辽宁省供碘地区人群甲状腺功能与碘营养关系的研究

Iodine nutrition and thyroid function in iodized salt supplied regions

目的探讨成人和孕妇碘营养水平对甲状腺功能的影响。方法在辽宁省沿海城市、沿海农村和内陆农村3个不同类型地区采集健康成人和孕妇空腹静脉血、尿液，家中食用盐、饮用水，测定血清促甲状腺激素（TSH）、游离三碘甲腺原氨酸（FT3）、游离甲状腺素（n）、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）、尿碘（UI）、盐碘（SI）和水碘。结果共采集盐样150份，盐碘为（30．1±6．0）mg／kg。共采集成人尿样271份，尿碘中位数为203．2μg／L；孕妇尿样72份，尿碘中位数为176．3μg／L。3个地区的孕妇和沿海地区成人碘营养水平适宜，内陆农村地区成人尿碘中位数为244．4μg／L，高于适宜但未达到碘过量水平。内陆农村地区的成人、孕妇FT4水平（11．7、10．7pmol／L）略高于沿海城市（11．2、8．6pmol／L）和沿海农村（10．9、9．6pmol／L），不同地区成人、孕妇TSH、FT3、FT4水平比较差异无统计学意义（P均〉0．05）。孕妇UI、FT4、FT3水平（176．3μg／L、9．5pmol／L、4．3pmol／L）显著低于成人（203．2μg／L、11．3pmol／L、4．7pmol／L，P均〈0．05）。沿海地区成人低T4血症检出率（4．4％，10／173）显著高于内陆成人（2．0％，2／98，P〈0．05），且低T4血症检出者均为女性。孕妇低T4血症检出率（16．7％，12／72）明显高于成人（4．4％，12／271，P〈0．05）。各地成人、孕妇的甲状腺功能亢进症（甲亢）、甲状腺功能减退症（甲减）和亚临床甲状腺功能减退（亚甲减）检出率比较差异均无统计学意义（P均〉0．05）。结论供应碘盐地区，人群甲状腺功能与碘营养水平关系密切，孕妇和成年妇女存在碘缺乏风险，应加强对这类人群甲状腺功能的监测。

Objective To study the effect of different iodine nutrition on thyroid function in adult and pregnant women. Methods A random sampling method was used to select healthy adult and pregnant woman from the communities of coastal city, coastal rural and inland rural areas in Liaoning Province. Drinking water, urine and salt samples were collected to measured urinary iodine（UI）, salt iodine（SI） and water iodine content. Fasting venous blood was collected to measured thyroid stimulate hormone （TSH）, freethyroxine （FT4）, free triiodothyronine （FT3）, thyroglobulin antibody （TgAb） and thyroid peroxidase antibody （TPOAb） with the method of immunoassay chemical luminescence. Results A total of 150 salt samples were collected, means of SI was （30.1 ± 6.0）mg/kg. A total of 72 pregnant woman and 271 adults were investigated in iodized salt supplied regions, median UI of pregnant woman and adults were 176.3, 203.2 μg/L. Iodine nutrition of pregnant women and coastal region aduhs was in an adequate level. Means of SI of inland adults （244.4 μg/L） was higher than appropriate level but not reached the excessive level. FT4 of the adults （11.7 pmol/L） and pregnant women（ 10.7 pmol/L） in inland regions were slightly higher than that of coastal city, rural adults （11.2, 8.6 pmol/L） and pregnant women （10.9, 9.6 pmol/L）. TSH, FT3 and FT4 were not statistically different between regions （all P 〈 0.05）. But UI, FT4 and FT3 levels of pregnant women（176.3μg/L, 9.5 pmol/L, 4.3 pmol/L） were significantly lower than that of the adults （203.2 μg/L, 11.3 pmol/L, 4.7 pmol/L, all P 〈 0.05）, Hypothyroxinemia（4.4%, 10/173） was higher than that of the inland adults （2.0%, 2/98, P 〈 0.05）. And all hypothyroxinemia were found in women of childbearing age. Hypothyroxinemiaprevalence of pregnant women （ 16.7 %, 12/72 ） was higher than that of adults （4.4%, 12/271, P 〈 0.05）, The prevalence of hypothyroidism, hyperthyroidism and subclinical hyperthyroidism between the 3 regions adults and pregnant women were not statistically different （all P 〉 0.05）. Conclusions Under appropriate supply conditions of iodized salt, iodine nutrition and thyroid function are closely related. Pregnant women and women of childbearing age are at risk of iodine deficiency. The thyroid function of these people should be strengthen detect.