轻度碘缺乏城市食盐加碘后甲状腺疾病流行病学调查研究

 目的 评价轻度碘缺乏城市贵阳食盐加碘25年后的碘营养状态及各种甲状腺疾病的患病情况。
方法 采用分层整群抽样方法，抽取贵阳市云岩区宅吉社区20岁及以上居民1509人，测定其血清促甲状腺素（TSH）、游离T₃、游离T₄、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）水平、尿碘水平及甲状腺B超检查；同时抽取8~10岁学龄儿童80名，测定其尿碘水平。
结果 8~10岁儿童尿碘中位数为228.7 μg/L。成人临床甲状腺功能减退症（甲减）、亚临床甲减、临床甲状腺功能亢进症（甲亢）及亚临床甲亢的患病率分别为1.79%、14.12%、1.52%及1.06%，亚临床甲减的患病率显著高于临床甲减（P < 0.05）；TPOAb及TgAb的阳性率分别为14.38%及 13.59%，自身免疫性甲状腺炎的患病率为4.44%。甲状腺肿大患病率为1.06%，其中，弥漫性甲状腺肿（0.86%）较结节性甲状腺肿（0.20%）多见（P < 0.05）。
结论 食盐加碘25年后，贵阳市处于碘超足量状态，成人临床甲减、亚临床甲减、甲状腺自身抗体阳性及自身免疫性甲状腺炎的患病率均较高。

An epidemiological survey of the prevalence of thyroid diseases in mild iodine deficiency city after salt iodization

Objective To investigate the current status of iodine nutrition and the prevalence of thyroid diseases in Guiyang, a mild iodine deficiency city practiced salt iodization for 25 years. 
Methods A representative sample of 1509 adults aged 20 years old or above in Guiyang, selected by a multistage stratified sampling method, participated in the study. After an overnight fasting, serum thyroid hormones, serum thyroid autoantibodies, and urine iodine were measured. B-mode ultrasonography of the thyroid was performed in the population. Meanwhile，urine iodine of 80 children aged 8-10 years old in the same community were measured after an overnight fasting.
Results The median of 8-10 years old children′s urinary iodine was 228.7 μg/L. The prevalence of overt hypothyroidism, subclinical hypothyroidism, overt hyperthyroidism and subclinical hyperthyroidism was 1.79%, 14.12%, 1.52% and 1.06% respectively. The prevalence of subclinical hypothyroidism was significantly higher than overt hypothyroidism (P < 0.05) and was significantly higher in female than that in male (P < 0.05). The prevalence of positive thyroid peroxidase antibody, positive thyroglobulin antibody and autoimmune thyroiditis was 14.38%,13.59% and 4.44% respectively, which were significantly higher in female than that in male (all P values <0.05). The prevalence of diffuse goiter and nodular goiter was 0.86% and 0.20% respectively, with a significant difference (P < 0.05). 
Conclusion After 25 years of salt iodization, the iodine nutrition in Guiyang is more than adequate with high prevalence of overt hypothyroidism, subclinical hypothyroidism and autoimmune thyroiditis.