河北某水源性高碘地区成人甲状腺疾病的流行病学调查

目的：调查水源性高碘地区－河北省黄骅市歧口村、高头村≥14岁人群甲状腺疾病的流行状况，方法：入户问卷调查4230人的基础上，采样调查1074人，所有采样调查对象均详细填与甲状腺疾病调查表，接受体检查和B超检查，测定血清促甲状腺激素（TSH）、甲状腺自身抗体（TAA）和甲状腺球蛋白（TG），留取空腹尿样测量尿碘、TSH异常者测定甲状腺激素和TSH受体抗体（TRAb）。结果：采样人群的尿碘中位数为614．61μg/L。临床甲状腺功能亢进症（甲亢）和亚临床甲亢的患病率分别为1．21％和1．12％；临床甲亢中92．3％为Graves病所致，亚临床甲亢中75％TRAb阳性；回顾性分析普遍食盐碘化前后临床甲亢平均年发病率差异无显著性，临床甲状腺功能减低症（甲减）和亚临床甲减的患病率分别为1．96％和6．05％，患者TAA阳性率分别为85．71％和29．23％。采样人群甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGAb）阳性率分别为11．6％和9．3％。弥漫性甲状腺肿，结节性甲状腺肿、单发结节和多发结节的患病率分别为3．26％、2．61％、1．77％和6．4％。甲状腺癌病率为91．58／10万，结论：在尿磺中位数为614．61μg/L的碘营养状态下，甲状腺功能减退症和甲状腺癌患病率显著增高，提示这一碘摄入量并不安全。

An epidemiological survey of thyroid disorders in an area with high iodine content in water supply

OBJECTIVE: To investigate the status of thyroid disorders among people aged 14 years and older residing in Huanghua County, an iodine excess intake area in north China. METHODS: 4,230 people were asked to fulfill the questionnaire and 1,074 among them aged (36.97 +/- 12.83) years were accepted to be samples for the test. All subjects who were taken as samples needed to fill the questionnaire on thyroid disorders in detail, accept physical and ultrasound examination. Their morning fasting urine were collected for measurement of iodide concentration, and their sera were measured for thyroid-stimulating hormone(TSH, the third generation), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) and thyroglobulin (TG). If some people had abnormal TSH level, their free T4, free T3 and TSH receptor antibody(TRAb) were measured. RESULTS: The median level of urinary iodide of the sample subjects was 614.61 micrograms/L. The prevalence of clinical and subclinical hyperthyroidism was 1.21% and 1.12% respectively; 92.3% of the clinical hyperthyroidism were of Graves' disease and 75% of the subjects with subclinical hypothyroidism were TRAb positive. The average incidence of clinical hyperthyroidism was not different between 2 periods before and after general iodinization of table salt in this area (1991-1995 and 1996-2000). The prevalence of clinical and subclinical hypothyroidism was 1.96% and 6.05% respectively. All the clinical patients were female, among them 85.71% were TPOAb and/or TGAb positive, while only 29.23% of the subclinical patients were TPOAb and/or TGAb positive. Positive TPOAb and TGAb were seen in 11.6% and 9.3% respectively of the sample subjects with an age-related increase. Positive thyroid autoantibody was more common in the female and those with abnormal TSH. The prevalence of thyroid cancer during the period of 1994-2000 was 91.58/100,000. CONCLUSION: The high prevalence of hypothyroidism and thyroid cancer indicates that excessive iodine intake in this area is not safe.