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[目的]了解浙江省台州市椒江区居民碘营养和甲状腺疾病状况。[方法]2010年4—6月,采用横断面调查研究,分层整群抽样法,调查3个村311户居民,尿碘检查944人,甲状腺检查793人。B超法检查甲状腺,砷铈催化分光光度法测定尿碘浓度,化学发光免疫测定法检测甲状腺激素,直接滴定法检测盐碘含量。[结果]检查793人,查出甲状腺结节182例,患病率为22.95%,甲状腺结节患病率随年龄增大而上升(χ2=72.12,P=0.001);其中6~14岁组患病率为0.00%,≥15岁组患病率为25.60%,两组差异有统计学意义(χ2=27.24,P=0.001);女性患病率(26.97%)明显大于男性(17.82%)(χ2=9.25,P=0.002)。调查8~10岁儿童31人,甲状腺肿大率为0.00%。尿碘<100μg/L组甲状腺结节患病率大于≥100μg/L组(χ2=12.50,P=0.007)。标化患病率百果村为19.44%、高张村为26.43%、华景村为19.42%。944人尿碘中位数(median urinary iodine,MUI)为178.25μg/L,其中儿童185.85μg/L、孕妇138.50μg/L、哺乳妇女181.40μg/L、普通人群176.00μg/L,百果村184.40μg/L、高张村152.00μg/L、华景村192.00μg/L。孕妇33人中,甲状腺球蛋白抗体(thyroglobulinantibody,TgAb)和甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性者2例,阳性率6.06%。在B超检查异常的178人中,游离三碘甲腺原氨酸(free triiodothyronine,FT3)升高者171例,占96.07%;游离甲状腺素(free thyroxine,FT4)和总甲状腺素(total thyroxine,TT4)均升高者178例,占100.00%;总三碘甲腺原氨酸(total triiodothyronine,TT3)升高者159例,占89.33%;促甲状腺素(thyrotropin,TSH)异常者11例(减低3例,升高8例),异常率6.18%;TgAb和TPOAb阳性者27例,阳性率15.17%。调查311户中,碘盐覆盖率77.50%,碘盐合格率90.30%,合格碘盐食用率74.34%,盐碘均值28.74mg/kg。检测自来水9份,水碘中位数2.2μg/L。[结论]椒江区人群碘营养处于适宜状态,孕妇碘营养不足,碘盐作为甲状腺结节的病因尚缺乏依据。
[Objective] To understand the iodine nutrition and thyroid disease in Jiaojiang District, Taizhou City, Zhejiang Province. [Methods] From April to June 2010, a cross-sectional investigation and stratified cluster sampling method was used to investigate 311 households in 3 villages, urinary iodine examination of 944 people and thyroid examination of 793 people. Thyroid was examined by B-ultrasonography, urinary iodine concentration was determined by arsenic-cerium catalytic spectrophotometry, thyroid hormones were detected by chemiluminescence immunoassay and salt iodine content by direct titration. [Results] Among the 793 patients examined, 182 cases of thyroid nodules were found with the prevalence of 22.95%. The prevalence of thyroid nodules increased with age (χ2 = 72.12, P = 0.001). Among 6 to 14 years old The prevalence rate was 0.00%. The prevalence rate was 25.60% in the group of ≥15 years old. The difference between the two groups was statistically significant (χ2 = 27.24, P = 0.001). The prevalence rate of females was significantly higher than that of males (26.97% vs 17.82% (χ2 = 9.25, P = 0.002). Thirty-one children aged 8-10 years were surveyed and the goiter rate was 0.00%. The prevalence of thyroid nodules in urine iodine <100μg / L group was greater than ≥100μg / L group (χ2 = 12.50, P = 0.007). The standardized prevalence rate of Baiguo Village was 19.44%, that of Gaochang Village was 26.43%, and that of Huajing Village was 19.42%. The median urinary iodine (MUI) of 944 persons was 178.25 μg / L, including 185.85 μg / L for children, 138.50 μg / L for pregnant women, 181.40 μg / L for lactating women and 176.00 μg / L for general population. 184.40μg / L, Gao Zhangcun 152.00μg / L, Hua Jingcun 192.00μg / L. Among 33 pregnant women, 2 were positive for thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb), the positive rate was 6.06%. Of the 178 patients who had abnormal B-ultrasound, 171 cases had elevated free triiodothyronine (FT3), accounting for 96.07%; free thyroxine (FT4) and total thyroxine , TT4) were elevated in 178 cases, accounting for 100.00%. The total triiodothyronine (TT3) increased in 159 cases, accounting for 89.33%. Thyrotropin (TSH) abnormalities in 11 cases (3 cases decreased, 8 cases increased), abnormal rate was 6.18%; 27 cases were positive for TgAb and TPOAb, the positive rate was 15.17%. Among the 311 households surveyed, the iodized salt coverage rate was 77.50%, the qualified rate of iodized salt was 90.30%, the qualified iodized salt consumption rate was 74.34%, and the average salt iodine value was 28.74mg / kg. Test tap water 9, water iodine median 2.2μg / L. [Conclusion] The population of iodine nutrition in Jiaojiang District is in a suitable state, the iodine nutrition of pregnant women is insufficient, and the cause of iodine salt as thyroid nodules is still lacking basis.