广西食盐加碘与居民碘营养调查

Salt iodization and risk assessment of iodine nutritional status in Guangxi

目的 评估实施食盐加碘后广西不同人群碘营养状况及其风险。方法 于2020年,采用分层抽样方法,在广西抽取9个市18个县(市、区),共抽取8~10岁儿童3 700名,当地生活半年以上的成人和孕妇709、788名,开展问卷调查和甲状腺超声检查,同时,测定盐碘、尿碘和血清甲状腺激素浓度。结果 盐碘中位数为24.1 mg/kg,其中,学龄儿童、成人和孕妇的盐碘中位数分别为23.8、25.0、24.9 mg/kg;内陆和沿海地区调查对象的盐碘中位数分别为24.3、23.0 mg/kg,差异有统计学意义(P<0.01)。学龄儿童的尿碘浓度中位数为181.2μg/L,范围为ND~2 186.0μg/L,该人群碘营养状况处于适宜水平。其中,男童的尿碘浓度高于女生,差异有统计学意义(P<0.01);内陆地区儿童的尿碘浓度高于沿海地区,差异有统计学意义(P<0.01)。成人的尿碘浓度中位数为130.0μg/L,范围为4.0~711.9μg/L,该人群碘营养状况处于适宜水平。其中,男性、女性成人的尿碘浓度间比较,差异无统计学意义(P>0.05);内陆地区成人的尿碘浓度低于沿海地区,差异有统计学意义(P<0.05)。孕妇的尿碘浓度中位数为143.7μg/L,范围为10.4~866.0μg/L,该人群碘营养状况略显不足。其中,不同孕期孕妇的尿碘浓度间比较,差异无统计学意义(P>0.05)。内陆地区孕妇的尿碘浓度低于沿海地区,差异有统计学意义(P<0.05)。成人血清的TSH浓度中位数为1.620 mIU/L(范围为0.005~47.770 mIU/L),FT_(3)、FT_(4)浓度分别为(4.29±1.08) pmol/L和(16.03±2.98) pmol/L。与沿海地区比较,内陆地区成人血清TSH、FT_(3)、FT_(4)浓度均较高,差异有统计学意义(P<0.01);与男性比较,女性成人血清TSH浓度较高,而FT_(3)、FT_(4)浓度均较低,差异有统计学意义(P<0.01)。各常见甲状腺疾病检出情况如下:低TF_4血症2.3%、亚甲减3.3%、甲减0.9%、亚甲亢3.1%、甲亢1.5%。沿海地区亚甲亢检出率高于内陆地区,差异有统计学意义(P<0.05)。学龄儿童甲状腺容积平均为(2.8±1.2) ml,甲状腺肿大率为0.5%(18/3 700)。其中,男生甲状腺容积和甲肿率分别为(2.8±1.2) ml和0.4%,女生甲状腺容积和甲肿率分别为(2.9±1.3) ml和0.5%,差异均无统计学意义(P>0.05);内陆儿童甲状腺容积和甲肿率分别为(2.8±1.2) ml和0.5%,沿海地区儿童甲状腺容积和甲肿率分别为(3.0±1.2) ml和0.6%,不同地区甲状腺容积差异有统计学意义(P<0.01)。成人甲状腺容积平均为(7.9±3.0) ml,甲状腺肿大率为1.4%(10/709)。其中,男性甲状腺容积和甲肿率分别为(8.1±2.4) ml和0%,女性甲状腺容积和甲肿率分别为(7.7±3.3) ml和2.2%,两者甲肿率差异有统计学意义(P<0.05);内陆人群甲状腺容积和甲肿率分别为(8.1±3.0) ml和1.5%,沿海人群甲状腺容积和甲肿率分别为(6.5±3.0) ml和0.9%,差异均无统计学意义(P>0.05)。结论 广西居民的碘营养状况总体处于适宜和安全水平,但孕妇略显不足。食盐加碘并未造成当地居民的碘摄入过量,需加强人群碘营养和甲状腺激素水平动态监测。

