山西省不同水碘含量地区供应碘盐模式探讨

Discussion on the mode of iodized salt supply in different water iodine content areas of Shanxi Province

目的探讨山西省不同水碘地区供应碘盐的不同模式,促进因地制宜、科学补碘策略的落实。方法根据2017年山西省外环境水碘含量调查及碘缺乏病监测结果,选择供应碘盐和供应未加碘食盐的水碘值分别介于40~49μg/L、50~59μg/L和60~69μg/L的村作为调查点;在供应碘盐村选择281名8~10岁儿童、111名孕妇,在供应未加碘盐村选择267名8~10岁儿童、39名孕妇,进行尿碘水平测定;对全部8~10岁儿童进行甲状腺容积测定;对供应未加碘食盐地区孕妇测定甲状腺功能;比较供应碘盐和未加碘食盐的居民碘营养状况等。结果不同水碘地区,供应碘盐和未加碘食盐的儿童及孕妇尿碘中位数均处于适宜水平;供应碘盐和未加碘食盐的地区儿童甲肿率均小于5%;不同水碘地区供应未加碘食盐地区的孕妇甲状腺功能异常率无统计学差异,但在水碘值在40~49μg/L和50~59μg/L组有低T4血症检出,检出率分别为5.6%和9.1%,两组低T4血症检出率无统计学差异(χ2=0.133,P=0.715)。结论山西省水碘值在40~69μg/L的地区,无论供应碘盐还是未加碘食盐,均能基本满足儿童及孕妇的碘营养需求。建议水碘值在40~69μg/L的适碘地区实施"双轨制",既可供应碘盐也可供应未加碘食盐,也可同时供应,自主选择。其中水碘值在40~59μg/L的地区的孕妇如果选择食用未加碘食盐,则建议适当额外补碘。

Objective To explore the different modes of iodized salt supply in different water iodine concentration areas of Shanxi Province for promoting the implementation of scientific iodine supplement strategy.Methods According to the results of investigation on iodine content of water in Shanxi Province in 2017 and the monitoring results of iodine deficiency in Shanxi Province in 2017.The villages with water iodine values of 40-49 μg/L,50-59 μg/L and 60-69 μg/L were selected as the survey points,and they were classified as iodine salt supply area and non-iodized salt supply area;281 children aged 8-10 years and 111 pregnant women were selected in the village where iodized salt was supplied;267 children aged 8-10 years and 39 pregnant women were selected in the village without iodized salt supply;thyroid volume was measured in all children aged 8-10 years;thyroid function of pregnant women in areas without iodized salt supply was measured.The iodine nutritional status of residents who supplied iodized salt and non-iodized salt were compared.Results In the different water iodine concentration areas,the median urinary iodine levels of children and pregnant women with iodized salt and with non-iodized salt were at the appropriate level;the goiter rates of children with iodized salt and with non-iodized salt were less than 5%;there was no significant difference in the thyroid function of pregnant women in areas with different water iodine concentration.However,in the water iodine value of 40-49 μg/L and 50-59 μg/L groups,the detection rate of low T4 was 5.6% and 9.1%,respectively.There was no significant difference in the detection rate of low T4 between the two groups(χ2=0.978,P=0.613).Conclusion In Shanxi Province,the iodine value of water in 40-69 μg/L areas,whether supply iodized salt or not,can basically meet the iodine nutritional needs of children and pregnant women.It is suggested that a "double track system" should be implemented in areas where the iodine value of water is between 40 μg/L and 69 μg/L,which can supply iodized salt and non-iodized salt at the same time or supply one of them solely.Among them,if pregnant women in areas with water iodine value of 40-59 μg/L choose to eat non-iodized salt,it is recommended to supplement iodine appropriately.