浙江省台州市椒江区人群碘营养状况研究

目的]了解浙江省台州市椒江区居民碘营养和甲状腺疾病状况。方法]2010年4—6月,采用横断面调查研究,分层整群抽样法,调查3个村311户居民,尿碘检查944人,甲状腺检查793人。B超法检查甲状腺,砷铈催化分光光度法测定尿碘浓度,化学发光免疫测定法检测甲状腺激素,直接滴定法检测盐碘含量。结果]检查793人,查出甲状腺结节182例,患病率为22.95%,甲状腺结节患病率随年龄增大而上升（χ2=72.12,P=0.001）;其中6~14岁组患病率为0.00%,≥15岁组患病率为25.60%,两组差异有统计学意义（χ2=27.24,P=0.001）;女性患病率（26.97%）明显大于男性（17.82%）（χ2=9.25,P=0.002）。调查8~10岁儿童31人,甲状腺肿大率为0.00%。尿碘〈100μg/L组甲状腺结节患病率大于≥100μg/L组（χ2=12.50,P=0.007）。标化患病率百果村为19.44%、高张村为26.43%、华景村为19.42%。944人尿碘中位数（median urinary iodine,MUI）为178.25μg/L,其中儿童185.85μg/L、孕妇138.50μg/L、哺乳妇女181.40μg/L、普通人群176.00μg/L,百果村184.40μg/L、高张村152.00μg/L、华景村192.00μg/L。孕妇33人中,甲状腺球蛋白抗体（thyroglobulinantibody,TgAb）和甲状腺过氧化物酶抗体（thyroid peroxidase antibody,TPOAb）阳性者2例,阳性率6.06%。在B超检查异常的178人中,游离三碘甲腺原氨酸（free triiodothyronine,FT3）升高者171例,占96.07%;游离甲状腺素（free thyroxine,FT4）和总甲状腺素（total thyroxine,TT4）均升高者178例,占100.00%;总三碘甲腺原氨酸（total triiodothyronine,TT3）升高者159例,占89.33%;促甲状腺素（thyrotropin,TSH）异常者11例（减低3例,升高8例）,异常率6.18%;TgAb和TPOAb阳性者27例,阳性率15.17%。调查311户中,碘盐覆盖率77.50%,碘盐合格率90.30%,合格碘盐食用率74.34%,盐碘均值28.74mg/kg。检测自来水9份,水碘中位数2.2μg/L。结论]椒江区人群碘营养处于适宜状态,孕妇碘营养不足,碘盐作为甲状腺结节的病因尚缺乏依据。

A Survey on Iodine Nutrition Condition of Residents in Jiaojiang District, Taizhou City, ZhejiangProvince

Objective ] To understand the prevalence of thyropathy among the residents of Jiaojiang District and relatediodine nutrition condition. Methods ] A cross-sectional design survey was conducted among residents of 311 households in 3 villages by stratified cluster sampling from April through June. A t.otal of 944 subjects were registered to urinary iodine test （arsenic-cerium catalyzed spectrophotometry） and 793 to type-B ultrasound thyroid examination. Other tests included chemiluminesent immunoassay for thyroid hormone and direct titration for iodine in table salt. Results I The thyroid nodule rate was 22.95% （182/793） and increased with age （x^2=72.12, P=0.001）. The difference of thyroid nodule rate between the 6-14 years group （0.00%） and the≥ 15 years group （25.60%） was statistically significant （x^2=27.24, P=0.001）, and that between female （26.79%） and male （17.82%） was also found statistically significant （x^2=9.25, P=0.002）. No enlarged thyroid was found in the 31 children （8-10-year-old）. The prevalence rate of thyroid nodule in the group of urinary iodine 〈100 μg/L was higher than that in the group of urinary iodine I〉 100μg/L （x^2=12.50, P=0.007）. The standardized prevalence rates in Baiguo Village, Gaozhang Village and Huajing Village were 19.44%, 26.43% and 19.42% respectively. The median urinary iodine （MUI） of all944 residents was 178.25 μtg/L, with 185.85 μg/L for the children investigated, 138.50 μg/L for the pregnant females, 181.40 μg/L for the lactating females, 176.00 μg/L for the general population, 184.40μg/L for Baiguo Village, 152.00 μg/L for Gaozhang Village and 192.00μg/L for Huajing Village. Among the pregnant females examined, 6.06% （2/33） were found positive in both thyroglobulin antibody （TgAb） and thyroid peroxidase antibody （TPOAb）. Among the 178 participants with B-type ultrasonic abnormalities, an elevated free triiodothyronine （FT3） was found in 171 cases （96.07%）; elevated free thyroxine （FT4） and total thyroxine （TT4） were found in 178 cases （100.00%）; an elevated total trii0dothyronine （TT3） in 159 case （89.33%）; thyrotropin （TSH） abnormality showed in 11 cases （3 reduced, 8 increased） （6.18%）; TgAb-positive and TPOAb-positive were found in 27 cases （15.17%）. The iodized salt coverage rate of the 311 households surveyed was 77.50%, of which 90.30% were qualified iodized salt, the consumption rate of qualified iodized salt was 74.34%, and the mean of iodine content in salt was 28.74mg/kg. Of the 9 tap water samples, the median of iodine content was 2.2 μg/L. Oonclusion ] The iodine condition is generally acceptable in Jiaojiang District, but not sufficient among pregnant women. The hypothesis regarding iodized salt as the cause of thyroid nodules is not supported by available evidences.