浙江省宁波市江北区不同人群碘营养状况和甲状腺结节的现况研究

A cross-sectional study of iodine nutritional status and thyroid nodules of people in Jiangbei District of Ningbo City, Zhejiang Province

目的了解浙江省宁波市江北区不同人群碘营养状况和甲状腺结节的患病情况．为科学补碘防控策略提供依据。方法采用分层整群抽样的方法确定3个调查点（分别代表城区、城乡结合部、农村），每个调查点抽取1个村或社区，每个村或社区抽取100户调查对象进行问卷调查、尿碘检测、盐碘检测。8-10岁儿童尿样分别采自3个调查点的3所学校，共计152份。孕妇尿样分别采自3个调查点的孕检人群，共计161份。同时，对所有调查对象进行甲状腺B超检查，并对甲状腺结节患者进行甲状腺功能检测[甲状腺球蛋白抗体（thyroglobulinantibody，TGAb）、甲状腺过氧化物酶抗体（thyroidperoxidaseantibody，TPOAb）、促甲状腺激素（thyroidstimulatinghormone，TSH）、血清游离三碘甲状腺原氨酸（freetriiodothyronine，n）、游离甲状腺素（freethyroxine，n）]。尿碘检测采用砷铈催化分光光度法，盐碘检测采用硫代硫酸钠直接滴定法，甲状腺功能检测采用化学发光法。结果共检测尿样913份，尿碘中位数为201．69μg／L，尿碘含量〈100μg／L的占14．68％（134／913），100—200μg／L的占31．87％（291／913），200—300μg／L的占29-24％（267／913），〉300μg／L的占24-21％（221／913）。共检测盐样300份，盐碘中位数为27．80mg／kg，碘盐覆盖率为94．67％（284／300），碘盐合格率为92．96％（264／284），合格碘盐食用率为88．00％（264／300）。共对913人进行甲状腺B超检查，甲状腺结节检出率为20．70％（189／913）。其中，城区、城乡结合部、农村3个调查点的检出率分别为19．44％（62／319）、20．13％（60／298）、22．64％（67／296），且差异无统计学意义（X2=0．286，P〉0．05）。女性检出率为24．95％（127／509），高于男性的15．35％（62／404），男女比较差异有统计学意义（x2=8．635，P〈0．01）。随着尿碘水平升高，甲状腺结节检出率也随之增加，并且与性别、年龄、食用高盐食品、直系亲属甲状腺疾病史有关[比值比（OR）分别为0．70、1．03、2．86、1．03，P均〈0．05]。结论江北区居民碘营养状况总体处于适宜水平。合格碘盐食用率偏低，提示食用碘盐仍是保证居民碘营养的首选。甲状腺结节检出率较高，且与性别、年龄、食用高盐食品、直系亲属甲状腺疾病史有关，应加强监测。

Objective To understand the iodine nutritional status and thyroid nodules in different groups of people in Jiangbei District, and provide a basis for set up scientific prevention and control strategies on iodine supplementation. Methods Stratified cluster sampling method was used to determine the 3 survey points （representing the city, the rural-urban fringe zone and the rural areas）, one village or community was chosen in each survey point, 100 families in every village or community were surveyed through questionnaire survey, urinary iodine testing and salt iodine testing. Urine samples of children aged 8 - 10 were collected from three schools of three survey points. Urine samples of pregnant women were collected from three survey points. All respondents were examined by thyroid B-ultrasound, and thyroid function tests[thyroglobulin antibody （TGAb）,thyroid peroxidase antibody （TPOAb）, thyroid stimulating hormone （TSH）, free triiodothyronine （FT3）, free thyroxine（FT4）] were performed / in patients with thyroid noduleS,. Urinary iodine concentration was determined by arsenic cerium catalytic spectrophotometry salt iodine eon ntration was determined by sodium thiosulfate direct titration method, thyroid function was monitored by chemiluminescence method. Results Urinary iodine of 913 people was determined, the / 7 urinary iodine median μg 201.69 μg/L, among these, under 100 μg/L was 14.68% （1341913）, between 100 - 200 μg/L was 31.87% （2911913/）, between 200 - 300μg/L was 29.84% （2671913）, and over 300 μg/L was 24.21% （221/ 913）. The median of 300 samples of salt iodine was 27.80 mg/kg, the coverage rate of iodized salt was 94.67% （284/ 300）, the qualified rate was 92.96% （2641284）, and the rate of qualified iodized salt used was 88.00% （2641300）. A total of 913 people were taken thyroid B-uhrasound, the detection rate of thyroid nodules was 20.70% （1891913）. Among these, the detection rates of the city, the rural-urban fringe zone, the rural areas were 19.44%（62/319）, 20.13% （601298）, 22.64% （671296）, and the differences were not statistically significant （X2 = 0.286, P 〉 0.05）. The detection rate of female was 24.95% （1271509）, which was higher than that of male [15.35%（62/404）, X2 = 8.635, P 〈 0.01]. With the increase of salt taken, the detection rate of thyroid nodules increased, and it was connected with gender, age, consumption of high salt foods, and the immediate family history of thyroid disease [OR = 0.70, 1.03, 2.86, 1.03, all P 〈 0.05]. Conclusions From a general point of view, iodine nutritional status of residents in Jiangbei District is at suitable levels. The coverage rate and qualification rate of iodized salt have reached the standard for elimination of iodine deficiency disorders, but the rate of qualified iodized salt used is low. The rate of thyroid nodulesis is higher, and it is related with gender, age, consumption of high salt foods, and the immediate family history of thyroid disease; therefore, monitoring should be strengthened.