碘伏皮肤消毒对医护人员甲状腺功能影响的研究

Effects of iodophor on the thyroid glands of female medical workers

目的 探讨长期应用碘伏做术前皮肤消毒对医护人员甲状腺功能和自身免疫状态的影响。方法 选择 119名长期应用碘伏做术前皮肤消毒的女性医务人员 ,以 12 3名同医院年龄配对的无碘伏接触史的女性医护人员作为对照。测定尿碘、促甲状腺激素 (TSH)、游离甲状腺素 (FT4 )、游离三碘甲状腺原氨酸 (FT3)、甲状腺球蛋白抗体 (TPO Ab)和甲状腺球蛋白抗体 (TG Ab) ,B超检查其甲状腺。结果 暴露组、非暴露组的尿碘中位数 (MUI)分别为 30 0 4μg/L和 2 6 9 1μg/L(P >0 0 5 ) ;甲状腺肿患病率分别为 3 4%和 2 4%(P >0 0 5 ) ;暴露组甲状腺疾病的总患病率显著高于非暴露组( 11 8%比 4 1%,P =0 0 2 6 ) ,各种甲状腺疾病的患病率与非暴露组相比都有增加的趋势 ,并尤以临床甲状腺功能亢进症 (甲亢 )和亚临床甲状腺功能减退症 (甲减 )为著。暴露组的临床甲亢患者多在应用碘伏 2～ 4年发病。暴露组的TPO Ab滴度均值显著高于非暴露组 ( 2 9 5IU/L比 2 2 4IU/L ,P =0 0 48)。结论 碘伏应用于术前皮肤消毒可能引起女性医护人员甲状腺疾病发病率增加。有碘伏暴露史的医护人员应当定期进行甲状腺功能和甲状腺自身抗体的检测。

Objective To investigate the long-term effects of iodophor on thyroid function and autoimmunity in females. Methods 119 medical personnel who have been using iodophor as preoperative skin disinfectant more for than 2 years and 123 medical personnel who have not exposed to iodophor were studied. The urinary iodine, thyroid-stimulating hormone (TSH), free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid peroxydase antibody (TPO-Ab) and TG-Ab in serum were measured and the thyroid were examined by B mode ultrasound apparatus. Results The median urinary iodine (MUI) was 300.4 μg/L in the exposed group, not significantly higher than that in the non-exposed group (269.1 μg/L, P>0.05). The TSH levels of the exposed group and non-exposed group were 1.66 mU/L and 1.62 mU/L (P=0.84). B mode ultrasound examination showed that the prevalence rate of thyroid disorders was 3.36% in the exposed group, not significantly different from that in the non-exposed group (2.44%). The thyroid autoantibody positive rate was not significantly different between these two groups too. The titer of autoantibody in the exposed group was 29.5 IU/L, significantly higher than that in the non-exposed group (22.4 IU/L, P=0.048). The titer of TG-Ab in the exposed group was 21.85 IU/L, not significantly different from that in the non-exposed group (18.7 IU/L, P=0.542). The mean titer of TPO-Ab in exposed group was 29.5 IU/L, significantly higher than that in non-exposed group (22.4 IU/L, P=0.048). The total prevalence rate of all sorts of thyroid disorders in the exposed group was 11.76%, significantly higher than that in non-exposed group (4.07%, P=0.026). The thyroid disorders discovered included clinical hyperthyroidism and subclinical hypothyroidism. Conclusion Using iodophor as preoperative skin disinfectant may result in an increased incidence of thyroid disorders in female medical personnel. Medical personnel with iodophor exposure history should have their thyroid function and thyroid autoimmune status examined regularly.