改水降碘对水源性高碘地区儿童甲状腺肿及结节的干预效果

Effectiveness of changing water resource on children＇s goiter and nodule in water-borne high iodine areas

目的 了解改换低碘水源后8 - 10岁儿童的甲状腺肿（甲肿）、甲状腺结节患病情况及碘营养水平，评价干预效果。方法 2014 - 2017年，在河北省选取水源性高碘地区的海兴县马厂村、良章村为监测点，采用横断面调查方法，每个村抽取8 - 10岁儿童100名，男女各半，监测改水前（2014年）、改水后1 - 3年（2015 - 2017年）的生活饮用水水碘、尿碘含量、儿童甲肿及甲状腺结节患病情况。水碘检测采用适合缺碘及高碘地区的砷铈催化分光光度测定法（国家碘缺乏病参照实验推荐方法）；尿碘检测采用砷铈催化分光光度测定法（WS／T 107-2006）；儿童甲状腺检测采用B超法，判定标准依据《地方性甲状腺肿诊断标准》（WS 276-2007）。结果 两个村在改水前水碘中位数为861.0 μg／L，改水后1 - 3年分别为71.6、29.1、30.4 μg／L，改水前后整体比较差异有统计学意义（χ^2 = 8.48，P 〈 0.05）。改水前两个村的儿童尿碘中位数为705.0 μg/L，改水1 - 3年后儿童尿碘中位数分别为306.0、143.0、140.0 μg/L，改水前后比较差异有统计学意义（Z = 6.56、10.82、11.19，P均 〈 0.05）。改水前儿童甲肿率为10.3%（21／203），改水后1 - 3年甲肿率分别为6.3%（13／205）、6.4%（13／203）、3.8%（8／208），改水前与改水后3年比较差异有统计学意义（χ^2 = 6.61，P 〈 0.05）；改水前儿童甲状腺结节检出率为11.3%（23／203），与改水后3年结节检出率［1.4%（3／208）］比较差异有统计学意义（χ^2 = 13.42，P 〈 0.05）。结论 改换低碘水源3年后，当地儿童甲状腺肿病情基本恢复正常、甲状腺结节检出率明显降低，干预效果良好。

Objective To understand the prevalence of goiter and nodule as well as the iodine nutritional status of 8 to 10 years old children after changing water source with lower iodine so as to evaluate its intervention effectiveness. Methods From 2014 to 2017, Machang Village and Liangzhang Village of Haixing County in Haixing County were selected as monitoring sites in the water-sourced high iodine area in Hebei Province. Using the cross-sectional survey method, 100 children aged 8 to 10 years old were randomly selected in each village, half male and half female. Dynamic monitoring of drinking water iodine content, children＇s prevalence of goiter and nodule as well as urinary iodine content were conducted before and 1 - 3 years after changing water resource. Iodine detection was performed using an arsenic cerium-catalyzed spectrophotometric method suitable for iodine-deficient and high-iodine areas （recommended method for national iodine deficiency disease reference experiment）; urinary iodine was detected by arsenic cerium catalytic spectrophotometry （WS/T 107-2006）. The thyroid test was performed using the B-ultrasound method and the criterion was based on the ＂Diagnostic Criteria for Endemic Goiter＂ （WS 276-2007）. Results The median iodine content of water in the two villages before the reformation was 861.0 μg/L, and it was 71.6, 29.1 and 30.4 μg/L in 1 - 3 years after water was changed. The overall difference before and after water change was statistically significant （χ^2 = 8.48, P 〈 0.05）. The median urine iodine of children in the two villages before the change of water was 705.0 μg/L, and the median urine iodine of children was 306.0, 143.0 and 140.0 μg/L after 1 - 3 years. The differences were statistically significant （Z = 6.56, 10.82, 11.19, P 〈 0.05）. The goiter rate was 10.3% （21/203） before changing water, and the goiter rate was 6.3% （13/205）, 6.4% （13/203） and 3.8% （8/208） in 1 - 3 years after water exchange, and the difference between before and 3 years after water exchange was statistically significant （χ^2 = 6.61, P 〈 0.05）. Children＇s nodule prevalence before and 3 years after changing water was 11.3% （23/203） and 1.4% （3/208）, the difference was statistically significant （χ^2 = 13.42, P 〈 0.05）. Conclusion Three years after changing water resource, children＇s goiter prevalence is back to normal in general, and nodule prevalence is decreased significantly, which indicates sound intervention effectiveness.