海南省碘缺乏病高危地区重点人群调查结果

Iodine deficiency disorders in high-risk areas of Hainan province from 2007 to 2009： an analysis of survey results

目的 了解海南省缺碘高危地区碘缺乏病防治现状和防治措施落实效果.方法 2007-2009年,采用典型抽样方法,在海南省碘盐覆盖率低的8个市（县）,以乡为单位搜索10岁以下新发地方性克汀病（地克病）患儿 在乡小学校,抽取8～10岁儿童,采用触诊、B超法检查儿童甲状腺 收集儿童尿样 测定儿童智商（IQ） 对五年级学生进行健康教育问卷调查.入户采集育龄妇女尿样和家中食用盐样,同时对妇女进行健康教育问卷调查.尿碘测定采用砷铈催化分光光度法,盐碘测定采用半定量法,IQ测定采用中国联合型瑞文测验（CRT-C2）.结果 共调查72个乡（镇）,其中8～10儿童7937名、育龄妇女1797名、5年级学生4128名,线索调查发现疑似新发地克病患儿1例.居民碘盐覆盖率由2007年的44.6%（629/1411）提高到2009年的92.1%（1688/1832）.儿童甲状腺肿大（甲肿）率触诊法、B超法由2007年的5.9%（269/4548）、6.0%（274/4548）下降到2009年的1.6%（24/1461）、0.1%（2/1461） 尿碘中位数由2007年的97.4μg/L上升2009年165.0μg/L 尿碘〈50.0μg/L和〈100.0μg/L的比例由2007年的21.4%（973/4548）、51.2%（2329/4548）下降到2009年的75%（110/1461）、23.4%（342/1461） 育龄妇女尿碘中位数由2007年的73.7μg/L上升到2009年的126.1μg/L,其中孕妇的尿碘中位数由2007年的55.7μg/L上升到2008年117.9μg/L、2009年的121.5 μg/L,但仍〈150.0μg/L.五年级学生、育龄妇女碘缺乏病的健康教育问卷调查及格率分别由2007年29.8%（446/1495）、24.1%（179/742）提高到2009年65.8%（732/1112）、72.1%（264/366）.儿童IQ值为90.4±16.0,IQ低下（≤69）的比例为12.6%（1000/7937）.结论 海南省高危地区碘缺乏病病情逐年改善,但孕妇碘营养水平仍较低,今后应加强对孕妇的补碘.

Objective To know the prevalence of iodine deficiency disorders（IDD） and the implementation of control measures against the disorders in high-risk areas of Hainan province. Methods Typical sampling principle was used. Eight townships with lower coverage rate of iodized salt were chosen in IDD high-risk counties of Hainan. New cretinism cases were screened among children aged 10 years and under. Intelligence quotient （IQ）value, urinary iodine （UI） concentration and thyroid gland size （by palpation and B ultrasonic） were investigated in children aged 8 to 10 years and questionnaire was also carried out among students from grade 5 in elementary school. Edible salt and urine of women of childbearing age were collected to detect iodine levels, respectively,questionnaire was also carried out among the women of childbearing age. The UI was determined by As3-Ce4＋ catalytic spectrophotometer, the salt iodine level was determined using self-quantitative kit. IQ values were measured by the Combined Raven Test in China （CRT-C2）. Results Seventy-two townships were investigated in three consecutive years, 7937 children aged 8 to 10 years, 1797 women of childbearing age and 4128 students of grade 5 were included in the survey. One child was diagnosed as suspected new cretinism case. The coverage rate of iodized salt was increased from 44.6%（629/1411） in 2007 to 92.1%（1688/1832） in 2009. The goiter rate was dropped from 5.9% （269/4548）, 6.0% （274/4548） in 2007 to 1.6% （24/1461）, 0.1% （2/1461） in 2009 bypalpation, and by B-ultrasound, respectively, in children aged 8 to 10 years. The median urinary iodine（MUI） was found to be increased from 97.4 μg/L in 2007 to 165.0 μg/L in 2009, and the percentage of UI less than 50.0 μg/L, and 100.0 μg/L were dropped from 21.4%（973/4548）, 51.2%（2329/4548） in 2007 to 7.5 %（110/1461）, 23.4%（342/1461） in 2009, respectively. The MUI of women of childbearing age was found to be elevated from 73.7 μg/L in 2007 to 126.1 μg/L in 2009, and the value was also increased from 55.7 μg/L to 121.5 μg/L in pregnant women, but these values were still lower than 150.0 μg/L The pass rate of the questionnaire of IDD controlling among the students of grade 5 and the women of childbearing age was raised from 29.8% （446/1495） ,24.1% （179/742） in 2007 to 65.8%（732/1112）, 72.1%（264/366） in 2009, respectively. The mean IQ of children was 90.4±16.0, and the percentage of IQ value less than 69 was 12.6% （1000/7937）. Conclusions The diseased state of IDD has improved in the high-risk counties of disorders in Hainan province, but the pregnant women are still iodine deficient. Iodine supplimentation should be promoted among pregnant women.