浙江省8~10岁儿童碘营养水平与甲状腺肿调查

Iodine nutrition and goiter prevalence among children at ages of 8 to 10 years in Zhejiang Province

目的了解浙江省8~10岁儿童碘营养水平及甲状腺肿患病情况,为防治儿童碘缺乏病提供依据。方法于2021年采用多阶段分层随机抽样方法,以浙江省11个市的90个县(市、区)为现场调查点,抽取8~10岁非寄宿制儿童为调查对象。采集调查对象家庭食盐样品和随机尿样,采用直接滴定法和砷铈催化分光光度法分别检测盐碘和尿碘含量,评价儿童碘营养水平;超声测量儿童甲状腺侧叶,计算甲状腺肿大率。结果调查19363人,其中男童9710人,女童9653人,男女性别比为1.01∶1。城市10704人,占55.28%;农村8659人,占44.72%。沿海地区9149人,占47.25%;内陆地区10214人,占52.75%。盐碘含量为(19.79±9.25)mg/kg,合格碘盐15252份,合格碘盐覆盖率为78.77%。其中城市儿童合格碘盐覆盖率为76.70%,低于农村儿童的81.21%(χ^(2)=68.301,P<0.001);沿海地区儿童合格碘盐覆盖率为68.05%,低于内陆地区儿童的88.27%(χ^(2)=1270.769,P<0.001)。尿碘中位数为195.1μg/L,家庭盐碘与儿童尿碘含量呈正相关(r_(s)=0.383,P<0.001)。碘不足、碘适宜、碘超适宜和碘过量分别为2885、7137、5414和3927人,占14.90%、36.86%、27.96%和20.28%。不同地区和性别儿童碘营养状况分布差异有统计学意义(χ^(2)=283.277,P<0.001;χ^(2)=126.349,P<0.001)。超声检查7195人,甲状腺肿大率为2.45%。城市儿童甲状腺肿大率为2.76%,高于农村儿童的2.00%(χ^(2)=3.962,P=0.047)。结论2021年浙江省8~10岁儿童碘营养状况总体适宜,儿童甲状腺肿大率符合碘缺乏病消除标准限值,但仍需强化碘盐质量监督,加强碘缺乏病防治干预。

Objective To investigate the status of iodine nutrition and prevalence of goiter among children at ages of 8 to 10 years in Zhejiang Province in 2021,so as to provide insights into the management of iodine deficiency in children.Methods A total of 90 counties(districts)were sampled as field survey sites from 11 cities of Zhejiang Province using a multi-stage stratified random sampling method in 2021,and non-residential children at ages of 8 to 10 years in these sites were sampled as study subjects.Subjects'household edible salt samples and random urine samples were collected.The iodine content in salt and urinary iodine level were determined using the direct titration method and arsenic-cerium catalytic spectrophotometry for evaluation of iodine nutrition among children.In addition,the lateral lobe of the thyroid gland was measured using ultrasound,and the prevalence of goiter was estimated.Results A total of 19363 children were recruited,including 9710 male children and 9653 female children,with a male to female ratio of 1.01︰1,and there were 10704 urban children(55.28%)and 8659 rural children(44.72%),9149 children living in coastal areas(47.25%)and 10214 children in inland regions(52.75%).The mean iodine content was(19.79±9.25)mg/kg in salt,and the coverage of qualified iodized salt(15252)was 78.77%.The coverage of qualified iodized salt was significantly lower in urban children than in rural children (76.70% vs. 81.21%;χ^(2)=68.301, P<0.001), and was lower in children living in coastal regions than in inland regions (68.05% vs. 88.27%;χ^(2)=1 270.769, P<0.001). The me dian urinary iodine concentration was 195.1 μg/L, and the household iodine content in salt correlated positively with uri nary iodine concentration in children (r_(s)=0.383, P<0.001). There were 2 885 children with iodine deficiency (14.90%), 7 137 children with adequate iodine (36.86%), 5 414 children with excessive iodine intake (27.96%), and 3 927 chil dren with iodine overdose (20.28%), and the distribution of iodine nutrition in children varied significantly in regions (χ^(2)=283.277, P<0.001) and gender (χ^(2)=126.349, P<0.001). The prevalence of goiter was 2.45% among 7 195 children receiving ultrasound examinations, and a higher prevalence rate of goiter was detected in urban children than in rural children (2.76% vs. 2.00%;χ^(2)=3.962, P=0.047). Conclusions The overall urinary iodine nutrition was adequate among children at ages of 8 to 10 years in Zhejiang Province in 2021, and the prevalence of goiter in children fell within the threshold defined in the criteria of elimination of iodine deficiency. However, the supervision of the iodized salt quality remains to be improved and iodine deficiency control remains to be reinforced.