中老年人群碘营养状况监测与桥本甲状腺炎影响因素的调查研究

Monitoring of iodine nutritional status in middle-aged and elderly population and investigation research on the influencing factors of Hashimoto′s thyroiditis

目的明确中老年人群碘营养状况,指导居民科学补碘,探讨桥本甲状腺炎的发病相关危险因素,为防治甲状腺疾病提供科学依据。方法分层抽样选取2019年5月~2020年1月于济南市长清区人民医院住院及健康查体的600例中老年人群,所调查对象来自长清区各乡镇街道常住人口,搜集性别、年龄、病史、血压、血脂、甲状腺功能、甲状腺超声检查等临床资料,并进行尿碘检测。符合桥本甲状腺炎诊断标准的56例患者作为桥本组,选取与桥本组年龄结构无显著差异的401例受试者作为对照组。采用单因素分析和多因素Logistic回归分析桥本甲状腺炎发生可能的影响因素。结果受检者尿碘中位数为152.7μg/L,碘缺乏者61例(10.17%),碘过量者39例(6.50%)。两组的高血压发生率、无合并症占比比较,差异有统计学意义(P<0.05);两组的性别、年龄、吸烟史、饮酒史、血脂异常、脑梗死、冠心病、糖尿病比较,差异无统计学意义(P>0.05)。两组的血清促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)水平比较,差异有统计学意义(P<0.05);两组的游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)及尿碘水平比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,TSH(OR=1.251,95%CI:1.163~1.346,P<0.05)、TGAb(OR=1.016,95%CI:1.012~1.020,P<0.05)、TPOAb(OR=1.010,95%CI:1.006~1.014,P<0.05)是桥本甲状腺发生的危险因素,无合并症是桥本甲状腺发生的保护因素(OR=0.188,95%CI:0.054~0.653,P<0.05)。结论所调查人群总体处于碘营养适宜水平,个体差异大,部分碘缺乏者因盲目忌碘饮食所致。无合并症是桥本甲状腺炎发生的保护因子;TSH、TGAb和TPOAb是桥本甲状腺炎发生的危险因子,TSH每升高1单位,发生风险增加1.251倍。

Objective To clarify the iodine nutritional status of middle-aged and elderly people,to guide the residents to supplement iodine scientifically,and to explore the risk factors of Hashimoto′s thyroiditis,so as to provide scientific basis for the prevention and treatment of thyroid diseases.Methods Stratified sampling was used to select 600 middle-aged and elderly people who were hospitalized and underwent health check-ups in Changqing People′s Hospital of Ji′nan City from May 2019 to January 2020.The survey subjects were from the permanent residents of various towns and streets in Changqing District,the clinical data of gender,age,medical history,blood pressure,blood lipids,thyroid function and thyroid ultrasound examination were collected,and urine iodine test was performed.A total of 56 patients who met the diagnostic criteria for Hashimoto′s thyroiditis were regarded as the Hashimoto group,and 401 subjects with no significant difference in age structure from the Hashimoto group were selected as the control group.Single factor analysis and multivariate Logistic regression were used to analyze the possible influencing factors for incidence of Hashimoto′s thyroiditis.Results The median urinary iodine was 152.7μg/L,61 cases(10.17%)were iodine deficient,and 39 cases(6.50%)were iodine excess.There were statistically significant differences in the incidence of hypertension and the proportion of no comorbidities between the two groups(P<0.05).There were no significant differences in gender,age,smoking history,drinking history,dyslipidemia,cerebral infarction,coronary heart disease,diabetes between the two groups(P>0.05).There were statistically significant differences in the serum thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb)and thyroid peroxidase antibody(TPOAb)levels between the two groups(P<0.05).There were no significant differences in the levels of free triiodothyronine(FT3),free thyroxine(FT4)and urine iodine between the two groups(P>0.05).The results of multivariate Logistic regression analysis showed that TSH(OR=1.251,95%CI:1.163-1.346,P<0.05),TGAb(OR=1.016,95%CI:1.012-1.020,P<0.05),TPOAb(OR=1.010,95%CI:1.006-1.014,P<0.05)were risk factors for incidence of Hashimoto′s thyroid,no comorbidities were protection factors for incidence of Hashimoto′s thyroid(OR=0.188,95%CI:0.054-0.653,P<0.05).Conclusion Population surveyed are generally at the appropriate level of iodine nutrition,with large individual differences.Some iodine deficient people are caused by blindly avoiding iodine diet.No comorbidities are the protective factor of Hashimoto′s thyroiditis,and TSH,TGAb and TPOAb are the risk factors of Hashimoto′s thyroiditis.The risk of Hashimoto′s thyroiditis increases by 1.251 times when TSH increases by 1 unit.