江苏高碘地区碘营养状态变化对老年人群甲状腺功能的影响:一项系列横断面调查  

Impact of iodine nutritional status changes on thyroid function in the elderly in high iodine areas of Jiangsu province:A serial cross-sectional surveys

作　　者：张梦杰 张丽娜[1] 密玮诺 孙宇 沈统高 陈国芳[1] 刘超[1] 徐书杭[1] Zhang Mengjie;Zhang Lina;Mi Weinuo;Sun Yu;Shen Tonggao;Chen Guofang;Liu Chao;Xu Shuhang(Department of Endocrinology,the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China;Department of Endocrinology,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian 223800,China;Diabetes and Endocrinology Hospital of Suining County,Xuzhou 221200,China)

机构地区：[1]南京中医药大学附属中西医结合医院内分泌科,210028 [2]徐州医科大学附属宿迁医院内分泌科,223800 [3]徐州睢宁县糖尿病内分泌医院,221200

出　　处：《中华内分泌代谢杂志》2024年第1期37-43,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：2020年江苏省重点研发计划(BE2020726);中华国际医学交流基金会甲状腺中青年医生研究项目(BQE-JZX-202115);江苏省卫生健康委员会, 2020年度医学科研项目(M2020102)。

摘　　要：目的调查水源性高碘地区改水后≥65岁老年人碘营养状态的变化及对老年人甲状腺功能的影响。方法选取2015年至2017年我国31省市甲状腺疾病、碘营养和糖尿病的全国流行病学调查(TIDE研究)的江苏徐州姚集镇(水源性高碘地区)调查结果,选取2021年5月至8月对江苏省宿迁顺河镇(碘大于适宜量地区)及徐州姚集镇≥65岁老年人群甲状腺疾病的筛查、监控和干预(TOPS研究)的调查结果。每位受试者均完成问卷调查、体格检查、实验室检测和甲状腺超声检查。最终纳入≥65岁老年人2 717名,其中,组1为TIDE组,258名;组2为TOPS徐州组,1 313名;组3为TOPS宿迁组,1 146名。结果组2的尿碘浓度(UIC)显著低于组1[(235.16±67.09)μg/L对(491.58±384.93)μg/L,P<0.001],但与组3的差异无统计学意义[(235.16±67.09)μg/L对(231.62±66.11)μg/L,P>0.05]。组2的血清促甲状腺素(TSH)水平显著低于组1[(2.92±5.14)μIU/mL对(4.15±9.19)μIU/mL,P<0.001]。与组2和组3相比,组1老年人亚临床甲状腺功能减退症(甲减)的患病率最高(22.48%对10.13%和8.12%,P<0.001)。无论是在高碘地区还是在碘大于适宜量地区,TSH水平均与年龄呈线性相关。随着年龄的增长,TSH水平逐渐升高。结论增龄和碘营养状态与老年人TSH水平改变显著相关。高碘地区老年人碘营养状况恢复正常后可显著减少老年人甲减的患病率。Objective To investigate the alteration in iodine nutritional status and influence on thyroid function in the elderly aged≥65 years following water source modification in high iodine areas.Methods Data from Yaoji Town,Xuzhou,Jiangsu(an area with high iodine due to water sources)of the national epidemiological survey on thyroid diseases,iodine nutrition,and diabetes(TIDE study)in 31 provinces and cities in China from 2015 to 2017 were utilized.Additionally,data from the screening,monitoring,and intervention on thyroid diseases(TOPS study)in the elderly(≥65 years)in Shunhe Town,Suqian,Jiangsu(an area with iodine levels exceeding the recommended amount),and Yaoji Town,Xuzhou from May to August 2021,are included.Each subject completed a questionnaire,physical examination,laboratory tests and thyroid ultrasound examinations.A total of 2717 subjects aged≥65 years were included,including group 1,258 subjects in TIDE study;Group 2,1313 subjects in TOPS Xuzhou area;Group 3,1146 subjects in TOPS Suqian area.Results The urinary iodine concentration(UIC)in group 2 was significantly lower than that in group 1[(235.16±67.09)μg/L vs(491.58±384.93)μg/L,P<0.001],but no significant difference compared with group 3[(235.16±67.09)μg/L vs(231.62±66.11)μg/L,P>0.05].The serum TSH level in group 2 was significantly lower than that in group 1[(2.92±5.14)μIU/mL vs(4.15±9.19)μIU/mL,P<0.001].Compared with group 2 and 3,the prevalence of subclinical hypothyroidism in the elderly in group 1 was the highest(22.48%vs 10.13%and 8.12%,P<0.001).TSH levels were linearly correlated with age in both excessive iodine and more than adequate iodine nutrition areas.TSH level was gradually increased with age.Conclusion The alteration in TSH levels among the elderly is notably linked to both aging and iodine status.The prevalence of hypothyroidism in the elderly can be significantly reduced when the iodine nutrition status of the elderly returns to normal.

关 键 词：碘营养状态 碘过量 老年人群 促甲状腺素 甲状腺功能减退 

分 类 号：R153.3[医药卫生—营养与食品卫生学]