广西壮族自治区普遍食盐加碘对甲状腺疾病谱的影响

Changes of the spectrum on thyroid disease after the ten-year implementation of universal salt iodization in Guangxi Zhuang Autonomous Region

目的分析广西壮族自治区实行全民普遍食盐加碘（USI）前后不同碘环境下甲状腺疾病谱变迁的特点。方法按地理分布特点选取南宁、桂林、百色、北海4城市医院1991--2006年经手术后病理确诊5998例甲状腺疾病患者的尿碘水平，并检测1000例甲状腺正常人群尿碘水平作对照，分析USI前后碘环境的改变与甲状腺病谱变迁的相关性。结果USI后，甲状腺患者及对照组的尿碘水平均较USI前增高，且甲状腺疾病患者尿碘水平高于对照组（分别为324．3μg／L、238．5μg／L，P〈0．05），其中结节性甲状腺肿、毒性弥漫性甲状腺肿、毒性结节性甲状腺肿、慢性淋巴细胞性甲状腺炎、甲状腺乳头状癌患者尿碘水平较USI前明显增高（分别为263．8μg／L vs 69．75μg／L、289．7μg／L vs 228．3μg／L、346．8μg／L vs．268．4μg／L、350．3μg／L vs316．2μg／L、378．5μg／L vs 305．8μg／L），而毒性结节性甲状腺肿、甲状腺乳头状癌、慢性淋巴细胞性甲状腺炎的构成比（％）较USI前增高（分别为7．59 vs．4．80、5．85 vs 4．02、3．88 vs 2．46），但结节性甲状腺肿较USI前下降（63．56 vs．69．75）。结论广西壮族自治区USI后甲状腺疾病谱发生明显变化，碘摄入过量可能是毒性结节性甲状腺肿、慢性淋巴细胞性甲状腺炎、甲状腺乳头状癌的危险因素。

Objective To reveal the relationship between iodine nutrition and the change of spectrum on thyroid diseases through comparing the different iodine environments pre- and post- the universal salt iodization （USI） campaign. Methods To compare the urinary iodine concentration between 1000 normal people and 5998 patients with thyroid disease who had undergone surgical operations, from 4 major cities, including iodine deficient and rich areas of Guangxi Zhuang Autonomous Region. Results After USI was put into practice, the urinary iodine concentration of patients with thyroid appeared higher than those of normal people （324.3μg/L vs. 238.5 μg/L, P〈 0.05）. The urinary iodine concentrations of nodular goiter, Graves disease, toxic nodular goiter, thyroid papillary carcinoma and Hashimoto＇ s thyroiditis were higher than those before the USI was taken （263.8μg/L vs. 69.75 μg/L, 289.7μg/L vs. 228.3 μg/L, 346.8 μg/L vs. 268.4 μg/L, 350.3μg/L vs. 316.2 μg/L and 378.5 μg/L vs. 305.8 μg/L）. The proportions of toxic nodular goiter, thyroid papillary carcinoma and Hashimoto＇ s thyroiditis appeared as 7.59% vs. 4.80%, 5.85% vs. 4.02% and 3.88% vs.2.46%, all higher than those before the implementation of USI, except the nodular goiter which showed a reduction （63.56% vs. 69.75%）. Conclusion The spectrum of thyroid diseases appeared an obvious change in Guangxi within the last 10-year implementation of USI. However, the excessive intake of iodine might serve as a risk factor for toxic nodular goiter, thyroid papillary carcinoma and Hashimoto＇ s thyroiditis.