郑州市碘缺乏病防治措施与效果评价

目的探讨郑州市碘缺乏病(IDD)综合性防治措施,评价防治效果,提出今后发展策略.方法通过回顾并分析郑州市几十年IDD防治工作历史资料.掌握郑州市IDD流行概况;研究探讨并系统总结IDD综合性防治措施,建立协调完善的防治工作机制;采用国家统一制定的IDD达标考核评估方法,客观评价郑州市IDD防治效果;在此基础上提出今后防治策略.结果①流行概况郑州市辖6区5市1县,是IDD流行较重的地区之一.70年代地甲病(碘缺乏病)普查,共查出病人18.5万人,克汀病病人94例,患病率达11.86%,病区分布在荥阳、新密、巩义、新郑、登封5市43个乡镇928个行政村,病区总人口达152万人.20世纪90年代IDD病情调查,发现居民生活饮用水碘含量4.17～9.37μg/L,7～14岁儿童甲状腺肿大率为17.16%,儿童尿碘中位数38.87μg/L.表明全市因外环境缺碘导致碘营养不良普遍存在,所辖6区5市1县均为缺碘地区;②防治措施坚持以食盐加碘为主的综合性防治措施,市、县、乡、村4级联动,行政、法律、经济手段三管齐下,狠抓防治措施落实.首先,加强组织协调,建立政府领导、部门协作,社会参与的工作机制.表现为一是市政府制订下发<郑州市2000年消除碘缺乏病规划纲要>,对地方病防治工作实施目标管理责任制,从而调动基层政权参与管理、监督和防治的积极性;二是建立政府主管领导下病区调研和部门协调议事制度,及时解决防治工作中出现的实际问题;三是各级政府每年都将IDD防治经费列入同级财政预算,保证专款专用;四是建立健全市、县、乡、村4级防治网络,形成上下贯通的IDD防治服务体系;第二,加强法制建设,强化碘盐管理,确保合格碘盐有效供应.根据国家相关政策法规,结合我市不同时期的具体情况,市政府制订出台<郑州市盐业市场管理办法>等地方性法规,下发规范性文件,建立食盐专营体制和碘盐供销责任制;卫生、盐业管理部门加强碘盐质量监测,加大市场稽查力度,确保合格碘盐有效供应,1995-1999年全市定量监测碘盐17 505份,合格率98,07%;第三,坚持"防、治、研"相结合的方针,加强IDD防治科研和病情监测工作,为制定防治策略提供科学依据;第四,深入开展宣传和健康教育工作,动员社会各界积极参与消除IDD工作;③防治效果全市IDD病情得到有效控制,8～10岁学生甲肿率(B超法)降至4.38%,人群尿碘中位数达282.1μg/L,碘盐合格率为97.13%(其中盐库99%,销售点98.67%,居民用户96.38%),1999年河南省IDD评估组认定我市已实现消除IDD阶段目标.结论郑州市经采取以食盐加碘为主的综合防治措施,已实现消除IDD阶段目标,应采取有效策略以实现可持续发展目标.     

加碘方糖防治学龄儿童碘缺乏病的实验观察

加碘方糖防治学龄儿童碘缺乏病的实验观察@徐也睛$新疆地方病防治研究所!新疆乌鲁木齐830002 @古丽娜$新疆地方病防治研究所!新疆乌鲁木齐830002 @蒋继勇$新疆地方病防治研究所!新疆乌鲁木齐830002 @徐晶$新疆地方病防治研究所!新疆乌鲁木齐830002加碘方糖;;碘缺乏病;;学龄儿童     

克拉玛依市独山子区碘缺乏病防治措施与效果

为检验食用加碘盐和肌注碘油防治地方性甲状腺肿的效果,于１９９６年和１９９８年两次对克拉玛依市独山子区７－１４岁学龄儿童进行补碘前后甲状腺肿大情况调查。结果显示：防治前后甲状腺肿大率分别为２９．７％和１７．３０％;食用加碘盐和以食用碘盐为主并辅以肌注碘油组治疗甲状腺肿大有效率分别为６４．７％和８０．９％。通过全民食用加碘盐并科学合理地使用碘油可以有效地纠正居民的碘营养缺乏状况。     

