河北沧州饮水中碘氟含量差异地区儿童甲状腺结节的检出情况
Detection of thyroid nodules in children from areas with different drinking water iodine and fluoride contents in Cangzhou, Hebei Province
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摘要:
背景 甲状腺结节的检出率高达19%~68%。现已公认饮水碘含量过高或缺乏均可造成甲状腺形态和功能的损害。但饮水氟与碘双重因素对甲状腺形态和功能的影响，各地的研究结果不一致。
目的 本研究拟通过调查河北省沧州市饮水中不同碘、氟含量地区儿童甲状腺结节检出情况，为探讨环境中碘、氟含量是否与儿童甲状腺结节发生有关提供基础数据。
方法 采用多级分层整群抽样的方法，分别在沧州市的单纯高碘、低碘、碘正常、高碘高氟（分为3个亚组）、低碘高氟地区，选择具有中小学的1~2个行政村，以在当地出生并持续居住在本地的8~15岁学龄儿童为对象，采用彩色多普勒超声检查其甲状腺结节的情况。
结果 共调查儿童1 859人，其中女生933人，男生926人。单纯高碘地区248人、低碘地区216人、碘正常地区316人、高碘高氟地区737人、低碘高氟地区342人。8~10岁儿童869人，11~15岁990人。不同地区儿童家中无碘盐率为77.9%~97.6%。单纯高碘、低碘、碘正常三个地区比较：8~10岁及11~15岁儿童甲状腺结节检出率均无差异（χ2=4.270，P=0.118；χ2=5.506，P=0.064）；同一地区，11~15岁与8~10岁儿童甲状腺结节检出率无差异（χ2=0.299，P=0.584；χ2=0.000，P=1.000；χ2=0.240，P=0.878）。不同高碘高氟亚组间8~10岁及11~15岁儿童甲状腺结节检出率的差异有统计学意义（χ2=37.933，P < 0.000 1；χ2=27.385，P < 0.000 1），两年龄组甲状腺结节检出率均在高碘高氟1区最高（23.08%，29.82%）。低碘高氟地区与单纯低碘地区比较：8~10岁儿童甲状腺结节检出率两地区之间差异无统计学意义（χ2=1.907，P=0.167），但11~15岁儿童甲状腺结节检出率前者（7.44%）高于后者（1.75%）（χ2=4.721，P=0.030）；同一地区，两年龄组儿童甲状腺结节检出率之间无差异（χ2=0.235，P=0.627；χ2=1.390，P=0.238）。
结论 河北省沧州市饮水中氟含量正常、碘含量不同地区8~15岁儿童甲状腺结节检出率没差异；饮水碘、氟含量均高，碘及氟含量不同地区8~15岁儿童甲状腺结节检出率不同；低碘高氟地区11~15岁儿童甲状腺结节检出率高于单纯低碘地区。
Abstract:Background The detection rate of thyroid nodules has reached 19%-68%. It has been recognized that excessive or lack of iodine in drinking water can cause damage to thyroid morphology and function. However, the combined effects of fluoride and iodine in drinking water on thyroid morphology and function are inconsistent in the studies from different regions.
Objective This study intends to investigate the detection of thyroid nodules in children with different iodine and fluoride contents in drinking water from Cangzhou, Hebei Province, and to provide preliminary data to explore whether iodine and fluoride contents are associated with the detection of thyroid nodules in children.
Methods By the method of multistage stratified cluster sampling, in excess iodine area, deficient iodine area, normal iodine area, excess iodine-fluoride area (the area was further divided into three subgroups), and deficient iodine and excess fluoride area in Cangzhou, the study examined thyroid nodules of local children aged 8-15 years in primary or secondary schools from 1-2 administrative villages by color Doppler ultrasonography.
Results A total of 1 859 children were investigated, of which 933 were girls and 926 were boys. There were 248 children in the excess iodine area, 216 in the deficient iodine area, 316 in the normal iodine area, 737 in the excess iodine-fluoride area, and 342 in the deficient iodine and excess fluoride area. There were 869 children aged 8-10 years, and 990 children aged 11-15 years. In the selected areas, the proportion of non-iodized salt consumption in the children's households ranged from 77.9% to 97.6%. Comparison among the excess iodine area, the deficient iodine area, and the normal iodine area showed that there was no significant difference in the detection rate of thyroid nodules of the children aged 8-10 and 11-15 years (χ2=4.270, P=0.118; χ2=5.506, P=0.064), and there was no significant difference in the detection rate of thyroid nodules between the two age groups in the same area (χ2=0.299, P=0.584; χ2=0.000, P=1.000; χ2=0.240, P=0.878). Comparison among the three subgroups in excess iodine-fluoride area showed that there were significant differences in the detection rate of thyroid nodules of children aged 8-10 and 11-15 years (χ2=37.933, P < 0.000 1; χ2=27.385, P < 0.000 1), and the highest detection rates of thyroid nodules in the two age groups were both in the subgroup 1 (23.08%, 29.82%). Comparison between the deficient iodine and excess fluoride area and the deficient iodine area showed that the detection rates of childhood thyroid nodules at the age of 8-10 years were not significantly different (χ2=1.907, P=0.167), but in the group at the age of 11-15 years, the detection rate of childhood thyroid nodules in the former area was significantly higher (7.44%) than the latter (1.75%) (χ2=4.721, P=0.030), and there was no significant difference in the detection rate of thyroid nodules between the two age groups in the same area (χ2=0.235, P=0.627; χ2=1.390, P=0.238).
Conclusion In the normal fluoride area with different contents of iodine in water, there is no difference in the detection rate of thyroid nodules among children aged 8-15 years in Cangzhou of Hebei Province. In the excess fluoride-iodine area, the detection rate of thyroid nodules among children aged 8-15 years varies with the content of iodine in water. Compared with the deficient iodine area, the detection rate of thyroid nodules among children aged 11-15 years is higher than that in the deficient iodine and excess fluoride area.
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