广西甲状腺疾病谱的变迁与食盐加碘的关系  

The change of spectrum of thyroid diseases within ten years implementation of universal salt iodization in Guangxi Zhuang Autonomous Region

作　　者：张嘉越[1] 李松明[1] 韦丽宁[1] 陈佑江[2] 浦涧[3] 李金明[4] 李瑞[1] 冷津立[1] 庞飞雄[1] 岑延增[1] 农江[5] 何红艳[1] 叶艳妮[1] 

机构地区：[1]中国人民解放军第三0三医院普通外科,广西530021 [2]中国人民解放军第一八一医院普外科,桂林541002 [3]广西右江民族医学院附属医院普外科,百色533000 [4]北海市人民医院普外科,广西536100 [5]中国人民解放军第三0三医院病理科,广西530021

出　　处：《中华内分泌外科杂志》2013年第3期221-225,共5页Chinese Journal of Endocrine Surgery

基　　金：广西省自然科学基金项目（0728254）

摘　　要：目的分析广西地区实行全民普遍食盐加碘（universal salt iodization，USI）10年前后不同碘环境下甲状腺疾病谱变迁的特点，探讨碘与广西甲状腺疾病谱变迁的关系。方法分别选取南宁、桂林、百色及北海4城市的解放军三0三、一八一医院、右江民族医学院及北海市医院经手术病理确诊的甲状腺疾病5998例（疾病组）与1000例甲状腺正常人群（对照组），对其尿碘水平行对照分析。结果USI后2组的尿碘水平均较USI前增高；疾病组尿碘水平高于对照组，其中，在USI前、UAI后5年及USI后10年3个阶段，结节性甲状腺肿尿碘分别为[（56．7、26．4、275．3）μg/L，P〈0．05]、毒性弥漫性甲状腺肿[（228．3、245．6、289．7）μg/L，P〈0．05]、毒性结节性甲状腺肿[（268．4、358．5、346．8）μg/L，P〈0．05）]、慢性淋巴细胞性甲状腺炎[（323．5、384．7、357．6）μg/L，P〈0．05）]、甲状腺乳头状癌（315．8、380．6、378．2）μg/L尿碘水平较USI前明显增高；毒性结节性甲状腺肿构成比呈递增趋势（4．8％、6．25％、7．59％，P〈0．05）；甲状腺乳头状癌在甲状腺癌构成比（USI前／USI后10年：77．59％／88．45％；P〈0．05）及慢性淋巴细胞性甲状腺炎的构成比较USI前增高（USI前／USI后5年：3．35％／5．41％，P〈0．05；USI前／USI后10年：3．35％／6．61％，P〈0．05），USI后10年结节性甲状腺肿构成比较USI前下降（USI前／USI后10年，70．54：65．83％，P〈0．05）。结论USI10来，广西甲状腺疾病谱发生明显变化，碘过量可能是毒性结节性甲状腺肿、慢性淋巴细胞性甲状腺炎、甲状腺乳头状癌的危险因素之一。Objective To reveal the relationship between the iodine nutrition and the change of spectrum of thyroid diseases by analyzing the change of spectrum of thyroid diseases in different iodine environments before and after universal salt iodization （USI） was put into practice. Methods To compare the urinary iodine concentration between 1000 cases of health control（the control group） and 5998 patients with thyroid disease confirmed by surgery and pathology. All the people were from 4 major cities of Guangxi Zhuang Autonomous Region, covering the iodine deficient areas as well as the iodine rich areas. Results After USI was put into practice, the urinary iodine concentration was higher in patients with thyroid disease than in the control group. The urinary iodine concentration in patients with nodular goiter（56.7, 26. 4 and 275.3μg/Lg/L, P 〈 0. 05 ）, Grave＇s disease （228.3, 245.6 and 289. 7 μg/Lg/L,P 〈0. 05）, toxic nodular goiter（268.4,358.5 and 346. 8 μg/Lg/L,P 〈0. 05）, thyroid papillary carcinoma（315.8, 380. 6 and 378. 2 μg/Lg/L） and Hashimoto＇s thyroiditis（323.5, 384. 7 and 357.6 μg/Lg/L, P 〈 0. 05 ） increased than that before USI was taken. The proportion of toxic nodular goiter was increasing in 3 stages of USI（4. 8% , 6. 25% , 7.59% ,P 〈 0. 05 ）, that of thyroid papillary carcinoma in thyroid carcinoma（ before USI/10 years after USI：77. 59%/88.45% ;P 〈 0. 05 ） and that of Hashimoto＇s thyroiditis （ before USI ： 5 years after USI,3.35%/5.41% , P 〈0.05 ;before USI：10 years afer USI,3.35%/6. 61% ,P 〈0. 05 ） increased than that before USI, while the proportion of nodular goiter decreased after 10 years of USI （before USI： 10 years afer US/, 70.54： 65.83% ,P 〈 0. 05 ）. Conclusion The spectrum of thyroid diseases in Guangxi changes greatly within 10 years since USI was taken.The excessive intake of iodine may be one of the dangerous factors leading to toxic nodular goiter, thyroid papillary carcinoma, and Hashimoto＇s thyroiditis.

关 键 词：甲状腺疾病 食盐加碘 碘营养过剩 疾病谱 

分 类 号：R581[医药卫生—内分泌]