不同甲状腺健康状况成人血清碘含量及影响因素研究

Serum iodine levels and influencing factors of adults with different thyroid health conditions

目的探讨不同甲状腺健康状况成人血清碘医学参考值、分布特征及其影响因素,评估血清碘对个体碘营养评价的重要性。方法2017年2月至2018年11月,采用多阶段分层整群抽样,在辽宁省沿海地区营口市、内陆地区沈阳市各抽取1个社区和1个农(渔)业村作为调查点,对居住满5年的18岁及以上成人进行问卷调查、临床查体和甲状腺超声检查,并采集所有对象空腹静脉血血样、随机1次尿样进行血清碘、甲状腺激素和抗体及尿碘含量检测。采用百分位数法建立血清碘95%医学参考值,分析不同甲状腺健康状况成人血清碘参考值、分布特征及其影响因素;受试者工作特征(ROC)曲线评估碘营养指标对甲状腺疾病的诊断价值。结果共调查成人2931人,血清碘为62.1(53.6,72.2)μg/L,范围为5.6~642.3μg/L;尿碘为167.6(111.2,244.2)μg/L,碘营养总体处于适宜水平。共检出甲状腺疾病患者1089例,检出率为37.2%(1089/2931);其中,甲状腺结节597例、地方性甲状腺肿(地甲肿)56例、甲状腺功能减退症(甲减)42例、亚临床甲减161例、甲状腺功能亢进症(甲亢)27例、亚临床甲亢18例、自身免疫性甲状腺病(AITD)474例;不同血清碘成人甲状腺疾病检出率比较差异有统计学意义(χ^(2)=13.80,P<0.05)。正常成人、甲减(无甲状腺素干预)、甲亢(无抗甲状腺素药物治疗)、AITD、地甲肿、甲状腺结节患者血清碘参考值范围分别为37.2~103.0、12.5~52.8、49.9~163.1、34.3~129.3、27.3~92.8和37.9~119.5μg/L。ROC曲线分析结果显示,甲亢、亚临床甲亢、地甲肿、甲状腺结节和AITD患者血清碘ROC曲线下面积(AUC)分别为0.94、0.61、0.55、0.53和0.52。单因素分析结果显示,不同位置、地区、年龄、受教育程度、职业、摄碘量、血压、身体质量指数成人血清碘比较差异均有统计学意义(均P<0.05)。结论不同甲状腺健康状况成人血清碘差异较大,应分别制定评价标准和体系;血清碘是个体碘营养评价的重要指标。

Objective To explore the medical reference values,distribution characteristics and influencing factors of serum iodine in adults with different thyroid health conditions,and to evaluate the importance of serum iodine in evaluating individual iodine nutrition.Methods From February 2017 to November 2018,multi-stage stratified cluster sampling was used to select one community and one agricultural(fishing)village in the coastal Yingkou City and the inland areas of Shenyang City of Liaoning Province as survey sites.Cluster sampling of adults over 18 years old who had lived for five years were conducted with questionnaire survey,clinical physical examination and thyroid ultrasound examination.Fasting venous blood samples and one random urine sample were collected from all subjects for serum iodine,thyroid hormone,antibody and urine iodine detection.The 95%medical reference value of serum iodine was established by using the percentage quantile method,and the reference value,distribution characteristics and influencing factors of serum iodine in adults with different thyroid health status were analyzed.The diagnostic value of iodine nutritional indicators in thyroid diseases was evaluated by the receiver operating characteristic(ROC)curve.Results A total of 2931 adults were surveyed,with serum iodine levels of 62.1(53.6,72.2)μg/L,ranging from 5.6 to 642.3μg/L;urine iodine was 167.6(111.2,244.2)μg/L,and the overall iodine level was at an appropriate level.A total of 1089 patients with thyroid diseases were examined,with a detection rate of 37.2%(1089/2931);among them,there were 597 cases of thyroid nodules,56 cases of endemic goiter,42 cases of hypothyroidism,161 cases of subclinical hypothyroidism,27 cases of hyperthyroidism,18 cases of subclinical hyperthyroidism,and 474 cases of autoimmune thyroid disease(AITD).There was a statistically significant difference in the detection of thyroid diseases among adults with different levels of serum iodine(χ^(2)=13.80,P<0.05).The reference values of serum iodine in normal adults,hypothyroidism(without thyroid hormone intervention),hyperthyroidism(without anti thyroid hormone drug treatment),AITD,endemic goiter,and thyroid nodules were 37.2-103.0,12.5-52.8,49.9-163.1,34.3-129.3,27.392.8,and 37.9-119.5μg/L,respectively.The R0C curve analysis results showed that the serum iodine area under curve(AUC)of patients with hyperthyroidism,subclinical hyperthyroidism,endemic goiter,thyroid nodules,and AITD were 0.94,0.61,0.55,0.53,and 0.52,respectively.The results of univariate analysis showed that there were statistically significant differences in adult serum iodine levels among different positions,regions,age,education level,occupation,iodine intake,blood pressure,and body mass index(P<0.05).Conclusions There are significant differences in serum iodine levels among adults with different thyroid health conditions,and evaluation standards and systems should be developed separately.Serum iodine is an important indicator for evaluating individual iodine nutrition.