不同碘营养水平地区分化型甲状腺癌的流行病学研究

Epidemiological analysis of differentiated thyroid cancer in geographical regions with different iodine intake levels

目的:分析不同碘营养水平地区分化型甲状腺癌(DTC)的流行病学特征,探讨碘与甲状腺癌(TC)之间的关系。方法:结合历史资料和预调查,选择福州市平潭县和永泰县作为本次流行病学调查的高碘地区和适碘地区;采集2011年两地三年级学生清晨空腹尿标本,运用砷铈催化分光光度法检测尿碘值;收集福建省肿瘤防治中心记录的两地全民补碘以后TC发病的详细资料,分析两地DTC的发病情况及TC病理类型构成比的变化。结果:2011年平潭县碘营养水平高于永泰县[(281.3±171.9)μg/L vs.(151.4±77.2)μg/L,t=18.44,P=0.00];与往年比较,平潭县碘摄入不足的比例逐渐减少,但摄入超足量和过量的比例则逐渐增高,永泰县碘摄入不足的比例逐渐减少,碘摄入超足量和碘过量的比例趋于稳定,而碘摄入足量的比例逐渐增高。2001—2011年,平潭县DTC的平均年发病率52.725/10万,标化发病率50.945/10万,永泰县平均年发病率1.837/10万,标化发病率1.780/10万,差异有统计学意义(P=0.00)。无论是高碘地区还是适碘地区,女性DTC发病率均比男性高,且高碘地区女性比例更高(5.34:1 vs.2.74:1,χ2=6.15,P=0.02)。与永泰县比较,平潭县DTC比例更高(98.5%vs.91.0%,χ2=23.95,P=0.00),乳头状癌(PTC)占绝大多数(95.0%vs.83.3%,χ2=4.76,P=0.03),未分化癌(ATC)更为罕见(0.1%vs.1.3%,χ2=8.49,P=0.00)。结论:高碘地区及适碘地区DTC的发病率均在增高,但高碘地区发病率远高于适碘地区,并以女性多见。TC增高的趋势主要见于DTC,尤其见于PTC,而ATC则变得更为罕见,这种趋势在高碘地区尤为明显。

Objective: To analyze the epidemiological characteristics of the differentiated thyroid cancer(DTC) in regions with different iodine intake levels and investigate the relation between the iodine level and thyroid carcinoma(TC). Methods: Based on the historical and pre-survey data, Pingtan county and Yongtai county of Fuzhou city were selected as high-iodine intake region and normal-iodine intake region, respectively, for this epidemiological investigation. he morning urine samples before breakfast from students in grade 3 at primary school in the two regions, for the year 2011, were collected, and their urinary iodine values were determined by arseniccerium catalytic spectrophotometric method. he detailed data on prevalence of TC in the two regions ater national iodine supplementation program were obtained from Fujian tumor prevention and treatment center. hen, the prevalence of DTC and constituent ratio of the pathological types of TC were analyzed. Results: The iodine intake level of Pingtan county was significantly higher than that of Yongtai county in 2011 [(281.3±171.9) μg/L vs.(151.4±77.2) μg/L, t=18.44, P=0.00], and compared with previous years, the proportion of insuicient iodine intake was gradually decreased but the proportion of more than adequate or excessive iodine intake was gradually increased in Pingtan county; the proportion of insuicient iodine intake was gradually decreased and the proportions of adequate or excessive iodine intake tended to be stable, but the proportion of suicient iodine intake was gradually increased in Yongtai county. From 2001 to 2011, the average annual incidence of DTC in Pingtan county was 52.725/100 000 and the standardized incidence rate was 50.945/100 000, which in Yongtai county was 1.837/100 000 and 1.780/100 000 respectively, and the difference between the two regions was statistically significant(P=0.00). The incidence of DTC in women was higher than that in men regardless of whether they were in high-iodine intake or normal-iodine intake region and, moreover, the percentage of females was much higher in high-iodine intake region(5.34:1 vs. 2.74:1, χ2=6.15, P=0.02). Compared with Yongtai county, the proportion of DTC in Pingtan county was higher(98.5% vs. 91.0%, χ2=23.95, P=0.00), and the papillary thyroid carcinoma(PTC) accounted for the majority(95% vs. 83.3%, χ2=4.76, P=0.03), while the anaplastic thyroid carcinoma(ATC) was far rarer(0.1% vs. 1.3%, χ2=8.49, P=0.00). Conclusion: he incidence of DTC has increased in both high-iodine intake and normal-iodine intake regions and, however, it is far higher in high-iodine intake region than that in normal-iodine intake region, and is more prevalent in women. he increasing trend of TC is mainly responsible for DTC and especially for PTC, with the ATC becoming even rarer, and this trend is especially obvious in high-iodine intake region.