上海市闵行区学龄儿童尿碘水平及不同甲状腺容积标准的适用性分析

Urine iodine concentrations and feasibility of different thyroid volume criterion in school-age children of Minhang District in Shanghai

目的评价2017年上海市闵行区8~10岁儿童的尿碘水平;分析WHO 2007和中国甲状腺容积标准对上海学龄儿童甲状腺肿的适用性。方法按五方位随机抽取5个街道各40名8~10岁学龄儿童进行尿碘含量测定和甲状腺左右两叶超声检测,利用公式计算出除甲状腺峡部之外的甲状腺容积(即甲状腺左右叶之和),根据WHO 2007甲状腺容积标准和我国WS 276-2007《地方性甲状腺肿诊断标准》分别对其甲肿率进行判定。结果本次调查的8~10岁学龄儿童尿碘中位数为252μg/L,不同年龄段和不同性别儿童的尿碘频数分布差异均无统计学意义(χ~2=3.802,0.283,均P>0.05)。该人群的甲状腺容积范围为0.326~7.144(M=2.793)ml,呈非正态性分布。在不同年龄段对甲状腺容积进行多个独立样本中位数比较的K-W检验,甲状腺容积随着年龄的增加而增大(H=8.635,P<0.05)。同一年龄组男女甲状腺容积的差异无统计学意义(H=0.382,0.971,0.703,均P>0.05)。尿碘中位数与儿童甲状腺容积的相关无统计学意义(r=0.062,P>0.05)。用WHO2007标准判定的各年龄组和性别间儿童的甲肿率,在9岁年龄组、女生组、合计组与中国WS 276-2007标准的差异有统计学意义(χ~2=7.568,12.75,均P<0.01)。结论上海市闵行区8~10岁学龄儿童处于尿碘水平稍大于适宜的碘营养水平,提示应指导其合理调整饮食,加强长期动态监测,真正做到科学适量补碘。另外,由于甲状腺容积可能存在着遗传差异,WHO 2007甲状腺容积标准对上海学龄儿童可能不适用。

[Objective]To evaluate the urine iodine（UI） concentrations of children aged 8 to 10 years old in Minhang District of Shanghai in 2017,analyze the feasibility of judging the goiter using the WHO2007 and Chinese thyroid volume（TV） criteria in Shanghai school-age children. [Methods] Five sub-districts were selected according to the five direction policy and 40 school-age children were chosen from each sub-district,to detect their UI concentration and thyroid lobes. The TV（except the thyroid isthmus,that is sum of the left and right lobes of the thyroid gland） was calculated by using the formula,and judging the goiter by using WHO2007 TV criteria and Diagnostic criteria for endemic goiter（WS 276-2007）. [Results] The median value of UI was252 μg/L in children aged 8-10 years. The frequency distribution of children＇ UI showed no significant difference among different groups in age and gender（χ^2=3.802,0.283,all P〉0.05）. The TV of the sample group was 0.326-7.144（M=2.793）ml,showing non-normality distribution. K-W test of TV in multiple independent samples median at different age groups revealed that TV increased with the increment of age（H=8.635,P〈0.05）. There were no significant difference in TV between boys and girls in the same age group（H=0.382,0.971,0.703,all P〉0.05）. There was no significant correlation between median UI and TV（r=0.062,P〉0.05）. For the goiter prevalence judged by the WHO2007 and Chinese TV criteria,the differences were statistically significant in 9 year-old age group,girl group and aggregated group（χ^2=7.568,12.75,both P〈0.01）. [Conclusion] The UI concentration of children aged 8 to 10 years old in Minhang District is slightly higher than the appropriate range. The results suggest that it is necessary to guide them to adjust diet rationally and strengthen long-term dynamic monitoring so as to achieve proper iodine supplement. In addition,due to genetic differences in TV,the WHO2007 TV criteria may not apply to Shanghai school-age children.