2022年晋中市水源性高碘地区居民碘营养水平调查

A survey on iodine nutrition level of residents in water source high iodine areas of Jinzhong City in 2022

目的掌握山西省晋中市高碘地区居民在实施高碘防控措施后的碘营养水平及病情变化趋势。方法2022年4-10月,采用多阶段分层随机抽样方法,根据高碘村水碘检测结果,首先确定0~<10、10~<40、40~100、>100~<300、≥300μg/L 5个水碘水平,随后依次抽取6、3、4、2、3共18个监测村,调查改水工程运行情况,并采集两户居民末梢水水样(每户采集2份平行水样)检测水碘含量。分别采集18~60岁成人、6~12岁学生、孕妇及哺乳期妇女家中食用盐盐样、一次随机尿样,检测盐碘和尿碘含量;同时进行甲状腺检查,记录异常结果。结果18个监测村改水率和改水工程运转率均为100.00%,水碘中位数范围为2.25~366.10μg/L;未加碘盐率为100.00%(903/903)。成人(n=466)、学生(n=389)、孕妇及哺乳期妇女(n=48)的尿碘中位数分别为253.8、326.0、223.1μg/L,碘营养水平分别为超适宜量、碘过量、碘适宜。0~<10、10~<40、40~100、>100~<300、≥300μg/L水碘组成人的尿碘中位数分别为213.9、236.7、199.6、347.8、424.7μg/L,学生的尿碘中位数分别为275.6、293.4、300.2、460.9、449.5μg/L,水碘水平与成人和学生的尿碘含量均呈正相关(r s=0.26、0.19,均P<0.001)。成人、学生、孕妇及哺乳期妇女的甲状腺肿大率均低于5%,结节检出率分别为21.24%(99/466)、22.88%(89/389)、22.92%(11/48)。结论随着改水措施和未加碘盐的落实,不同人群的甲状腺肿大率控制在较低水平,但是受多因素影响,结节检出率较高。水碘>100μg/L地区人群碘营养水平较高,需要继续实施改水降碘措施并供应未加碘盐;水碘<100μg/L地区可根据每年水碘检测结果合理配送碘盐或未加碘盐。孕妇和哺乳期妇女则需要精准、科学补碘,以确保母婴碘充足。

Objective To study the iodine nutrition level and disease trend of residents in water source high iodine areas of Jinzhong City Shanxi Province after implementing high iodine prevention and control measures.Methods From April to October 2022,according to the results of water iodine detection in villages with high iodine level,5 water iodine levels(0-<10,10-<40,40-100,>100-<300,≥300μg/L)were determined by multi-stage stratified random sampling method.Then 18 monitoring villages(6,3,4,2,3 villages in each water iodine level)were selected,the operation of water improvement project was investigated,and two households tap water samples were collected(2 parallel water samples for each household)to detect the water iodine level.Household salt sample and a random urine sample were collected from adults aged 18-60,students aged 6-12,pregnant and lactating women to detect salt iodine and urinary iodine levels.At the same time,thyroid examination was performed and abnormal results were recorded.Results The water improvement rate and the operation rate of the water improvement projects in 18 villages were all 100.00%,and the median water iodine ranged from 2.25 to 366.10μg/L.The rate of non iodized salt was 100.00%(903/903).The median urinary iodine in adults(n=466),students(n=389),pregnant and lactating women(n=48)were 253.8,326.0 and 223.1μg/L,respectively.The iodine nutrition levels were over appropriate,excess and appropriate,respectively.The median urinary iodine of adults in 0-<10,10-<40,40-100,>100-<300,and≥300μg/L water iodine groups were 213.9,236.7,199.6,347.8,and 424.7μg/L,respectively;the median urinary iodine levels of students were 275.6,293.4,300.2,460.9 and 449.5μg/L,respectively.Water iodine levels were positively correlated with urinary iodine levels of adults and students(r s=0.26,0.19,P<0.001).The goiter rates in adults,students,pregnant and lactating women were all less than 5%;and the detection rates of nodules were 21.24%(99/466),22.88%(89/389)and 22.92%(11/48),respectively.Conclusions With the implementation of water improvement measures and non iodized salt,the goiter rate of different populations is controlled at a low level,but the nodule detection rate is high due to the influence of multiple factors.The iodine nutrition level of the population in the area of water iodine>100μg/L is higher,so it is necessary to continue to implement the measures of water iodine reduction and supply non iodized salt.Iodized salt or non iodized salt can be reasonably distributed in areas with water iodine<100μg/L according to the annual water iodine test results.Pregnant and lactating women need accurate and scientific iodine supplementation to ensure adequate iodine for mothers and babies.