上海市黄浦区8~10岁儿童甲状腺容积的影响因素及参考区间上限值研究  

Impact factors and reference range upper limit of thyroid volume in children aged 8-10 years old in Huangpu District,Shanghai

作　　者：陈玮华 单成迪[1] 宋黎黎[1] 马立芳[1] 曹云[1] 钱悠舜 何霭娜[1] 肖珺 CHEN Weihua;SHAN Chengdi;SONG Lili;MA Lifang;CAO Yun;QIAN Youshun;HE Aina;XIAO Jun(Shanghai Huangpu District Center for Disease Control and Prevention,Shanghai 200023,China)

机构地区：[1]上海市黄浦区疾病预防控制中心,上海200023

出　　处：《环境与职业医学》2025年第2期205-210,237,共7页Journal of Environmental and Occupational Medicine

基　　金：上海市黄浦区医学优势专科项目(2023PYZK04)。

摘　　要：[背景]学龄儿童作为防治碘缺乏病的重点人群之一,持续监测其碘营养水平具有重要意义。我国现行的甲状腺容积参考区间仅基于年龄,未考虑个体发育水平的差异,且甲状腺容积分布因经济、人口和环境等原因可能存在区域差异。世界卫生组织提出的甲状腺容积参考正常区间的上限值并非基于中国人群。[目的]了解上海市黄浦区8~10岁儿童碘营养状况及甲状腺容积分布情况,探讨甲状腺容积的影响因素并提出其健康儿童的参考区间上限值,为卫生部门开展该区甲状腺健康的筛查和管理提供依据。[方法]2017、2020和2023年抽取上海市黄浦区共600名8~10岁儿童,测定其身高、体重、甲状腺容积、尿碘和家庭食用盐碘含量。利用人口密度和区域面积作为区域变量,以年龄、体表面积(BSA)和体质指数(BMI)作为甲状腺容积个体水平潜在影响因素构建多水平模型,评估其对甲状腺容积的影响。对甲状腺容积进行分位数回归,基于年龄和BSA预测甲状腺容积的第98百分位数(P_(98))。[结果]2017、2020和2023年黄浦区儿童家庭中的碘盐覆盖率分别为72.0%、57.0%和48.0%,碘盐覆盖率随年份的增长而下降(χ^(2)=24.31,P<0.001)。2017年的儿童尿碘水平高于2020年和2023年(χ^(2)=18.77,P<0.001)。2017、2020、2023年的甲状腺容积中位数分别为2.29、2.49和2.97 mL,呈现逐年增大趋势(χ^(2)=60.04,P<0.001)。2023年的儿童甲状腺肿大率高于2017年和2020年(χ^(2)=6.57,P<0.05)。性别差异在尿碘水平、甲状腺容积和甲状腺肿大方面均无统计学意义。8、9、10岁儿童的甲状腺容积中位数分别为2.26、2.58和2.76 mL,甲状腺容积随年龄的增长而增大(χ^(2)=49.02,P<0.001)。甲状腺容积与年龄、BSA和BMI均呈正相关,相关系数分别为0.2846、0.3723和0.2950。分位数回归显示在调查儿童人群中BSA对甲状腺容积的第98百分位值影响最大。考虑人口密度或者区�[Background]As one of the key populations in the prevention and treatment of iodine deficiency disorders,it is important to continuously monitor the iodine nutritional level of school-age children.The current reference interval for thyroid volume in China is based on age only,without taking into account differences in individual developmental levels,and the distribution of thyroid volume may vary regionally due to economic,demographic,and environmental factors.The current reference cut-off points for thyroid volume proposed by the World Health Organization are not based on the Chinese population.[Objective]To understand the iodine nutritional status and distribution of thyroid volume(Tvol)among children aged 8-10 years in Huangpu District,Shanghai,China,to identify impact factors of Tvol,and to propose a reference range upper limit for local thyroid health surveillance,so as to provide a basis for goiter control and prevention.[Methods]Six hundred children aged 8-10 years in Huangpu District were recruited in 2017,2020,and 2023,and body height,weight,thyroid volume,urinary iodine,and iodine content of household edible salt were determined.A multilevel model was constructed using population density and area as regional variables,and age,body surface area(BSA),and body mass index(BMI)as potential impact factors for at the individual level,to assess their effects on thyroid volume.Quantile regression of thyroid volume was performed,and the 98th percentile(P98)of thyroid volume was predicted based on age and BSA.[Results]The iodized salt coverage in the households of surveyed children in 2017,2020,and 2023 was 72.0%,57.0%,and 48.0%,respectively,and the iodized salt coverage decreased by year(χ^(2)=24.31,P<0.001).The urinary iodine level of children in 2017 was higher than that in 2020 and 2023(χ^(2)=18.77,P<0.001).The Tvol medians of children in 2017,2020,and 2023 were 2.29,2.49,and 2.97 mL,respectively,and the Tvol increased by year(χ^(2)=60.04,P<0.001).The proportion of goiter was higher in children in 2023 than

关 键 词：儿童 甲状腺容积 黄浦区 参考区间 碘营养 

分 类 号：R153.2[医药卫生—营养与食品卫生学]