2011年哈尔滨市不同人群碘营养状况调查

Survey and evaluation of iodine nutritional status of different populations in Harbin city in 2011

目的调查及评价哈尔滨市不同人群的碘营养状况，为制定食盐加碘标准和科学补碘提供依据。方法2011年，在哈尔滨市的3个区和周边的3个县（市），各选择1个街道办事处（乡、镇），每个街道办事处（乡、镇）各选1个居委会（村），用系统抽样方法各抽取30户居民，分别检测家中碘盐、水碘和人均摄碘量。在每个抽中居委会（村）的居民户中，各抽取18～45岁成人20名；在每个被抽中的街道办事处（乡、镇），各选择孕妇、哺乳期妇女30名和8～10岁在校儿童100名，采集尿样，检测尿碘含量。根据调查结果，分析城区和农村的不同人群摄碘情况和碘营养情况。评估哈尔滨市居民的碘营养状况是否适宜。盐碘测定采用直接滴定法，水碘、尿碘测定采用砷铈催化分光光度测定方法。结果哈尔滨市城区和农村居民合格碘盐食用率分别为93．3％（84／90）和96.3％（156／162），均〉90％；盐碘最高值分别为38.3、46．0mg／kg，均未超过合格碘盐上限（50mg／kg），但有部分样品盐碘含量低于国家标准（20mg／kg）；从城区和农村水碘看，即便是最高值（9．40、8．40ug／L）也未达到10ug／L的标准。农村每人、每天吃盐8．33g，显著高于城区的7．03g（Z=-2．750，P〈0．01）；除农村8～10岁儿童尿碘（228．6ug／L）较高外，城区和农村成人（111．3、195．6ug／L）、孕妇（193．0、172．9ug／L）、哺乳期妇女（128．4、173．7ug／L）和城区儿童（186．8ug／L）尿碘中位数显示，碘营养水平均处于适宜状态。农村成人和儿童的尿碘中位数（195．6、228．6ug／L）明显高于城区成人和儿童（111．3、186．8ug／L，Z值分别为-2．294、-5．434，P〈0．05或〈0．01）。城区和农村成人、哺乳期妇女和孕妇碘缺乏人群的构成[46．7％（28／60）、21．6％（13／60）：21．1％（19／90）、21．3％（18／89）；27．8％（25／90）、42．2％（38／90）]明显高于碘过量人群的构成[4．6％（4／60）、5．0％（3／60）；16．7％（15／90）、16．9％（15／89）；4．4％（4／90）、0．0％（0／90）]，但农村儿童碘过量人群所占比例[26.3％（79／300）]明显高于碘缺乏人群[5．6％（17／300）]。结论哈尔滨市居民自然环境仍处于缺碘状态；除农村儿童外，居民的摄碘量和人群碘营养水平基本处于适宜状态，成人、哺乳期妇女和孕妇人群碘缺乏造成疾病的风险要高于碘过量造成的风险，农村儿童碘过量所致疾病风险要高于碘缺乏。因此，需加强对不同人群的监测，在落实科学补碘的同时根据不同人群加强科学补碘的宣传。

Objective To investigate current iodine nutritional status of different groups of people in Harbin city, and to provide the basis for development of salt iodization Standard and scientific iodine supplementation. Methods Three urban districts and three surrounding counties were chosen in Harbin, 2011. In each chosen urban district and county, one district office （township） was selected, and one residents committee （village） was chosen in each of the district office （township）, and 30 households were selected by systematic sampling. Iodized salt, water iodine and iodine intake per capita were investigated. In each of the residents committee （village）, 20 adults aged 18 - 45, 30 pregnant women or lactating women, and 100 school children aged 8 - 10 were selected. Urine samples were collected and urinary iodine level were tested. Salt iodine was determined by direct titration, water and urinary iodine by arsenic cerium catalytic spectrophotometry. Iodine uptake and iodine nutritional status of different populations in Harbin urban and rural areas were compared. Results The edible rate of qualified iodized salt were 93.3% （84/90） and 96.3% （156/162） in Harbin urban and rural residents, respectively, which were all greater than 90%, and the highest value of salt iodine were 38.3, 46.0 mg/kg, respectively, in urban and rural areas, which all did not exceed the upper limit（50 mg/kg） of qualified iodized salt, but there were some samples of salt iodine content below the national standard （20 mg/kg）. Water iodine value in urban and rural areas, even the highest value（9.40, 8.40 ug/L）, was failed to meet the national standard 10 ug/L; salt eaten by rural people per person a day（8.33 g） was significantly higher than that of the urban people （7.03 g, Z = - 2.750, P 〈 0.01 ）; in addition to rural children aged 8 - 10, whose urinary iodine value（228.6 ug/L） was higher, the values in urban and rural adults （ 111.3, 195.6 ug/L）, pregnant women （ 193.0, 172.9 ug/L）, lactating women （128.4, 173.7 ug/L） and urban children（186.8 ug/L）were all in appropriate level. The urinary iodine medians（195.6, 228.6 ug/L） of adults and children in rural were significantly higher than that of urban adults and children（Ill.3,186.8 ug/L, Z = - 2.294, - 5.434, P 〈 0.05 or 〈 0.01, respectively）, Population composition of iodine deficiency in both urban and rural adults, lactating and pregnant women[46.7%（28/60）, 21.6%（13/60）; 21.1%（19/90）, 21.3% （18/89）; 27.8% （25/90）, 42.2% （38/90）] were significantly higher than that of the population composition with iodine excess[4.6%（4/60）, 5.0%（3/60） ; 16.7%（15/90）, 16.9% （15/89） ; 4.4% （4/90）, 0.0%（0/90） ], but proportion of iodine excessive population in rural children[26.3%（79/300）] was significantly higher than proportion of iodine deficiency[5.6%（17/300）]. Conclusions The natural environment of Harbin city is still in the iodinedeficient state. In addition to children in rural areas, the iodine intake and iodine nutrition level is basically appropriate; the risk of disease caused by iodine deficiency in adults, lactating and pregnant women is higher than by iodine excess, but the situation of children in rural is on the opposite. Therefore, we should strengthen the monitoring of different populations, and supplement iodine scientifically based on their need.