无统计学差异(P>0.05);在亚组分析中,严重的亚临床甲减组(TSH≥10 m U/L)中糖尿病肾病的患病率显著高于TSH在0.35-9.99 m U/L之间的患者(P<0.05)。多因素logistic回归分析结果提示在2型糖尿病患者中,严重亚临床甲减可增加慢性肾脏病的患病风险。结论 在2型糖尿病患者中,慢性肾脏病的患病风险在严重亚临床甲减人群中高于甲状腺功能正常及轻微的亚临床甲减人群。     

MULTIVARIATE ANALYSIS OF RELATIONSHIPS BETWEEN IODINE BIOLOGICAL EXPOSURE AND SUBCLINICAL THYROID DYSFUNCTIONS

Objective To assess the relationships between iodine biological exposure and subclinical thyroid dysfunctions. Methods The cross-sectional survey was performed to obtain the epidemiologic data of population in three communities with different iodine biological exposure： mild iodine deficiency [median urinary iodine concentration （MUI） of 50-99 μg/L], more than adequate iodine intake （MUI of 200-299 μg/L）, and excessive iodine intake （MUI over 300 μg/L）. Univariate and multivariate analysis （logistic regression analysis） were used to analyze the risk factors of subclinical hypothyroidism and subclinical hyperthyroidism. Logistic regression analysis with sex and age controlled suggested that more than adequate iodine intake （OR = 3.172, P = 0.0004） and excessive iodine intake （OR = 6.391, P = 0.0001） increased the risk of subclinical hypothyroidism, while excessive iodine intake decreased the risk of subclinical hyperthyroidism （OR = 0.218, P= 0.0001）. Logistic regression analysis including interaction of iodine intake and antibodies [tryroid peroxidase antibody （TPOAb） and thyroglobulin antibody （TgAb）] suggested that excessive iodine intake was an independent risk factor of subclinical hypothyroidism （OR = 6.360, P= 0.0001）, but independent protect factor of subclinical hyperthyroidism （OR = 0.193, P= 0.0001）. More than adequate iodine intake and it＇s interaction with TgAb increased the risk of subclinical hypothyroidism independently, in addition, it decreased the risk of subclinical hyperthyroidism at the present of TPOAb. Conclusion Both excessive iodine intake and more than adequate iodine intake could increase risk of subclinical hypothyroidism, supplement of iodine should be controlled to ensure MUI within the safe range.     

不同碘摄入量对农村学龄儿童甲状腺疾病及智商水平的影响

目的 了解不同摄入量地区儿童甲状腺功能和智商水平,探讨高碘对儿童的影响。方法 在低碘报 量的辽宁盘山地区[尿碘中位数（MUI）为99μg/L],中度碘摄入量的辽宁彰武地区（MUI为338μg/L）,高碘摄入量的河北黄骅地区（MUI为631μg/L）分别选择190、236和313名儿童进行中国联合型瑞文智力测验,对其中的116、110和112名儿童进行甲状腺功能,甲头腺自身抗体（TAA）和尿碘测定。结果 盘山、武、黄骅地区临床甲状腺功能亢进症（甲亢）、亚临床甲亢和临床甲状腺功能减低症（甲减）患病率比较差异无显著意义,但是亚临床甲减的患病率差异有显著意义（P＝0.001）,黄骅和彰武亚临床甲减患病率分别是盘山的4.76倍和3.37倍,所有这些亚临床甲减病人血清TAA除1例阳性外,其他均为阴性。甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGAb）阳性率3个地区之间比较差异无显著意义。黄骅地区血清甲状腺球蛋白（TG）值显著高于其他2个地区（P＝0.0157）,彰武高于盘山,但差异无显著意义。黄骅儿童智商值明显高于彰武（P＝0.0012）,盘山儿童智商值高于彰武,低于黄骅,但差异无显著意义。结论 高碘摄量使儿童患亚临床甲减的危险性增加,高碘地区儿童亚临床甲减多数是非自身免疫源性的。未发现高碘对儿童智力发育的影响。     

Effect of different iodine intake on schoolchildren’s thyroid diseases and intelligence in rural areas