Objective To assessment the iodine nutritional status and risk of different populations in Guangxi after salt iodization.Methods A total of 3700 children aged 8-10 years,709 adults and 788 pregnant women from 18 counties in 9 cities of Guangxi were selected by stratified sampling method in 2020.Who were questionnaire,examined on thyroid ultrasonography.And salt iodine,urinary iodine and blood thyroid hormone levels were assayed respectively.Results The median of salt iodine was 24.1 mg/kg,and the median of salt iodine for school-aged children,adults and pregnant women were 23.8,25.0,24.9 mg/kg respectively.The median of salt iodine in inland and coastal areas were 24.3 and 23.0 mg/kg respectively,the difference was statistically significant(P<0.01).The median of urinary iodine in school-aged children was 181.2μg/L,the check-out range were ND-2186.0μg/L.The urinary iodine concentration of boys was higher than that of girls,whose difference was statistically significant(P<0.01).And the urinary iodine of children in inland areas was higher than that in coastal areas,whose difference was statistically significant(P<0.01).The median of urinary iodine in adults was 130.0μg/L,the check-out range was 4.0-711.9µg/L.The iodine nutritional status of them was at an appropriate level.There was no significant difference in urinary iodine concentration between male and female adults(P>0.05).But the urinary iodine of adults in inland areas was lower than that in coastal areas,whose difference was statistically significant(P<0.05).The median of urinary iodine in pregnant women was 143.7μg/L,the check-out range was 10.4-866.0μg/L.The iodine nutritional status of them was slightly insufficient.There was no significant difference in urinary iodine concentration among different stages of pregnancy(P>0.05).But the urinary iodine of pregnant women in inland areas was lower than that in coastal areas,whose difference was statistically significant(P<0.05).The median concentration of TSH in adult was 1.620 mIU/L(the check-out range were 0.005-47.770 mIU/L).The concentration of FT_(3) and FT_(4) were(4.29±1.08)pmol/L and(16.03±2.98)pmol/L respectively.Compared with the coastal areas,the serum concentrations of TSH,FT_(3) and FT_(4) were higher in the inland areas,and the difference was statistically significant(P<0.01).Compared with males,the TSH concentration was higher,but FT_(3) and FT_(4) concentration were lower in females,the differences were statistically significant(P<0.01).The results of common thyroid diseases:low FT_(4) hyperlipidemia was 2.3%,subclinical hypothyroidism was 3.3%,hypothyroidism was 0.9%,subclinical hyperthyroidism was 3.1%and hyperthyroidism was 1.5%.The detection rate of hyperthyroidism in coastal areas people was higher than that in inland areas,and the difference was statistically significant(P<0.05).The thyroid volume of school-age children was(2.8±1.2)ml and the goiter rate was 0.5%(18/3700).Among them,the thyroid volume and goiter rate of boys were(2.8±1.2)ml and 0.4%respectively,but(2.9±1.3)ml and 0.5%in girls.There was no significant difference between the two groups(P>0.05).The thyroid volume and goiter rate in inland areas children were(2.8±1.2)ml and 0.5%respectively,but(3.0±1.2)ml and 0.6%in coastal areas children.There wase significant difference in thyroid volume between different areas(P<0.01).The thyroid volume of adults was(7.9±3.0)ml and the goiter rate was 1.4%(10/709).Among them,the thyroid volume and goiter rate of males were(8.1±2.4)ml and 0%respectively,but(7.7±3.3)ml and 2.2%in females.There was significant difference in goiter rate between the two groups(P<0.05).The thyroid volume and goiter rate in inland areas people were(8.1±3.0)ml and 1.5%respectively,but(6.5±3.0)ml and 0.9%in coastal areas npeople.There was no significant difference between the two groups(P>0.05).Conclution The iodine nutritional status is generally at an appropriate and safe level of guangxi residents,but slightly insufficient in pregnant women.It did not cause excessive iodine intake by salt iodization among local residents.Routine monitoring of iodine nutrition and blood thyroid hormone should be carried out intensive.