不同碘摄入量地区居民甲状腺肿和甲状腺结节的流行病学对比研究

A comparative epidemic study of goiter and thyroid nodules in areas with different iodine intake

目的 研究不同碘摄入量人群甲状腺肿 (甲肿 )和甲状腺结节的患病率。方法 对盘山县、彰武县和黄骅市的缺碘、碘充足和高碘 3个农村地区 3386名 14岁居民进行甲状腺 B超检查、甲状腺功能、甲状腺自身抗体 (TAA)和尿碘测定。结果 缺碘、碘充足、高碘地区尿碘中位数 (MU I)分别为 10 3、374和 6 15 μg/ L;弥漫型甲肿患病率分别为 19.5 %、13.6 %和 5 .1% ;结节型甲肿患病率分别为 3.7%、3.5 %和 2 .5 %。甲状腺单发结节检出率分别为 8.8%、8.3%和 4 .1% ;多发结节检出率分别为 3.8%、1.9%和 6 .7%。非毒性甲肿患者血清 TSH水平盘山和彰武明显低于同地区无甲肿者 (P <0 .0 1) ;TAA阳性率高于正常人群 (P <0 .0 5 ) ,以黄骅为显著。结论 在 MU I为 10 0～ 6 0 0 μg/ L 的碘摄入量范围内 ,随碘摄入量增加弥漫性甲肿患病率逐渐降低 ,结节性甲肿患病率无明显变化。缺碘地区甲状腺单发结节高发 ,高碘地区多发结节高发。缺碘和碘充足地区甲肿有自主性功能 ,高碘地区甲肿无自主功能。非毒性甲状腺肿、特别是高碘甲状腺肿存在自身免疫异常。

Objective To investigate the prevalence of goiter and thyroid nodules,in the areas with different iodine intakes.Methods Thyroid B ultrasound,thyroid function, thyroid autoantibody and urinary iodine examination were carried out in 3 386 adult inhabitants from 3 rural communities of Pansan (iodine-deficient), Zhangwu (by iodinated salt from year 1996) and Huanghua (iodine excessive).Results The respective median urinary iodine(MUI) in the three communities were 103.1 μg/L,374.8 μg/L and 614.61 μg/L (P<0.01). The prevalence rates of diffuse goiter were 19.5%,13.6% and 5.1% respectively. The prevalence rates of nodular goiter were 3.7%, 3.5% and 2.5% respectively. The detection rates of single-thyroid nodule were 8.8%, 8.3% and 4.1% respectively. The detection rates of multiple-thyroid nodules were 3.8%, 1.9% and 6.7%. The TSH levels in inhabitants with nontoxic goiter were found to be lower than in those without goiter in Panshan and Zhangwu. There was no such discrepancy in Huanghua. In the three areas, especially Huanghua, the thyroid autoimmune antibody (TAA) positive rates of inhabitants with goiter were higher than those with normal thyroid ultrasound (P<0.05).Conclusions The prevalence rate of diffuse goiter significantly decreases with the increasing of area of iodine intake within the MUI scope of 100~600 μg/L, whereas the prevalence rate of nodular goiter shows no obvious alteration. There is a high prevalence rate of single-thyroid nodule in iodine-deficient area; there is a high prevalence rate of multiple-thyroid nodule in iodine-excessive area. Goiters in iodine-deficient areas and in iodine-sufficient areas were observed to have presence of thyroid autonomic function, whereas for goiters in iodine-excessive areas this was not the case. Nontoxic goiters especially iodine excessive-goiter presented abnormally on the autoimmune analysis.