2013-2022年陕西省宝鸡市碘缺乏病监测结果分析

Analysis of iodine deficiency disorders monitoring results in Baoji City,Shaanxi Province from 2013 to 2022

目的了解新盐碘标准执行10年间陕西省宝鸡市居民碘营养状况与其变化趋势,评价碘缺乏病防治效果,为落实科学补碘措施提供依据。方法2013-2015年在陕西省宝鸡市的每个县(区),按东、西、南、北、中划分为5个片区,每个片区抽取1个镇(街道,简称镇),每个镇抽取4个行政村,每个行政村抽取15户居民,采集家中食用盐盐样,检测盐碘含量;同时在每个抽中的镇各抽取1所小学,每所小学抽取8~10岁42名儿童(年龄、性别均衡),进行甲状腺触诊检查。2016-2022年每个县(区)按东、西、南、北、中划分为5个片区,每个片区抽取1个镇,每个镇抽取1所小学,每所小学抽取8~10岁非寄宿学生42人(年龄、性别均衡),采集家中食用盐盐样,检测盐碘含量,并进行甲状腺触诊检查;同时在每个镇抽取4个行政村,在每个行政村抽取10户居民,采集家中食用盐盐样,检测盐碘含量;每个县(区)在所抽取的5个镇中各抽取21名孕妇,采集家中食用盐盐样,检测盐碘含量。2013-2022年,与同期盐碘监测同步,采集抽中儿童、孕妇(早、中、晚孕期均衡)尿样,检测尿碘含量。盐碘含量测定采用直接滴定法,川盐及其他强化食用盐采用仲裁法(GB/T 13025.7-1999);甲状腺检查依据《地方性甲状腺肿诊断标准》(WS 276-2007)进行诊断和分度;尿碘检测采用《尿中碘的砷铈催化分光光度测定方法》(WS/T 107-2006)。结果2013-2022年共采集居民食用盐盐样37609份,各年度碘盐覆盖率、碘盐合格率和合格碘盐食用率范围分别为98.00%~100.00%、94.16%~99.55%、92.28%~99.67%,盐碘中位数范围为22.42~26.80 mg/kg。共检查8~10岁儿童25437人,各年度甲状腺肿大(甲肿)率范围为0.35%~3.02%。共采集尿样33270份,其中儿童21698份、孕妇11572份,各年度儿童尿碘中位数范围为203.70~275.47μg/L,孕妇尿碘中位数范围为167.65~218.57μg/L。各年份儿童尿碘水平呈下降趋势(Z=3.04,P=0.002);而孕妇尿碘中位数各年间比较,差异无统计学意义(Z=1.61,P=0.110)。结论陕西省执行新盐碘标准的10年间,宝鸡市碘缺乏病监测的各项指标均达标并保持碘缺乏病消除状态,儿童尿碘水平呈下降趋势,孕妇尿碘水平未见明显改变。建议宝鸡市扩大重点人群碘营养监测的范围,有效开展以监测信息为导向的因地制宜、分类指导的科学补碘措施。

Objective To investigate the iodine nutrition status of residents and its changing trend in Baoji City,Shaanxi Province during the 10 years implementation of a new salt iodine standard,evaluate the prevention and treatment effects,and provide a basis for implementing iodine supplementation measures scientifically.Methods From 2013 to 2015,each county(district)in Baoji City,Shaanxi Province was divided into 5 districts based on east,west,south,north,and central regions.One town(street,referred to as the town)was selected from each district,and four administrative villages were selected from each town.Fifteen residents from each administrative village were selected to collect edible salt samples from their homes and test the iodine content of the salt.At the same time,one primary school was selected from each selected town,and 42 children(age and gender were balanced)aged 8-10 were selected from each primary school for thyroid palpation examination.From 2016 to 2022,each county(district)was divided into 5 districts based on east,west,south,north,and central regions.One town was selected from each district,and one primary school was selected from each town.Forty-two non boarding students aged 8-10 were selected from each primary school to undergo thyroid palpation examination,and edible salt samples were collected from their home to detect salt iodine content.At the same time,4 administrative villages were selected from each town,and 10 households were selected from each administrative village to collect edible salt samples and test the salt iodine content;21 pregnant women were selected from each of the 5 towns in each county(district)to collect edible salt samples and test the salt iodine content.From 2013 to 2022,synchronous collection of urine samples from children and pregnant women(early,middle,and late pregnancy were balanced)was conducted to detect urine iodine content.Direct titration method was adopted for determination of salt iodine content,and arbitration method was adopted for Sichuan salt and other fortified edible salt(GB/T 13025.7-1999).Thyroid examination was performed according to the Diagnostic Criteria for Endemic Goiter(WS 276-2007).Urine iodine was detected by Arsenic Cerium Catalytic Spectrophotometric Method for Determination of Iodine in Urine(WS/T 107-2006).Results From 2013 to 2022,a total of 37609 household edible salt samples were collected.The coverage rate of iodized salt,the qualified rate of iodized salt and the consumption rate of qualified iodized salt for each year ranged from 98.00%to 100.00%,94.16%to 99.55%,and 92.28%to 99.67%,respectively.The median range of salt iodine was 22.42 to 26.80 mg/kg.A total of 25437 children aged 8-10 were examined,and the annual incidence of thyroid enlargement(goiter)ranged from 0.35%to 3.02%.A total of 33270 urine samples were collected,including 21698 from children and 11572 from pregnant women.The median range of urine iodine for children in each year was 203.70-275.47μg/L,median range of urine iodine in pregnant women was 167.65-218.57μg/L.The median urine iodine in children showed a decreasing trend from 2013 to 2022(Z=3.04,P=0.002);the median urine iodine of pregnant women did not show a significant decrease(Z=1.61,P=0.110).Conclusions During the 10 years implementation of the new salt iodine standard in Shaanxi Province,all indicators of iodine deficiency disorders monitoring in Baoji City have met the standards and maintained the elimination status of iodine deficiency disorders.The urine iodine levels of children have shown a downward trend,while urine iodine levels of pregnant women do not show significant changes.It is recommended that Baoji City expand the scope of iodine nutrition monitoring for key populations,and effectively carry out iodine supplementation measures scientificlly guided by monitoring information,tailored to local conditions,and classified guidance.