吐鲁番地区农村碘缺乏病危害及防治措施探讨

吐鲁番地区自然环境严重缺碘，土碘约２０μｇ／ｋｇ，水碘仅３～４μｇ／Ｌ。这里岩盐、湖盐、滩盐等土盐资源丰富，分布广，多数农村居民食用土盐或以食用土盐为主。食用土盐的８～１０岁儿童，平均尿碘为４５．６μｇ／Ｌ，平均吸碘率为６３％，触诊法检查甲状腺肿大率为７１．７％，Ｂ超法检查甲状腺体积平均为１０．２ｍｌ；食用土盐为主，仅部分或少量食用加碘盐的８～１０岁儿童，触诊法检查甲状腺肿大率为３６．６％；试用加碘器土盐水加碘防治碘缺乏病，试验区农村居民正确使用率高达９０％，推广难度不大，试用３个月后，食用土盐的儿童的平均尿碘上升到１９４．７μｇ／Ｌ，甲状腺体积平均缩小了１．６ｍｌ，防治效果良好。建议在继续推广加碘盐的同时，尽快实施土盐水加碘防治ＩＤＤ，加强组织领导，健全推广措施，充分调动各有关单位和人员的积极性，实现消除ＩＤＤ的目标     

山东省防治碘缺乏病健康教育问卷调查

1999年结合全国防治碘缺乏病监测工作,通过PPS抽样法对全省30个监测点共计600名小学5年级学生和150名家庭妇女进行了防治碘缺乏病基本知识问卷调查,结果显示学生组平均得分80分,522人及格及格率为87%,通过老师授课和看电视听广播,大多数学生对碘缺乏病有足够的认识,但也有部分学生还不知道吃加碘盐的重要性,也不知道缺碘对智力的损害,家庭主妇组的平均得分为78分,115人及格,及格率为77%,大部分妇女对碘缺乏病的第一认识是“大脖子”,对智力的损害认识不足,部分人在加碘盐的购买和使用中也存在认识不清和方法不当的问题,说明防治碘缺乏病的健康教育工作应持续进行同时注重工作力度和针对性。     

新疆碘缺乏病防治现状与主要措施分析

新疆地处欧亚大陆腹地,受地理与气候的影响,土壤、水的含碘量均较低,环境严重缺碘,是全国碘缺乏病(IDD)流行与危害最严重的省区.新疆16个地(州、市)96个县(市、区)844个乡(镇)均有碘缺乏病流行,甲状腺肿大率高达45.6%,因碘缺乏病造成的智力残疾占智力残疾总数的80%.碘缺乏病严重影响新疆人口素质的提高和经济发展.     

青海省环湖地区碘缺乏病监测结果及防治措施探讨

本文报告了环湖地区６县１９９６年碘缺乏病情监测情况，结果甲状腺肿大率为２２．９２％，碘盐合格率为５４．１５％，尿碘中位数为９５．６μｇ／ｌ，均低于国家消除碘缺乏病的标准，病情仍比较严重。因此，今后要加大防治知识的宣传力度，杜绝原盐对市场冲击，提高农牧民对碘缺乏病的认识，增强自我保健意识。     

陕西省碘缺乏病防治现状

为了及时准确的了解陕西省碘缺乏病的流行和防治现状,建立可持续消除碘缺乏病的有效工作机制,我们就全省1995-1999年的3次碘缺乏病病情监测和人群碘营养状况进行分析,现将结果报告如下.     

浅谈我国碘缺乏病防治成效与今后的策略

目的：总结碘缺乏病防治经验，分析存在的的问题，提出今后的防治策略。方法：应用全国碘缺乏病监测资料及重庆市有关调查资料进行分析。结果：2002年，8—10岁儿童甲状腺肿大率触诊法和B超法，全国分别为6．50％和6．18％，重庆市分别为14．18％和13．5％，与1999年相比，全国下降27．94％和25．90％，重庆市下降40．29％和42．75％；居民碘盐覆盖率和合格碘盐食用率有所提高或稳定；全国及重庆市均存在病情较重和碘盐食用率低以及非碘盐地区。结论：防治工作取得显著成效，也存在突出的问题，围绕提高合格碘盐食用率，巩固成果，采取相应防治策略。     

山东省碘缺乏病防治监测情况

山东省是全国碘缺乏病危害最严重的省份之一，据初步调查，碘缺乏地区分布在全省99个县（市、区），受威胁人口达6200多万，占全省总人口的70％以上。近年来，在省委、省政府的领导下，狠抓落实以食盐加碘为主、补服碘油为辅的综合性防治措施，碘缺乏病防治工作取得了阶段性成果。截止目前，全省（除少数高碘地区）基本实现了全民食盐加碘，合格碘盐入户率、特需人群碘油补服率和重点人群防治常识普及率均达到85％以上，8～10岁儿童甲状腺平均肿大率降至10％，安匠等12个示范县（市、区）经省级考核率先达到了国家规定的消除碘缺乏病标准。…     

