甲状腺功能正常成人血清碘参考值范围初探

A preliminary study on medical reference range of serum iodine in adults of normal thyroid function

目的了解甲状腺功能（简称甲功）正常成人碘营养状况，探索其血清碘参考值范围，为个体碘营养评价提供依据。方法对黑龙江省哈尔滨市某大学新入学的硕士研究生224人．排除甲功异常的个体和患有其他疾病者，筛选甲功正常成人，砷铈催化光光度法（WS／T107．1-2016）测定其尿碘，高氯酸-氯酸钠消解法测定血清碘，化学发光免疫分析法测定血清中游离三碘甲状腺原氨酸（freetriiodothyronine，FT3）、游离甲状腺素（freethyroxin，FT4）、促甲状腺激素（thyroid—stimulatinghormone，TSH）、甲状腺球蛋白自身抗体（thyroglobulinantibody，TGAb）和甲状腺过氧化酶自身抗体（thyroidperoxidaseantibody，TPOAb）。并对其中的指标进行评估和相关性分析。结果共检测185例甲功正常成人，尿碘水平[中位数（四分位数），M（P25，p75）]为140．40（90．30，198．95）μg／L。血清碘平均水平为（66．32±15．46）μg／L，正常成人血清碘95％医学参考值范围（x±1．96s）初步定为36．02～96．62μg／L。FT3平均水平为（5．18±0．51）μmol／L，FT4平均水平为（18．04±2．06）pmol／L，TSH水平为1．57（1．14，2．04）mU／L。血清碘受试者工作特征（receiveroperatingcharacteristic，ROC）曲线下面积为0．781，明显大于尿碘ROC曲线下面积（0．524），二者比较差异有统计学意义（t=-12．22．P〈0．05）。血清碘与n、TSH均无相关性（r=-0．071、0．045，P均〉0．05），与n呈正相关（r=0．280，P〈0．05）。结论血清碘比尿碘相对稳定，能够较准确反映近期人体碘营养状况，甲功正常成人血清碘医学参考值范围可为我国成人个体碘营养判断提供依据．

Objective To explore the iodine nutrition and medical reference range of serum iodine in adults of normal thyroid function, and to provide scientific evidence for individual iodine nutritional assessment. Methods Totally 244 postgraduate freshmen were selected in one university, which is located in Harbin, Heilongjiang Province. Adults of normal thyroid function were recruited, excluding the adults of abnormal thyroid function and other diseases. The following indicators were adopted to assess iodine status： arsenic cerium catalytic spectrophotometry （WS/T 107.1-2016） was used to detect urinary iodine, perchloric acid and sodium cholrate resolution method was used to detect serum iodine, chemiluminescence immune assay was used to detect free triiodothyronine （FT3）, free thyroxine （FT4）, thyroid stimulating hormone （TSH）, thyroglobulin antibody （TGAb）, thyroid peroxidase antibody （TPOAb）. To assess these indicators and conduct correlation analysis. Results A total of 185 adults with normal thyroid function were chosen, the level of urinary iodine [M （P25, P75）] was 140.40 （90.30, 198.95） μg/L. The average level of serum iodine was （66.32 ± 15.46） μg/L for the adults of normal thyroid function, the 95% medical reference range of serum iodine in normal adults was initially formulated as 36.02 - 96.62μg/L. The average level of FT3 in adults of normal thyroid function was （5.18 ：t： 0.51） pmol/L, the average level of FT4 was （18.04 ± 2.06） pmol/L, and the level of TSH was 1.57 （1.14, 2.04） mU/L. The area under the receiver operating characteristic （ROC） curve for serum iodine was 0.781, it was higher than the area under ROC curve for urinary iodine （0.524）, the difference was statistically significant （t = - 12.22, P 〈 0.05）. Serum iodine was positively associated with the level of Fr4 （r = 0.250, P 〈 0.05）, there was no significant correlation between serum iodine and FT3, TSH （r = - 0.071, 0.045, all P 〉 0.05）. Conclusions Serum iodine, which can accurately reflect recent iodine nutritional status, is relatively stable than urinary iodine. The medical reference range of serum iodine in normal adults is formulated in this study and it may provide scientific evidence for individual iodine nutritional assessment.