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水源性高碘摄入对学龄儿童甲状腺功能和甲状腺疾病的影响

ISSN号：1001-1889
期刊名称：《中国地方病防治杂志》
时间：0
分类：R581[医药卫生—内分泌;医药卫生—临床医学;医药卫生—内科学]
作者机构：[1]山东省地方病防治研究所,山东济南250014, [2]天津医科大学内分泌研究所
相关基金：山东省卫生科技发展计划项目（HW094）; ICCIDD资助项目; 国家自然科学基金重点项目（30230330）

作者：郭晓尉[1], 刘源[1], 翟丽屏[1], 黄居梅[1], 王健[1], 朱文澍[1], 陈祖培[2]

关键词：高碘, 碘营养, 促甲状腺素, 甲状腺激素, 甲状腺肿, 亚临床甲状腺功能减退症, Iodine excess, Iodine nutrition, Thyrotropin, Thyroid hormone, Goitre, Subclinical hypothyroidism

中文摘要：

目的探讨高碘摄入对儿童甲状腺功能和甲状腺抗体及甲状腺疾病的影响。方法在3个高水碘浓度的村庄对学龄儿童进行流行病学调查和样本采集。触诊甲状腺,检测饮用水碘含量和尿碘水平,测定垂体-甲状腺激素（TSH、FT3、FT4）水平和甲状腺自身抗体（TPOAb、TGAb）水平。结果 3个调查点的水碘中位数分别156.95μg/L、241.26μg/L和433.63μg/L;MUI为319.30μg/L、473.17μg/L和764.17μg/L;TSH为3.22 mU/L、4.27 mU/L和3.27 mU/L;FT3为6.00 pmol/L、5.83 pmol/L和5.96 pmol/L;FT4为17.29 pmol/L、17.62 pmol/L和16.36 pmol/L。TSH水平在水碘241.26μg/L、UI为200～299μg/L即超过适宜量情况下较高。3个调查点TSH高于正常值上限的异常率分别为18.2%、36.1%和14.7%;FT3分别为21.2%、5.6%和14.7%;TSH和FT3均无检测出低于正常值下限的。103名被检者的TGR为18.4%,发现亚甲减患者24例,亚甲减检出率为23.3%。100～199μg/L尿碘组无亚甲减患者,200～299μg/L尿碘组亚甲减检出率43.7%,≥300μg/L组的检出率20.7%。TPOAb、TGAb阳性率各为2.1%。结论水源性高碘摄入可导致高碘性甲状腺肿流行,引起部分机体甲状腺功能异常,造成亚甲减发病率升高。建议对此开展深入研究。

英文摘要：

Objective To understand thyroid function and thyroid autoantibody among the school-age children in high water iodine area and explore the influence of excess iodine intake on their health.Methods Epidemiological investigation of the children was conducted at 3 areas（A,B,C） which were different high water iodine villages.The samples of dinking water,urine and venous blood were collected from 103 subjects chosen randomly.The levels of TSH,FT3,FT4,TPOAb and TGAb in serum were measured.In addition,goiter and thyroid diseases were examined and recorded in detail.Results The median of iodine concentration of 3 areas was 156.95 μg/L,241.26 μg/L and 433.63 μg/L in water;319.30 μg/L,473.17 μg/L and 764.17 μg/L in urine.The median of urinary iodine（MUI） of all subjects was 472.72 μg/L.The ratio of samples with urinary iodine（UI） more than 300μg/L was 79.6%.The areas were two kinds of iodine intake： more than adequate iodine（A） and excessive iodine（B,C）.The level of serum TSH in 3 areas was 3.22 mU/L,4.27 mU/L and 3.27 mU/L;of FT3 was 6.00 pmol/L,5.83pmol/L and 5.96 pmol/L;of FT4 was 17.29 pmol/L,17.62 pmol/L and 16.36 pmol/L,respectively.Abnormal thyroid function was very common among the subjects with serum TSH outside the reference range in 18.2% of area A,36.1% of B and 14.7% of C,respectively.It was mainly thyroid hyperfunction（0% had low,23.3% had high serum TSH;0% had low,13.6% had high serum FT3）.Only 2.1% cases were TPOAb or TGAb positive.Total goitre rate（TGR） was 18.4% among them.24 patients with subclinical hypothyroidism were found,accounting for 23.3% and their UI of 100% were above 300 μg/L.Of the 24 patients,5 cases had goiter.Conclusions The epidemiological studies have shown that subclinical hypothyroidism and goitre were more prevalent in school-age children with an excess iodine intake in high water iodine areas.Probably,this was also a complication to thyroid adaptation to iodine intake.It is recommended that we should pay more attention to this phenomenon.

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