Comparative screening for thyroid disorders in old age in areas of iodine deficiency, long-term iodine prophylaxis and abundant iodine intake

OBJECTIVE The bisphosphonates have proven efficacy in the management of post-menopausal osteoporosis. However, the benefits of prolonged (<2 years) administration and the effects of discontinuation of bisphosphonate treatment are not clear. DESIGN We have previously reported a 2-year, randomized, double-blind, placebo-controlled trial of pamidronate therapy (150mg/day) in women with established post-menopausal osteoporosis. We now report the bone mineral density (BMD) changes in those women who continued for a third year of active treatment and were then observed off therapy for a further 12 months. PATIENTS Twenty-two women (mean age 66 years) continued on pamidronate in year 3, and in 16 of these the effects of subsequent discontinuation of therapy for 12 months were studied. MEASUREMENTS BMD was measured in the total body, lumbar spine and proximal femur using a Lunar DPX-L dual-energy, X-ray absorptiometer. RESULTS The third year of therapy with pamidronate was associated with a significant further gain in BMD only at the lumbar spine (2.1±0.8%, P=0.003), resulting in a total gain of 9.5±1.0% at that site over 3 years of treatment. In the total body, BMD tended to decline (?0.6±0.3%) in year 3. One year after discontinuation of pamidronate, there were significant losses of BMD in the total body (?1.9±0.3%, P<0.0001) and femoral trochanter (?2.7±0.9%, P=0.01), and non-significant changes at the lumbar spine (?0.9±0.8%), femoral neck (?0.5±1.6%), and Ward's triangle (?2.9±3.7%). By the end of one year off therapy, BMD was greater than baseline only in the lumbar spine (71±1.1%, P<0.0001) and femoral trochanter (4.5±1.88%, P<0.03). In the total body, BMD was 0.3±0.7% below the values at the trial’s inception (P=0.7). CONCLUSIONS These data demonstrate that the rate of bone gain associated with bisphosphonate use slows over time, and that significant bone loss follows withdrawal of these agents. These findings have important implications for the duration of use of these novel drugs in the therapy of osteoporosis and suggest a need for close observation following their discontinuation.     

Thyroid volumes and urinary iodine in Swiss school children, 17 years after improved prophylaxis of iodine deficiency

Salt iodine content in Switzerland was raised from 7.5 to 15 mg per kg in 1980, and since then dietary iodine intake has been considered to be sufficient, even though a slight decrease due to imported food has recently been reported. The aim of this study was to establish normal values for thyroid volumes of school children who can be assumed to have had a sufficient iodine intake all their lifetime. Moreover. the present investigation was undertaken to verify that iodine sufficiency had been achieved equally in two regions each served by one of the two Swiss salt producers. Mean iodine concentration in urine spot samples from school children was 16.1 microg/dl, and it was identical in both the city of Lausanne (n=215) and the city of Solothurn (n=208). Thus it can be stated that in both cities (served by two different salt producers) iodine intake is equal and sufficient. Accordingly, thyroid volumes measured by ultrasound in school children aged 6 to 16 years were the same in both Lausanne (n=202) and Solothurn (n=207). Moreover, the age-adjusted median volumes at the 97th percentiles closely agree with and validate provisional international reference values recently proposed by the World Health Organisation and by the International Council for Control of Iodine Deficiency Disease.     

山东省碘缺乏地区学龄儿童碘营养状况评估

目的掌握山东省碘缺乏地区儿童碘营养动态状况以评估全民食盐加碘措施效果和消除碘缺乏病进程。方法按照卫生部1995、1997、1999和2002年的监测方案分别进行碘缺乏病相关指标抽样调查。结果4次监测的居民户碘盐覆盖率分别为49.2%、84.0%、87.1%和93.0%,盐碘含量中位数分别为0 mg/kg、23.3 mg/kg、28.6 mg/kg和29.0 mg/kg。儿童尿碘中位数及>100μg/L的比例分别为234.1μg/L和75.8%、453μg/L和96.7%、267.3μg/L和86.5%、200.1μg/L和82.5%。儿童甲状腺肿大率触诊结果分别为26.3%、7.6%、13.2%和5.7%,B超结果后3次分别为7.6%、7.8%和1.6%。新生儿脐带血TSH>5 m IU/L的比例前3次分别为26.3%、27.7%和28.9%。结论山东省碘盐覆盖率逐年提高,儿童尿碘水平在正常范围内,甲状腺肿大率逐年降低。全民食盐加碘措施成效显著,儿童碘营养水平良好,应由碘缺乏病病情监测转变为碘营养监测。     

