【作者】 王燕玲；

【导师】 王式功；

【作者基本信息】 兰州大学 ， 环境科学， 2009， 博士

【摘要】 碘缺乏病目前仍是全球重要的公共卫生问题。甘肃省是中国碘缺乏病重病区之一，本文收集了自全民食盐加碘十多年以来甘肃省碘缺乏病的相关资料，对甘肃省碘缺乏病防治现状和发病趋势，进行了分析研究，并就目前全球关注的孕妇、哺乳期妇女、婴幼儿的碘营养状况及碘代谢特点进行了研究。在重点人群碘营养状况研究中，应用目前国内最灵敏的方法，提高了检测的灵敏度和准确性，更加科学地评价了重点人群的碘营养状况。本文还首次在甘肃省开展了大范围的碘缺乏病健康教育现状调查及干预措施效果评价研究。得出如下几点主要结论：1、自1995年实施全民食盐加碘以来，甘肃省儿童碘营养状况得到了明显改善，尿碘水平一直处于适宜的状态；儿童甲状腺肿大率明显下降，居民合格碘盐食用率逐年提高，甘肃省碘缺乏病防治工作取得了显著进展，但到2005年仍未达到国家碘缺乏病消除标准，部分落后地区重点人群的碘营养仍然不足，儿童智力受到了严重损伤，儿童智商值损失高达23个IQ值。2、影响甘肃省碘盐措施落实的主要因素为较高碘盐价格、部分地区碘盐销售网络不健全、群众缺乏碘缺乏病相关知识。3、全民食盐加碘能满足大多数孕妇、哺乳期妇女及婴幼儿碘营养需要，但在碘盐措施有效落实地区仍有部分孕妇、哺乳期妇女及婴幼儿存在碘营养不足；哺乳期妇女乳汁碘与其婴幼儿尿碘之间存在正相关性，提示乳汁碘可做为评价婴幼儿及母亲碘营养状况的一个重要指标；此外，低尿碘的孕妇及哺乳期妇女存在甲状腺功能异常的危险性增加，建议哺乳期妇女的尿碘应不低于150μg／L。4、甘肃省碘缺乏病防治进展存在乡村差别，乡级好于村级，但乡村两级均未达到国家碘缺乏病消除标准，表明碘缺乏病在甘肃省仍然是一个严重的公共卫生问题。5、甘肃省碘盐合格率、碘盐覆盖率及合格碘盐食用率逐年上升，非碘盐率逐年下降。2008年居民合格碘盐食用为96．2％，有非碘盐问题的县从2001年的11个县下降到2008年的3个县，从全省水平来看，我省的碘盐措施已得到了有效落实。但是非碘盐问题在少数民族地区仍很突出。6、甘肃省碘缺乏病健康教育工作薄弱。应用以“家庭主妇-家庭-社区”和“学校-学生-家庭-社区”两种主要健康教育模式，并结合多种形式的健康教育方式，干预前后，儿童和家庭主妇碘缺乏病健康教育知识知晓率均有显著提高，群众的行为转变率也有了提高。7、在碘盐措施落实不到位的少数民族地区采取应急补碘措施能有效的改善重点人群的碘营养状况，保护下一代免受缺碘造成的脑损伤。更多还原

【Abstract】 Iodine deficiency disorders (IDD) is still a public health problem in the world. Gansuprovince is one of severest IDD regions in China. In this thesis, we have collectedcorrelated information about IDD in Gansu since universal salt iodization t in 1995 andanalyzed the status and progress of IDD control and prevention in Gansu province. Westudied the iodine nutrition status of pregnant, lactating women and babies, which werepaied close attention in the world. Using most sensitive methods improved sensitivity andaccurate of detection which made the evaluation of iodine nutrition of target people morescientifically. For the first time, we carried out wide-ranging investigation and study abouthealth education status and effectiveness in Gansu province. We get some results, whichare summed up as follows:1、Since universal salt iodization t in 1995, the iodine nutrition status of children hasbeen improved and the urinary iodine of children has been optimal. The total goiter rate inschoolchildren has decreased and the consumption rate of qualified iodized salt increasedevery year, great progress has made in IDD control and prevention of Gansu. But IDDcontrol and prevention has not reached the standard of elimination and the iodine nutritionof target people was inadequate and the intelligence of schoolchildren damaged in somepoor and lagging regions.2、The main factors impacting iodized salt carrying out are the higher price of iodizedsalt, distempered marketing network in some areas and lack of IDD information in people.3、Iodine status of most of the target population for Universal Salt Iodization programis adequate, but iodine deficiency still existed in some. A positive correlation existedbetween the urinary iodine concentrations in infants and the breast milk iodineconcentrations of lactating women, which showed the breast milk iodine concentrationscan be used as a important index for assessing the iodine nutrition status of babied andmothers. A low iodine status increases the risk of thyroid function disorders, we suggestedthe urinary iodine of lactating women should be above 150μg/L.4、The progress of IDD control and prevention in center countryside was greater thanthat in village. However, IDD was still a severe healthy problem in Gansu province. IDDwas still a public health problem in Gansu province.5、The rate of qualified iodized salt, iodized salt converge rate and consumption rate of qualified iodized salt have increased every year, while non-iodized salt rate has decreasedevery year in Gansu province. The consumption rate of qualified iodized salt was 96.2% in2008. The counties with the problem of non-iodized salt rate decreased from 11 in 2001 to3 in 2008 and USI has effectively carried out in Gansu province.6, Health education was weak in Gansu. Using "materfamilias- family-community"and "school-student-community" health education pattern, the healthy education pass rateof children and women and people’s behavior change rate has been improved significantly.7、Taking iodine oil can improve the status of iodine nutrition and protect newbornsnot be harm by iodine deficiency in minority region with problem of non-iodized salt.更多还原