碘与甲状腺功能减退症关系的研究  

Relationship between iodine and hypothyroidism

作　　者：张江甲[1] 王青平[1] 殷丽[1] 张向东[2] 张峰峰[3] 刘博文[4] 桑志萍[1] 冀晶 Zhang Jiangjia;Wang Qingping;Yin Li;Zhang Xiangdong;Zhang Fengfeng;Liu Bowen;Sang Zhiping;Ji Jing(Department of Internal Medicine,the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China;Department of Iodine Deficiency Disorders and Keshan Disease,Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China;Clinical Laboratory,the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China;Department of Ultrasound,the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China)

机构地区：[1]山西省地方病防治研究所附属医院内科,临汾041000 [2]山西省地方病防治研究所碘缺乏病克山病研究室,临汾041000 [3]山西省地方病防治研究所附属医院检验科,临汾041000 [4]山西省地方病防治研究所附属医院超声室,临汾041000

出　　处：《中华地方病学杂志》2021年第5期345-349,共5页Chinese Journal of Endemiology

基　　金：山西省卫生计生委科研课题(201601137)。

摘　　要：目的探讨碘与甲状腺功能减退症(简称甲减)的关系。方法选取2017、2018年临汾市辖区在山西省地方病防治研究所附属医院就诊的原发性甲减初发患者(甲减组)以及健康体检人群(对照组)作为研究对象。采集研究对象随意1次尿样、空腹静脉血,检测尿碘、血碘以及血清总三碘甲状腺原氨酸(TT_(3))、总甲状腺素(TT_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb)水平。按照研究对象TSH检测结果,将甲减组分为甲减Ⅰ组(TSH≥10.00 mU/L)和甲减Ⅱ组(4.20 mU/L<TSH<10.00 mU/L),与对照组(0.27 mU/L≤TSH≤4.20 mU/L)进行对比分析。结果甲减Ⅰ组、甲减Ⅱ组和对照组各纳入研究对象97、96、175人,各组尿碘水平比较,差异无统计学意义(H=0.631,P>0.05)。各组血碘水平[(40.70±21.08)、(58.59±14.55)、(59.50±11.89)μg/L]比较,差异有统计学意义(F=50.559,P<0.01),且甲减Ⅰ组血碘水平低于甲减Ⅱ组和对照组(P均<0.01)。各组TT_(3)[中位数(四分位数间距):1.59(0.99,2.05)、2.25(1.98,2.59)、2.14(1.89,2.49)nmol/L],TT_(4)[35.18(16.06,70.23)、105.68(83.38,133.19)、107.18(89.92,128.30)nmol/L],FT_(3)[3.48(1.94,4.52)、5.01(4.57,5.50)、5.02(4.64,5.55)pmol/L],FT_(4)水平[7.14(3.12,10.76)、15.31(13.87,17.11)、16.69(14.87,18.20)pmol/L]比较,差异均有统计学意义(H=66.197、142.461、94.508、166.557,P均<0.01)。经进一步两两比较,甲减Ⅰ组TT_(3)、TT_(4)、FT_(3)、FT_(4)水平均明显低于甲减Ⅱ组和对照组(P均<0.01)。各组TgAb、TPOAb水平比较,差异均有统计学意义(H=85.507、101.726,P均<0.01)。经进一步两两比较,甲减Ⅰ组TgAb、TPOAb水平均明显高于甲减Ⅱ组和对照组(P均<0.01);甲减Ⅱ组TgAb、TPOAb水平均明显高于对照组(P均<0.01)。经相关性分析,尿碘与血碘呈正相关(r=0.170,P<0.05);血碘与TT_(3)、TT_(4)、FT_(3)、FT_(4)水平均呈正�Objective To explore the relationship between iodine and hypothyroidism.Methods Patients with primary hypothyroidism(hypothyroidism group)and healthy people(control group)from Linfen City who first came to the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Treatment in 2017 and 2018 were selected as the research subjects.One random urine sample and fasting venous blood sample were collected from the research subjects.The levels of urinary iodine,blood iodine and serum total triiodothyronine(TT_(3)),total thyroxine(TT_(4)),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid stimulating hormone(TSH),anti-thyroglobulin antibody(TgAb)and anti-thyroid peroxidase antibody(TPOAb)were detected.According to the results of TSH level,hypothyroidism group was divided into hypothyroidismⅠgroup(TSH≥10.00 mU/L)and hypothyroidismⅡgroup(4.20 mU/L<TSH<10.00 mU/L),and they were compared with control group(0.27 mU/L≤TSH≤4.20 mU/L).Results A total of 97,96 and 175 research subjects were included in hypothyroidismⅠgroup,hypothyroidismⅡgroup and control group,respectively.There was no significant difference in urinary iodine levels among the three groups(H=0.631,P>0.05).The blood iodine levels[(40.70±21.08),(58.59±14.55),(59.50±11.89)μg/L]in the three groups were significantly different(F=50.559,P<0.01),and the blood iodine level in hypothyroidismⅠgroup was lower than that in hypothyroidismⅡgroup and control group(P<0.01).The levels of TT_(3)[median(interquartile range):1.59(0.99,2.05),2.25(1.98,2.59),2.14(1.89,2.49)nmol/L],TT_(4)[35.18(16.06,70.23),105.68(83.38,133.19),107.18(89.92,128.30)nmol/L],FT_(3)[3.48(1.94,4.52),5.01(4.57,5.50),5.02(4.64,5.55)pmol/L]and FT_(4)[7.14(3.12,10.76),15.31(13.87,17.11),16.69(14.87,18.20)pmol/L]in the three groups were significantly different(H=66.197,142.461,94.508,166.557,P<0.01).After further pairwise comparison,the levels of TT_(3),TT_(4),FT_(3),and FT_(4) in hypothyroidismⅠgroup were significantly lower than those in hypothyroidismⅡgro

关 键 词：碘 甲状腺功能减退 血清 尿 

分 类 号：R581.2[医药卫生—内分泌]