沿海碘缺乏地区食盐加碘后7～15年甲亢住院率变化

目的观察沿海轻度碘缺乏地区实施全民食盐加碘(USI)措施后7～15年甲亢住院率的变化。方法采用回顾性调查方法查阅医院甲亢患者的住院病历,收集相关信息资料。结果甲亢住院率从USI后第7年的2.20/10万波动性上升为USI后第13年的5.46/10万(最高峰),接着下降为USI后第14年的4.70/10万,最后再上升为4.78/10万。结论连云港市实施USI后7～15年甲亢住院率呈现波动性上升趋势。     

山东省碘缺乏地区重点人群碘营养调查

目的 了解山东省当前盐碘水平状态下,碘缺乏地区重点人群碘营养状况及防治措施落实情况,为今后防治工作提供依据.方法 2007年,在山东省碘缺乏地区选择山区的岱岳、蒙阴,平原的莒县、高密,沿海的招远,共5个县(市、区)作为调查地区,在每个县(市、区)选择1个乡(镇)作为调查点.采用触诊、B超法进行8～10岁儿童甲状腺检查,直接滴定法检测其家中食用盐含碘量;砷铈催化分光光度法检测8～10岁儿童、孕妇、哺乳期妇女、2岁内婴幼儿及20～45岁育龄妇女5种重点人群的尿碘水平.结果 共检查514例8～10岁儿童甲状腺,触诊甲状腺肿大率为1.8%(9/514),B超检查甲状腺肿大率为1.2%(6/514);共检测501份食用盐,盐碘均值为30.95 mg/kg,碘盐覆盖率为94.6%(474/501),合格碘盐食用率为90.4%(453/501);共检测1707份尿样,尿碘中位数为216.7μg/L,8～10岁儿童、孕妇、哺乳期妇女、2岁内婴幼儿及20～45岁育龄妇女尿碘中位数分别为234.0、165.5、162.4、257.5、233.0μg/L.结论 山东省碘缺乏地区重点人群碘营养水平处于适宜或较适宜状态.表明目前盐碘水平能够满足山东省不同碘缺乏地区人群对碘的需求.

Abstract：

Objective To learn the iodine nutritional status of the vulnerable population with different iodine level under the current level of iodized salt in Shandong province and to offer prevention and cure measures.Methods Five groups of vulnerable population including school children aged 8 - 10, pregnant, lactation women, infants and women of childbearing age from mountain areas ( Daiyue, Mengyin counties ) , plain ( Luxian,Gaomi counties ) and coastal (Zhaoyuan county ) of five different iodine deficient areas were investigated in 2007.The thyroids of children aged 8 - 10 were checked by palpation and B ultrasound, their edible salt iodine level was detected by direct titration. The lever of urinary iodine of vulnerable population was examined by arsenic and cerium speetrophotometry. Results The goiter rates of 8 - 10 year-old were 1.8%(9/514) and 1.2%(6/514), respectively by palpation and B-ultrasonic. The mean iodine of 501 edible salt samples was 30.95 mg/kg. The coverage rate of iodized salt was 94.6% (474/501). The rate of qualified iodized salt was 90.4% (453/501). The median of urinary iodine was 216.7 μg,/L. The urinary iodine of school children aged 8 - 10, pregnant, lactation women, infants and women of childbearing age were 234.0, 165.5, 162.4, 257.5, 233.0 μg/L, respectively. Conclusions Current iodine nutritional level is basically appropriate in all groups of vulnerable people. The current iodine content of iodized salt could meet the needs of population from different iodine deficient areas of Shandong province.     

Silent iodine prophylaxis in Western Europe only partly corrects iodine deficiency; the case of Belgium

OBJECTIVE: Belgium is one of the Western European countries in which no program of iodine-deficiency correction using iodized salt has been implemented, in spite of well-documented mild iodine deficiency. In 1995, the median urinary iodine concentration was 55 microg/l (normal: 100-200) and the prevalence of goiter was 11% (normal: below 5%) in representative samples of schoolchildren aged 6-12 years. Based on these results, the authors of the present study and others had emphasized to health professionals and to the public the necessity for iodine supplementation. The objective of this study was to evaluate as to whether these efforts had resulted in an improvement in the status of iodine nutrition. DESIGN: We performed a national survey of the status of iodine nutrition in Belgium based on the determination of thyroid volume, obtained by ultrasonography, and urinary iodine concentrations in schoolchildren. METHODS: A mobile van equipped with an ultrasound instrument, a computer and a deep-freeze visited 23 schools selected from across the country. The sample included 2855 schoolchildren (1365 boys and 1490 girls) aged 6-12 years. RESULTS: The results show a homogeneous situation in the whole country, with a median urinary iodine concentration of 80 microg/l and a goiter prevalence of 5.7%. Urinary iodine slightly decreases with age in girls and reaches a critical value of 59 microg/l at the age of 12 years, together with a goiter prevalence of 18.4%. CONCLUSION: Iodine nutrition has improved slightly in Belgium but mild iodine deficiency continues, with public-health consequences. The improvement indicates silent iodine prophylaxis, as no official salt-iodization measures have been taken. Silent iodine prophylaxis only partly corrects iodine deficiency in Western Europe. Active measures, including the implementation of a program of salt iodization, are urgently required.     

