新疆地区成人碘营养和甲状腺功能调查

Survey on iodine nutrition and thyroid function in adults in Xinjiang

  • 摘要:
    背景 既往碘营养监测工作主要以孕妇和儿童等重点人群为调查对象,关于新疆地区成人的碘营养水平现况报道相对较少。
    目的 了解新疆南北疆不同经济水平地区健康成人碘营养及甲状腺功能状态,探讨碘营养水平对甲状腺功能的影响。
    方法 2021年5月采用分层整群抽样法,在新疆南北疆地区各抽取经济条件较好的和经济条件较差的一个县(市)作为调查地点,在每个调查地点抽取约100户居民家庭,采集食用盐盐样以及18岁以上的健康成人随机尿样和空腹静脉血,采用砷铈催化分光光度法测定尿碘浓度,采用直接滴定法检测盐碘含量,采用化学发光免疫测定法检测甲状腺激素。非正态定量资料比较采用非参数检验,正态定量资料组间比较采用t检验和方差分析,率的比较采用χ2检验,盐碘摄入量与尿碘水平的关联性分析采用Spearman相关分析。
    结果 共采集436份盐样,盐碘中位数为28.18 mg·kg−1,北疆与南疆地区合格碘盐覆盖率均>90%(P>0.05);共采集436份成人尿样,尿碘中位数为219.73 μg·L−1,北疆和南疆地区成人尿碘中位数分别为209.47 μg·L−1、244.80 μg·L−1,南疆地区高于北疆地区(P<0.05);北疆地区成人血清游离三碘甲腺原氨酸(FT3)均值和异常率均低于南疆地区(P<0.05);北疆地区、南疆地区抗甲状腺球蛋白抗体(TgAb)阳性率分别为21.39%、9.79%,抗甲状腺过氧化物酶抗体(TPOAb)阳性率分别为27.36%、10.64%,双抗体阳性率分别为16.42%、5.53%,其中北疆地区成人TgAb阳性率、TPOAb阳性率、双抗体阳性率均高于南疆地区(P均<0.05);北疆地区、南疆地区成人甲状腺功能异常率分别为14.43%、13.19%,组间差异无统计学意义(P>0.05),其中以亚临床甲状腺功能减退(亚甲减)为主,患病率分别为9.95%、9.36%。
    结论 新疆南北疆地区部分成人碘营养水平偏高,虽尚未发现该碘营养状态对人群甲状腺功能产生明显的影响,但高碘营养状态仍需持续关注。建议在对居民加强健康宣教的同时,持续监测成年人的碘营养状况。

     

    Abstract:
    Background Previous iodine nutrition monitoring has mainly focused on key populations such as pregnant women and children, and there are few reports on the status of iodine nutrition among adults in Xinjiang.
    Objective To understand the iodine nutrition and thyroid function status of healthy adults in northern and southern Xinjiang, and to explore the effect of iodine nutrition level on thyroid function.
    Methods In May 2021, a stratified cluster sampling method was used to select one county (city) with good and one county (city) with poor economic conditions in each of the northern and southern regions of Xinjiang as the survey sites, and about 100 households were sampled from each survey site to collect samples of edible salt as well as random urine samples and fastingvenous blood of healthy adults aged 18 years or older. Urinary iodine was determined by cerium arsenide catalytic spectrophotometric method, salt iodine by direct titration method, and thyroid hormones by chemiluminescence immunoassay. Non-parametric test was used for comparison of non-normal quantitative data, t-test and analysis of variance were used for comparison of normal quantitative data, χ2 test was used for comparison of rates, and Spearman correlation analysis was used for correlation between salt iodine intake and urinary iodine level.
    Results A total of 436 salt samples were collected, the median salt iodine level was 28.18 mg·kg−1, and the coverage rate of qualified iodized salt was >90% in both northern and southern Xinjiang regions (P>0.05). A total of 436 adult urine samples were collected, the median urinary iodine was 219.73 μg·L−1. The urinary iodine medians of adults in the northern and southern regions were 209.47 μg·L−1 and 244.80 μg·L−1, respectively, and it was higher in the southern region than that in the northern region (P<0.05). The mean value and abnormality rate of serum free triiodothyronine (FT3) of adults in northern Xinjiang was lower than those in southern Xinjiang (P<0.05). The positive rates of anti-thyroglobulin antibody (TgAb) were 21.39% and 9.79%, the positive rates of anti-thyroid peroxidase antibody (TPOAb) were 27.36% and 10.64%, and the positive rates of both antibodies were 16.42% and 5.53% in the northern and southern regions, respectively. The positive rates of TgAb, TPOAb, and both antibodies in northern Xinjiang were higher than those in southern Xinjiang (P<0.05). The rates of abnormal thyroid function in northern Xinjiang and southern Xinjiang were 14.43% and 13.19%, respectively, with no statistically significant differences between the regions (P>0.05), in which subclinical hypothyroidism was predominant, with prevalence rates of 9.95% and 9.36% in the northern and southern regions, respectively.
    Conclusion Some adults in northern and southern Xinjiang have high iodine nutrition levels, and although no significant effect has been found on thyroid function in the population, the high iodine nutrition status still requires continuing concern. It is recommended to monitor the iodine nutritional status of adults continuously while strengthening health education for residents.

     

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