吸烟对甲状腺影响的流行病学研究

Epidemiological study of the effects of smoking cigarette on thyroid gland

目的研究不同碘摄入量地区吸烟对甲状腺体积、功能以及甲状腺自身抗体的影响。方法对辽宁省盘山、彰武、河北省黄骅三个农村社区（分别为碘缺乏地区、碘充足地区、碘过量地区）1999年初访的3761人进行随访，随访率达80．2％。进行问卷调查、甲状腺B超检查、血液及尿液化验。通过logistic回归进行多因素分析。结果吸烟者甲状腺肿的发生率较不吸烟者增高（15．1％vs．11．5％，P〈0．05），吸烟者甲状腺的平均体积较不吸烟者大（14．92ml vs．13．18ml，P〈0．05）。通过logistic回归可见吸烟是增加甲状腺肿发生率的主要危险因素。吸烟者平均血清促甲状腺激素（TSH）水平和甲状腺球蛋白（Tg）水平与不吸烟者比没有差别。吸烟者甲状腺过氧化物酶抗体（TPOAb）≥100IU／ml的为10．8％，不吸烟者为9．0％，差异有统计学意义。多元logistic回归发现吸烟是增加TPOAb强阳性的主要危险因素。对三社区人群进行前瞻性研究，发现由不吸烟到吸烟者TPOAb变为≥100IU／ml的发生率为7．4％，远大于吸烟情况没有变化者的2．9％（P〈0．05）。多元logistic回归发现由不吸烟到吸烟是增加TPOAb≥100IU／ml发生率的主要危险因素。结论吸烟是增加甲状腺肿发生率和增加TPOAb阳性率的主要危险因素；由不吸烟到吸烟是TPOAb变为阳性的主要危险因素。

Objective To investigate the effect of cigarette smoking on thyroid gland volume, thyroid function and thyroid autoantibodies in the areas with different iodine intakes. Methods A crosssectional epidemiological study in Panshan （mild iodine-deficient area）, Zhangwu （more than adequate iodine intake area） and Huanghua （iodine-excessive area） was conducted in 3761 subjects in 1999.80.2 % of them were followed up in 2004. Questionnaires,thyroid function,thyroid autoantibodies,urinary iodine concentration,and thyroid B ultrasound were performed. Results The prevalence of goiter was higher in smokers than in non-smokers （ 15.1% vs. 11.5 %, P 〈 0.05 ）. The average thyroid volume was higher in smokers with phenomenon more obvious in Panshan and Huanghua areas. Data from logistic analysis showed that smoking cigarette was an independent risk factor of goiter. There was no difference in serum TSH and Tg level between smokers and non-smokers. The positive rate of TPOAb（~100 IU/ml） was higher in smokers than in non-smokers（ 10.8 % vs. 9.0 % , P 〈 0.05）and was especially obvious in Huanghua area. Smoking was a independent risk factor of increasing positive rate of TPOAb. During the prospective observation,it was found that the incidence of positive TPOAb（≥100 IU/ml） was 7.4% in the subjects that were from non-smokers turning to smokers and 2.9% in those whose smoking behavior did not change. Logistic analysis indicated that the shifting from non-smoking to smoking was independent risk factor for the increase on high incidence of positive TPOAb. Conclusion Smoking cigarette was a independent risk factor of goiter. Smoking was also a risk factor of increasing TPOAb positive rate. Shifting from not smoking to smoking was an independent risk factor of increasing high incidence of positive TPOAb.