不同碘摄入量社区甲状腺功能亢进症的五年流行病学随访研究  

Incidences of hyperthyroidism in communities with different iodine intake levels:a five-year prospective and comparative epidemiological survey

作　　者：杨帆[1] 李佳[1] 单忠艳[1] 滕晓春[1] 滕笛[1] 关海霞[1] 李玉姝[1] 崇巍[1] 于晓会[1] 范晨玲[1] 戴红[1] 于扬[1] 毛金媛[1] 何力 陈彦彦[1] 赵冬[1] 滕卫平[1] 

机构地区：[1]中国医科大学附属第一医院内分泌科,中国医科大学内分泌研究所,沈阳110001 [2]辽宁省彰武县疾病预防控制中心

出　　处：《中华内分泌代谢杂志》2006年第6期523-527,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：美国中华医学基金会资助项目(CMB 98-688);国家自然科学基金(39970350;30240013;30370680);辽宁省科技攻关计划(2003225005)

摘　　要：目的在3个不同碘摄入量农村社区进行的甲状腺疾病流行病学随访调查,分析和探讨不同碘摄入量对甲状腺功能亢进症(甲亢)发病率的影响及其意义,同时研究与甲亢发病相关的危险因素。方法在轻度碘缺乏的盘山社区、超足量碘摄入(既往轻度缺碘补碘后3年)的彰武社区和过量碘摄入的黄骅社区对3 761人进行了甲状腺疾病的流行病学的横断面研究,5年后以相同的检查指标对此人群进行了随访研究。结果(1)盘山、彰武和黄骅社区的学龄儿童尿碘中位数分别为87．6、213．9和633．5μg/L (P＜0．05),随访人群的碘营养状态与原始调查相比无明显变化；3个社区的随访人群总数为3 018人,随访率为80．2%。(2)3个社区的临床甲亢累积发病率分别为13．6/1000、9．4/1 000和8．1/1 000(P＞0．05),女性的累积发病率分别为16．4/1 000、11．2/1 000和9．1/1 000(P＞0．05)。(3)初访时任一甲状腺自身抗体阳性[甲状腺过氧化物酶抗体(TPOAb)＞50 IU/ml或甲状腺球蛋白抗体(TgAb)＞40 IU/ml]但无甲状腺病史及甲状腺功能改变者,5年后临床甲亢的发生率3个社区之间差异无统计学意义。(4)初访时TSH＜0．3 mlU/L、TPOAb阳性和甲状腺肿与临床甲亢的发生相关,其OR值分别为5．7(95%CI,2．1- 15．0)、3．8(95%CI,1．7-8．7)和3．1(95%CI,1．4-6．8)。结论在轻度缺碘地区补碘后最终不会使甲亢的发病率增加。慢性碘过量不会对临床甲亢的发病率和病因组成产生明显影响。TSH＜0．3 mIU/L、TPOAb阳性和甲状腺肿是临床甲亢发病的危险因素。Objective To analyze the relationship between different iodine intakes and epidemiologieal features of hyperthyroidism in 3 communities with different iodine intake levels, as well as to explore the risk factor for the pathogenesis of hyperthyroidism. Methods A cohort study was performed in 3 Chinese rural communities with long-term stable iodine nutrition status defined as mild deficient （Panshan）, more than adequate （Zhangwu, previously mild iodine deficiency and salt iodization lasting 8 years until 2004） and excessive （Huanghua）. A total of 3 761（934 males, 2 827 females） inhabitants aged above 13 participated in the original investigation in 1999 and 3 018（709 males, 2 309 females） of them received identical examinations after 5 years. Results Median urinary iodine concentration of sehool-agod children was 87.6μg/L in Panshan, 213.9μg/L in Zhangwu and 633.5 μg/L in Huanghua （P 〈 0.05 ） at following up, and no statistic significanee was found when comparing the corresponding data from original survey （83.5μg/L, 242.9μg/L and 650.9μg/L）. The accumulative incidence of hyperthyroidism was 13.6/1 000, 9.4/1 000 and 8.1/1 000 （P 〉0.05）, being 16. 4/1 000, 11.2/1 000 and 9.1/1 000 （P 〉0.05） in female, respectively in Panshan, Zhangwu and Huanghua. In original healthy subjects （without history of thyroid disease and overt thyroid dysfunction） merely with either positive thyroid peroxidase antibody （TPOAb 〉 50 IU/ml） or thyrogiobulin antibody （TgAb 〉 40 IU/ml）, the accumulative incidence ofnewly diagnosed hyperthyroidism was not significantly different among 3 communities in follow-up survey. TSH 〈 0.3 mIU/L, positive TPOAb or goiter in original healthy participants were associated with the occurrence of overt hyperthyroidism in 5 years [ Logistic Regression, OR = 5.7 （ 95 % CI 2.1-15 ）, OR = 3.8 （ 95 % CI 1.7-8.7 ） and OR = 3.1 （95% CI 1.4-6.8） respectively]. Conclusion Iodine supplementation in mild iodine deficient area does not increase

关 键 词：碘 甲状腺功能亢进症 流行病学研究 随访研究 危险因素 

分 类 号：R581.1[医药卫生—内分泌]