2011年云南省碘缺乏病监测结果分析

Monitoring results of iodine deficiency disorders in Yunnan Province in 2011

目的了解云南省碘缺乏病病情、居民碘营养水平及防治措施落实情况，为全省碘盐浓度调整提供科学依据。方法按照（2011年度地方病防治项目实施方案》（中疾控地病发[2011]13号），采用按人口比例概率抽样（PPS）方法在云南省抽取30个项目县（市、区），收集各县（市、区）历史水碘资料，排除水碘大于150μg／L的乡镇。采用单纯随机抽样法，每个项目县（市、区）抽取1所行政村小学，每个小学抽取约40名8～10岁学生（非寄宿），进行甲状腺容积检查，并测定家中食用盐的碘含量；在所选学生中抽取12名采集尿样进行尿碘含量测定；在抽中学校的所在村（居委会），按东、西、南、北、中5个方位各抽取1份饮用水水样，如为集中式供水地区，则采集2份末梢水样进行水碘测定；每个项目县（市、区）选取3个乡镇，每个乡镇抽取孕妇和哺乳期妇女各约5人，进行尿碘检测。在全省未开展碘缺乏病病情监测的其他96个县（市、区），按东、西、南、北、中5个方位各抽取1个乡镇（不足5个乡时全部抽取），每个乡镇各抽取1所行政村小学，每所小学各抽取约20名8～10岁学生（非寄宿学生，男、女各半），采集尿样，检测尿碘。甲状腺容积的检测采用B超法；食用盐碘含量的测定采用直接滴定法；尿碘及水碘水平的检测采用砷铈催化分光光度法。结果2011年云南省30个项目县（市、区），8～10岁学生甲状腺肿大率为1．8％（22／1207）；盐碘中位数为29．9mg／kg，碘含量的变异系数为22．8％，碘盐覆盖率为99．1％（1196／1207），碘盐合格率为96．1％（1149／1196），合格碘盐食用率为95．2％（1149／1207），其中1个县碘盐覆盖率〈95．0％，3个县碘盐合格率〈90．0％，4个县合格碘盐食用率〈90．0％；儿童尿碘中位数为274．1μg／L；水碘中位数为1．6μg／L；孕妇和哺乳期妇女尿碘中位数分别为217．3、171．5μg／L。96个县8～10岁儿童尿碘中位数为259．0μg／L。结论云南省外环境普遍缺碘；碘盐含碘量相对比较均匀，碘盐供应较好；儿童碘营养水平整体上处于超适宜范围，食用盐碘含量有下调的空间。

Objective To study the situation of iodine deficiency disorders （IDD）, iodine nutrition status and implementation of preventive measures in Yunnan Province, and to provide a scientific basis for adjusting the iodine content in salt. Methods The surveillance had been carried out based on the implementation plan of ＂2011 Endemic Diseases Control ＆ Prevention Project＂. Thirty counties （cities, districts） were selected by the method of population probability sampling （PPS）. Historical water iodine data were collected in each county （city, district）, which excluded the township where the water iodine was higher than 150 p,g/L. Using simple random sampling method, 1 administrative village primary school was selected in each county（city, district）. About 40（8 - 10 years old） students（non boarding） from the primary school were randomly selected to test the thyroid volume and the edible salt iodine. The urinary iodine（UI） of 12 students who were randomly selected from the 40 students was tested. In the village（neighborhood）, 5 drinking water samples were selected according to their sub-area positions in the north, the south, the east, the west and the center of the village, and in centralized water supply area, 2 tap water samples were collected to test the water iodine. Three townships were selected from each county（city, district）, 5 pregnantwomen and 5 lactating women were selected from each township to test UI. In other 96 counties（cities, districts）, 5 townships were randomly selected according to their sub-area positions in the north, the south, the east, the west and the center of the county （selected all if less than 5 townships）. One administrative village primary school was randomly selected from each township, about 20（about 8 - 10 year olds, non boarding, half male and half female） students were randomly selected from each primary school to test UI. The thyroid volume was determined by type-B ultrasound method. The salt iodine content was measured by sodium subsulfite method. Both UI and water iodine contents were determined by As3-Ce4＋ catalytic spectrophotometry. Results The goiter rate of children aged 8 - 10 years was 1.8%（22/1207） in the 30 counties in 2011. The median of salt iodine was 29.9 mg/kg. The coefficient variation（CV） of salt iodine was 22.8%. The iodized salt coverage rate was 99.1% （1196/1207）. The qualified rate of iodized salt and qualified iodized salt coverage rate was 96.1% （1149/1196） and 95.2% （1149/1207）, respectively. The iodized salt coverage rate that lower than 95.0% was found only in 1 county. The qualified rate of iodized salt that lower than 90.0% was found in 3 counties. The qualified iodized salt coverage rate that less than 90.0% was found in 4 counties. The median of urinary iodine（MUI） of children was 274.1 μg/L. The median of water iodine content was 1.6μg/L. The MUI of pregnant women was 217.3 μg/L. The MUI of lactation women was 171.5 μg/L. In 96 counties,the MUI of the students aged 8 - 10 years was 259.0 μg/L. Conclusions Iodine deficiency of external environment is universal in Yunnan Province. The iodine content in iodized salt is relatively uniform. The children＇s iodine nutrition status exceeds an appropriate level in Yunnan Province on the whole and the iodine content of salt should be reduced properly.