Background Reports are increasingly appearing on the side effects caused by excessive iodine intake. Our objective was to find out whether iodine excess would impair the thyroid function and intelligence of schoolchildren in rural areas of China.Methods A comparative epidemiological study was made on thyroid function and intelligence of the schoolchildren in the areas of low, moderate or excessive intake of iodine. In the area of low intake of iodine ( Panshan, Liaoning province, median urinary iodine (MUI) was 99 μg/L), of moderate intake of iodine (Zhangwu, Liaoning Province, MUI was 338 μg/L) and of excessive intake of iodine (Huanghua, Hebei Province, MUI was 631 μg/L). The numbers of schoolchildren from each area selected to take part in a Chinese version of Raven‘ s Test were 190,236 and 313, respectively, and then 116, 110 and 112 of them were tested for thyroid function, thyroid autoantibody (TAA) and urinary iodine (Ul).Results There were no significant differences in the incidences of overt hyperthyroidism, subclinicalhyperthyroidism and overt hypothyroidism in Panshan, Zhangwu and Huanghua. But significantdifferences were found in the incidences of subclinical hypothyroidism (P=0.001 ) in these three areas. The incidences of subclinical hypothyroidism in Huanghua and Zhangwu were 4. 76 and 3.37 times higher than that in Panshan. TAP, were negative in all the schoolchildren with subclinicalhypot hyroidism except for one. No significant difference was found among the rates of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in these three areas. Mean serumthyroglobulin (TG) value of Huanghua was markedly higher than those of the other two (P=0.02).Mean serum TG value of Zhangwu was higher than that of Panshan but the difference was not significant. Mean IQ value of the schoolchildren in Huanghua was markedly higher than that for Zhangwu (P=0.001). Mean IQ value of the schoolchildren in Panshan was lower than that of Huanghua and higher than that of Zhangwu but, again, the differences were not significant.Conclusions The increase of iodine intake may increase the risk for schoolchildren of subclinical hypothyroidism. In the area of iodine excess, most of the subclinical hypothyroidism cases are not of autoimmune origin. No obvious effect of excess iodine was found on mental development of schoolchildren.     

成都市成人碘营养及甲状腺疾病患病情况的调查研究

目的 通过2016–2017年及2019–2020年两次人群调查,了解成都市甲状腺疾病患病率及碘营养状况及相关危险因素数据,为卫生行政决策提供依据。方法 分别于2016年10月–2017年12月、2019年12月–2020年2月进行人群抽样调查。第一次调查采用分层整群随机抽样方法,选择成都市城市和农村各2个社区居民为调查对象;第二次调查采用序贯整群抽样选择成都市龙泉驿区周边社区居民。两次均选择18岁以上符合入选标准的自然人群为调查对象,第一次进行问卷调查、体格检查、甲状腺超声、血清甲状腺功能和尿碘检查,第二次仅进行甲状腺疾病患病情况问卷及一般情况的调查。统计分析碘营养状况、甲状腺疾病患病率及可能的危险因素。结果 第一次纳入受试者1 859人、第二次纳入16 152人。第一次调查结果显示成人尿碘中位质量浓度为172.10μg/L,碘足量或超足量人群占调查人数60%以上。甲状腺疾病患病率：显性甲亢（0.48%）、亚临床甲亢（0.43%）、Grave’s病（0.43%）、显性甲减（1.34%）、亚临床甲减（16.62%）、甲状腺抗体阳性（16.73%）、甲状腺过氧化物酶抗体阳性（12.96%...     

Plasma CRP, apolipoprotein A-1, apolipoprotein B and Lpa levels according to thyroid function status