山东省碘缺乏地区居民饮水含碘量调查

Objective To look into the current distribution of iodine deficiency area in Shandong province and to guide the re-defined iodine deficiency area and to supplement iodine scientifically. Methods In 2008, 100 iodine deficiency counties(cities, districts), designated in Shandong province's "to supplement iodized salt to eliminate the hazard of iodine deficiency management regulations", were selected in the study. One to three samples were collected from water source which was used by the majority of local residents in the 100 iodine deficiency places and iodine concentration was tested by As3+-Ce4+ catalyzing spectrophotometry. Results A total of 65 716 water samples were collected. Sample recovery efficiency reached 99.8%(65 572/65 716). The median water iodine was 5.57 μg/L, with 82.05%( 1097/1337 ) of the township(town) met criteria for the classification of iodine deficiency areas(water iodine ＜ 10 μg/L), 17.43%(233/1337) of the township (town) water iodine moderate(water iodine 10 - 150 μg/L), and 0.52%(7/1337)of the township(town) should be defined high iodine areas(water iodine ＞ 150 - 300 μg/L). Conclusions The iodine deficiency areas should be redefined because water iodine concentrations of iodine deficiency areas have changed. We suggest that the smallest place to supply salt with different range of iodine content is set to the township(town).     

山东省碘缺乏地区居民饮水含碘量调查

目的 了解山东省碘缺乏地区居民饮水含碘量分布现况,指导碘缺乏地区的重新划定及科学补碘措施的实施.方法 2008年以<山东省实施〈食盐加碘消除碘缺乏危害管理条例〉办法>划定的100个碘缺乏县(市、区)作为调查范围,以自然村为调查单位,采集1～3份饮用人数最多的水源样品,用砷铈催化分光光度法检测水碘.结果共收集水样65 716份,回收样品有效率达到99.8%(65 572/65 716),水碘中位数为5.57μg/L.有82.05%(1097/1337)的乡(镇)符合碘缺乏地区划分标准(水碘＜10 μg/L),17.43%(233/1337)的乡(镇)水碘适中(水碘10～150μg/L),0.52%(7/1337)的乡(镇)为高碘地区(水碘＞150～300μg/L).结论碘缺乏地区居民饮水含碘量发生改变,需进行重新界定;建议不同含碘量食盐供应范围最小单位设定为乡(镇).     

不同地区孕妇缺碘状况及干预补碘效果的调查研究

目的研究新疆生产建设兵团3个不同地区（轻度、中度、重度缺碘地区）4组孕妇碘营养水平,及采取干预补碘前后尿碘的变化,分析评价干预效果。方法选择碘盐覆盖率、尿碘水平不同的三类缺碘地区,调查孕妇服碘化油胶丸前后的尿碘水平。结果干预前4组孕妇的尿碘中位数分别为119.90、147.20、214.00和167.10μg/L,尿碘值〈100μg/L的比例分别是30.0%、4.3%、42.9%和20%;干预后1个月4组孕妇中位数分别为172.25、148.70、164.50和229.80μg/L;尿碘值〈100μg/L的比例分别是25.0%、22.2%、19.5%和0;干预后3个月中位数分别为150.00、103.60、176.60和219.60μg/L;尿碘值〈100μg/L的比例分别是25.0%、47.8%、13.8%和13.8%;干预后6个月中位数分别为119.90、147.20、214.00和167.10μg/L;尿碘值〈100μg/L的比例分别是25.0%、15.4%、13.8%和0;干预后9个月中位数分别为173.95、185.20、208.50和262.21μg/L;尿碘值在〈100.0μg/L的比例分别是21.9%、10.3%、26.1%和0。结论干预补碘可以使缺碘地区的孕妇尿碘中位数向高值偏移,能明显改善碘缺乏地区碘营养状况;在中度缺碘地区的孕妇用较小剂量200mg能满足自身的碘需求,在重度缺碘地区的孕妇用较大剂量400mg能满足自身的碘需求,特别是在干预后1个月、3个月,干预措施对尿碘的升高影响明显。