黑龙江省中老年人群甲状腺结节流行病学特征及其影响因素

Epidemiological characteristics and influencing factors of thyroid nodule in middle-aged and elderly people in Heilongjiang Province

目的了解黑龙江省中老年人群甲状腺结节患病情况,分析其流行特点及影响因素.方法2017年12月至2018年12月,在黑龙江省采用人口比例概率抽样法(PPS法)招募年龄为40~70岁的中老年人群,进行横断面调查.将调查对象按年龄分层(40~49、50~59、60~70岁),收集日间随意1次尿样,采用砷铈催化分光光度法(WS/T 107.1-2016)检测尿碘.同时,对调查对象进行问卷调查和甲状腺超声检查.采用logistic回归分析相关调查因素与甲状腺结节患病的关系.结果共纳入2771名中老年人,年龄为(54.32±8.24)岁,尿碘中位数为157.04μg/L,处于碘适宜水平.甲状腺结节患病率为43.63%(1209/2771),且患病率随着年龄的增长而增加(x2趋势=49.400,P<0.01);其中,女性患病率为46.98%(917/1952),明显高于男性的35.65%(292/819),差异有统计学意义(x2=30.082,P<0.01).甲状腺结节患者中,小结节占57.65%(697/1209),大结节占42.35%(512/1209),且大结节所占比例随着年龄的增长而增加(x2趋势=18.751,P<0.01);单发结节占42.76%(517/1209),多发结节占57.24%(692/1209),且多发结节所占比例随着年龄的增长而增加(x2趋势=18.437,P<0.01);以囊实性结节最为多见[47.97%(580/1209)],其次为实性结节[44.25%(535/1209)],囊性结节最为少见[7.78%(94/1209)].logistic回归分析显示,女性[比值比(OR)=1.868,95%置信区间(CI):1.538~2.269,P<0.01]、年龄(50~59岁组:OR=1.258,95%CI:1.020~1.550,P<0.05;60~70岁组:OR=1.762,95%CI:1.407~2.207,P<0.01)、超重(OR=1.303,95%CI:1.078~1.574,P<0.01)、高血压(OR=1.332,95%CI:1.037~1.712,P<0.05)以及糖尿病(OR=1.604,95%CI:1.077~2.387,P<0.05)是影响中老年人群甲状腺结节发生的独立危险因素.结论黑龙江省中老年人群甲状腺结节的流行有明显的年龄趋势和性别差异,随着年龄的增长,大结节、多发结节所占比例逐渐增加.对于女性、高龄、超重、高血压及糖尿病人群应加强早期筛查并关注其预后.

Objective To investigate the prevalence of thyroid nodule in middle-aged and elderly people in Heilongjiang Province,and to analyze its epidemiological characteristics and influencing factors.Methods From December 2017 to December 2018,middle-aged and elderly people aged 40-70 years old were recruited through probability proportional sampling(PPS)method for a cross-sectional survey.The respondents were stratified by age(40-49,50-59,60-70 years old),urine samples were collected at random once during the day,and urinary iodine was detected by arsenic-cerium catalytic spectrophotometry(WS/T 107.1-2016).At the same time,questionnaire surveys and thyroid ultrasound examinations were conducted on the respondents.Logistic regression was used to analyze the relationship between the related investigation factors and the thyroid nodule.Results A total of 2771 middle-aged and elderly people were included,and their age was(54.32±8.24)years old.The median of urinary iodine was 157.04μg/L,which was an iodine appropriate level.The prevalence of thyroid nodule was 43.63%(1209/2771),and the prevalence increased with age(χ2trend=49.400,P<0.01).The prevalence of thyroid nodule in females[46.98%(917/1952)]was significantly higher than that in males[35.65%(292/819),χ2=30.082,P<0.01].In patients with thyroid nodule,small nodule accounted for 57.65%(697/1209),large nodule accounted for 42.35%(512/1209),and the proportion of large nodule increased with age(χ2trend=18.751,P<0.01).Solitary nodule accounted for 42.76%(517/1209),multiple nodule accounted for 57.24%(692/1209),and the proportion of multiple nodule increased with age(χ2trend=18.437,P<0.01).Cystic-solid nodule was the most common[47.97%(580/1209)],followed by solid nodule[44.25%(535/1209)],and cystic nodule was the least common[7.78%(94/1209)].Logistic regression analysis showed female[odds ratio(OR)=1.868,95%confidence interval(CI):1.538-2.269,P<0.01],age(50-59 years old:OR=1.258,95%CI:1.020-1.550,P<0.05;60-70 years old:OR=1.762,95%CI:1.407-2.207,P<0.01),overweight(OR=1.303,95%CI:1.078-1.574,P<0.01),hypertension(OR=1.332,95%CI:1.037-1.712,P<0.05),and diabetes(OR=1.604,95%CI:1.077-2.387,P<0.05)were independent risk factors affecting the occurrence of thyroid nodule in middle-aged and elderly people.Conclusions The epidemiological characteristics of thyroid nodule in middle-aged and elderly people in Heilongjiang Province have obvious age trends and gender differences.The proportion of large nodule and multiple nodule increase with age.Early screening and attention to the prognosis of women,older,overweight,hypertension and diabetes people should be strengthened.