BACKGROUND: Altered lipid profile is a well-known manifestation of thyroid dysfunction. Recently, serum Lp(a) and C-reactive protein (CRP) have emerged as new cardiovascular risk factors, but studies on changes of these markers with respect to thyroid function status have produced variable results. To better understand the effects of thyroid dysfunction on the development of atherosclerosis, we investigated plasma CRP and lipid profiles such as apoA1, apoB, and Lp(a) in cases with differing severities of thyroid dysfunction. METHODS: Fifty four patients with hyperthyroidism, 35 patients with subclinical hyperthyroidism, 33 patients with overt hypothyroidism, 190 patients with subclinical hypothyroidism and 100 age- and sex-matched healthy control subjects were evaluated. Serum high sensitivity (hs)-CRP and Lp(a) were measured by immunonephelometry. RESULTS: No significant differences were found in serum hs-CRP, Lp(a), HDL-C or ApoA1 in different thyroid function groups. Serum total cholesterol and LDL-C levels were significantly lower in cases of hyperthyroidism than in cases of overt hypothyroidism, subclinical hypothyroidism or subclinical hyperthyroidism, or in healthy control subjects (p <0.01). Serum triglyceride levels were higher in overt hypothyroidism than in hyperthyroidism or healthy controls (p <0.05). Serum apoB levels were significantly lower in hyperthyroidism than in overt hypothyroidism, subclinical hypothyroidism or in healthy control subjects (p <0.01). These differences were consistently significant after adjustment for age and BMI. CONCLUSIONS: Serum CRP and Lp(a) levels, risk factors for atherosclerosis, were not found to be significantly affected by the degree of thyroid dysfunction. Increased risk of atherosclerosis in hypothyroidism does not appear to be associated with non-traditional cardiovascular risk factors, such as serum CRP, Lp(a) or apoA1 levels.     

Hypothyroidism and obesity. Cause or effect?

OBJECTIVE: To establish relationship between obesity and hypothyroidism and to analyze the frequency the frequency of primary hypothyroidism in obese patients and frequency of obesity in primary hypothyroidism patients. METHODS: We conducted this retrospective, observational study in the Department of Endocrinology and Obesity Clinic, Medwin Hospital, Hyderabad, India in Mar 2008. In the last 18 months (between September 2006 to February 2008), data on 625 consecutive primary hypothyroidism patients (Group I) and 450 patients from obesity clinic (Group II) were analyzed. Frequency difference between the 2 groups was assessed by Chi-square test. RESULTS: In Group I, 278/625 (44%) had body mass index (BMI) >25 kg/m2. Obesity was higher (46% versus 34%) in overt hypothyroidism than in subclinical hypothyroidism (p=0.21). More patients were overweight in overt hypothyroidism group than in subclinical hypothyroidism group (p=0.02). In obesity patients, overt hypothyroidism was present in 33% and subclinical hypothyroidism in 11% patients. CONCLUSION: Overall thyroid dysfunction was found more in obese individuals with varying degree of significance. Detailed studies are required to assess the cause and effect relation between obesity and hypothyroidism.     

成都地区居民甲状腺功能状况调查

目的:了解成都地区居民甲状腺疾病的发病情况。方法:随机抽取2014年6月至2015年5月四川大学华西医院健康体检中心进行健康体检的成都地区居民17 161名,按性别分为男性组(8 943名)和女性组(8 218名),按年龄分为青年组、中年组和老年组,根据不同分组进行比较甲状腺疾病的发病率。结果:甲减、亚临床甲减、亚临床甲亢、甲亢、桥本氏甲状腺炎(Hashimoto thyroiditis,HT)的发病率分别为0.68%、17.09%、0.41%、0.48%和17.76%。女性的甲减、亚临床甲减、亚临床甲亢、甲亢的发病率分别为0.92%、21.95%、0.63%、0.78%,均明显高于男性人群的0.46%、12.62%、0.21%、0.20%(均P<0.001)。女性青年、中年、老年组甲状腺功能异常的发病率分别为20.84%、26.78%、34.85%,且老年组甲状腺异常率明显高于中年和青年组(均P<0.05),老年组甲状腺异常发病率明显高于中年组和青年组(均P<0.05);男性青年、中年、老年组甲状腺异常的发病率分别为11.72%、11.85%、20.74%,且老年组甲状腺异常发病率明显高于中年组和青年组(均P<0.05)。HT患者中,TPOAb(+)Tg Ab(+)组甲减、亚临床甲减的发病率明显高于TPOAb(+)Tg Ab(-)组和TPOAb(-)Tg Ab(+)组发病率(均P<0.05)。结论:成都地区居民甲状腺功能紊乱的发病率较高,临床医师需注重对女性以及老年男性群体甲状腺功能的筛查,需同时注重对女性人群TPOAb、Tg Ab的筛查。对甲状腺功能正常的HT患者,需予以定期随访观察。     

Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction

BACKGROUND: Thyroid dysfunction may impair the quality of life (QoL) and may cause psychological symptoms. The aim of this study is to investigate prospectively the effects of thyroid dysfunction on quality of life, levels of depression/anxiety and the changes in these variables after treatment. METHODS: A total of 160 subjects, consisting of an overt hypothyroidism group (n = 33), a subclinical hypothyroidism group (n = 43), an overt hyperthyroidism group (n = 51), a subclinical hyperthyroidism group (n = 13), and a healthy control group (n = 20) were included in the study. All groups were evaluated with the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Short Form-36 (SF-36), and Brief Disability Questionnaire (BDQ). Health-related quality of life (HRQL) was measured by SF-36. RESULTS: Anxiety and depressive symptoms were more severe in patients with overt hypo- and hyperthyroidism (p <0.001). The QoL was worse in overt or subclinical hyper- and hypothyroidism groups than in the control group [p = 0.013 for physical composite score (PCS); p = 0.002 for mental composite score (MCS)]. Psychological symptoms and QoL were improved in overt and subclinical hypothyroidism and overt hyperthyroidism groups as a result of the treatment. The overt hyper- and hypothyroidism groups showed more improvement than the subclinical groups. CONCLUSIONS: This study suggests that restoration of euthyroidism is accompanied by improvement on QoL and psychological symptoms in all groups except the subclinical hyperthyroidism group. Controlled, randomized studies in larger groups are, however, necessary.     

缺碘补碘地区与高水碘地区女性亚临床甲状腺疾病检出率的比较

目的：通过对供应碘盐的缺碘地区与山西省停供碘盐的水源性高碘地区孕妇、哺乳妇女和育龄女性亚临床甲状腺疾病检出率的比较,分析2组人群在不同碘来源和碘营养水平下亚临床甲状腺疾病的患病情况,为碘相关甲状腺疾病敏感人群的筛检提供依据。方法：在我国6个省份选择缺碘补碘地区,调查当地孕妇、哺乳妇女、18~45岁育龄妇女3类人群,共991名;孕妇碘营养水平按<150、150～249、250～499和≥500 μg?L-1进行分组,哺乳妇女碘营养水平按<100和≥100　μg?L-1进行分组;在山西省选择高水碘地区,按水碘水平选择50~99、100~149、150~299和≥300 μg?L-1 4个地区,每个地区选择孕妇、哺乳妇女和育龄妇女各20名,共计241名。分别采集上述调查对象的血样和尿样,采用化学发光免疫测定法或放射免疫法测定血清学甲状腺功能指标,采用砷铈催化分光光度方法测定尿碘水平。结果：在碘缺乏地区和高碘地区,女性人群亚临床甲状腺功能减退症（亚临床甲减）和甲状腺抗体阳性的并发率分别为2.32%和4.98%,亚临床甲减患者中甲状腺抗体阳性人群约占1/3~1/2。碘缺乏地区和高碘地区女性人群亚临床甲状腺疾病的患病率分别为27.55%和34.85%,约占总女性人群的1/3。高水碘地区孕妇、哺乳妇女、18~45岁育龄妇女亚临床甲减检出率明显高于碘缺乏地区（P<0.05）;高水碘地区哺乳妇女甲状腺抗体阳性和亚临床甲减伴抗体阳性检出率明显高于碘缺乏地区（P<0.05）。不同碘来源下,当摄碘量适宜时,女性亚临床甲状腺疾病检出率比较差异无统计学意义（P>0.05）。随着碘暴露水平的增加,女性人群亚临床甲减和甲状腺抗体阳性患病率增加,二者的重合率也增加。孕妇碘营养<100 μg?L-1组低T4血症和总亚临床甲状腺疾病检出率均明显高于碘营养250~499 μg.L^-1组（P<0.05）,哺乳妇女碘营养<100 μg?L-1组低T4血症和总亚临床甲状腺疾病检出率均明显高于碘营养≥100 μg.L^-1组（P<0.05）。结论：在摄碘量适宜时,盐碘摄入碘与水碘摄入碘对亚临床甲状腺疾病的发生无影响;碘摄入量升高时,亚临床甲状腺疾病发病随之升高。