【作者】 滕晓春；

【导师】 滕卫平；

【作者基本信息】 中国医科大学 ， 内科学， 2002， 硕士

【摘要】 目的 研究未实行普遍食盐碘化的辽宁省农村社区甲状腺疾病的患病率，为探讨碘摄入量增加对甲状腺疾病影响的研究提供基础对照资料。 方法 (1)调查地区 辽宁省盘山县自产井盐，当地农民习惯于食用，USI政策在此难以推行。预调查中对117名7-14岁儿童尿碘及甲状腺B超检查，其尿碘中位数83.45μg/L，B超诊断的甲状腺肿大率28.9％，根据GB16005-1995碘缺乏病病区划分标准，该地区属于轻度碘缺乏地区，符合未实行USI地区的要求。(2)调查对象 包括两方面人群：问卷人群与采样人群问卷人群为居住于当地3年以上，年龄大于13周岁的居民，共4343人。问卷内容包括：户主及每个家庭成员的姓名、性别、年龄、职业及经济收入等一般情况，食用盐量，有无甲状腺疾病病史及家族史。对有甲状腺病史者尽量追查以前的医疗记录、确定发病时间及疾病诊断和治疗情况，采血复查。采样人群的确定及采样方法：属于问卷范围内的居民自愿参加进一步的调查，共1103人。内容包括：详细填写甲状腺疾病流行病学调查表(包括一般情况、摄碘盐情况、甲状腺疾病的既往史及家族史)；体格检查(包括身高、体重、心率，血压及甲状腺触诊)；甲状腺B超检查；并被采集空腹血清、空腹尿。(3)实验室测定方法 全部被调查人群检测TSH、TPOAb、TGAb、TC及尿碘浓度，TSH异常者检测FT3、FT4、TRAb。其中TSH、FT3、FT4、TPOAb、TGAb、TRAb、TG等指标均为美国DPC公司生产，运用IMMULITE方法(即第三代固相化学发光酶免疫分析法）测定；TMb为美国 Diasorin公司生产，运用 RM法测定。尿碘的测定采用砷体催化分光光度测定方法（GB／T 6682－1992），线性范围为O－300300 pg／L（4）甲状腺B超检查 应用B型超声诊断仪（韩国MEDISON SA－60o 7．5 M－Hgho一探头人并制定了B超检查下甲状腺体积的正常范围（男性大于25．6ITl、女性大于19．4 d视为甲状腺肿人 结 果 盘山社区成人尿碘中位数103．15pg／ L，其中小于100 pg／L占 49石％，小于 50pg／L占 17．71％。临床甲亢：盘山社区临床甲亢患病率为历．32％叶18八 人其中男性14．08％叶4／284厂女性17．09彻（l亿19人临床甲亢中 GD 15人，结节性甲状腺肿伴甲亢1人，另外2人未分类。新发临床甲亢中4人门乃）并无症状，其中3人ljVri升高，FT4正常，诊为D型甲亢。亚临床甲亢：亚临床甲亢患病率37．17％叶41八103入其中男性31．69％O汐／284入女性 41．51 ％c①4亿 人 41人中 2人有甲亢史，现处于治疗中门人服他巴 ＠，另 1人为‘’‘互治疗后人 3人为结节性甲状腺肿；2人为甲状腺腺瘤；2人为亚临床GD柬人为甲状腺炎；26人未分类。亚临床甲亢中T肌b阳性率较甲状腺功能正常组显著升高＊．20％VS 0·68％，P＜0·001八TPOAb和 TGAb阳性率同样较甲状腺功宜正常组高（19·51％ VS 7．27阮，P＜0．of；17．07％ VS 6．67阮f＜0．05人临床甲减：本次调查未发现有既往临床甲减患者，临床甲减患病率二．72％（ 3／1103），女性 3．66％。（3／819）。其中 2人为甲亢甲状腺次全切除术后，TP 0＊b＞5皿1＊／毗、＊GA b＞5 0000IU／InL；另外 1人 B超显示弥漫性甲状腺肿伴低回声，TPOAb＞且以见1＊／InL ／I’nA上＞1以地1＊／InL，诊为桥本氏甲状腺炎甲减。因此3例临床甲减皆与甲状腺自身免疫有关。亚临床甲状腺功能减低症：亚临床甲减患病率 9．07％o门八 L其中男性 7．04％o ·2·p／284入女性9．77We堆／819人亚临床甲减中3人为甲亢术后；2人为桥本氏甲状腺炎；2人为萎缩性甲状腺炎；3人未分类。亚临床甲减中TPOAb和TGAn阳性率较甲状腺功能正常组高（分别为40啪VS7．27％，P＜＊．of；40阮VS6．67％，P＜0．of）。甲状腺肿：盘山社区B超诊断的甲状腺肿大率20．65％，男性17．30％，女性ZI．97％。其中弥漫性甲状腺肿患病率为16．79％，弥漫性甲状腺肿与年龄、性别无明显的相关关系；结节性甲状腺肿患病率3石6％，患者随着年龄增长，其患病率逐渐增高。结节性甲状腺肿患者 TG值显著高于非结节性甲状腺肿者O．10 t 4．13 ys 6．77 t2．11 ＂g／Inl，P＜0．ofX且 TG与结节性甲状腺肿的体积呈正相关卜一0．709厂弥漫性甲状腺肿和结节性甲状腺肿患者 hH值较无甲状腺肿组反而降低（0．92。o．98 vs．01。1．03 m＊／L，P＞O．05；o．79土0．86 vs．01士1刀3 m＊／L，P＜0．01）。甲状腺结节：甲状腺结节患病率 11．44％，男性 8．65％，女性 12．28％。其中甲状腺单发结节63人（68．48阮），多发结节四 人（31．52％）。女性随年龄增长甲状腺结节患病率逐渐增加，65岁之后略下降；男性55岁之后患病率明显高于 55岁之前u1．58％ys 6．02％，P＜0．of人甲状腺自身抗体：盘山社区TPOAb的阳性率为8．04％，女性乃．64％）较男性问．58％）显著增高，P二 0．01；冗Ah 7．38％，女性”．13％）较男性p．sl％）显著增高，P＝0．of。弥漫性甲状腺肿患者 TPOAb阳更多还原

【Abstract】 ObjectiveTo investigate the prevalence of thyroid disease in a rural community without universal salt iodization ( USI) in Liaoning Province and to provide the control information on the influence of the additional iodine intake on the thyroid disease.Methods( 1) Study area: The survey was conducted in Panshan community , Liaoning province, China. Panshan was selected for its self - productive salt without iodine available for the local inhabitants and no previous iodine prophylaxis. In pre -investigations, 117 schoolchildren aged 8-14 years were selected. Median univary iodine excretion was 83.45 ug /L and the prevalence of goiter was 28.9%. According to GB 16005 - 1995, Panshan was an area with mild iodine - deficient intake. (2) Study populations: All of the 4343 inhabitants aged 14 years or more who had lived in the local area for more than 3 years were asked to finish the questionnaire which included personal details ( name,age,sex,profession) , personal and family history of goiter,hy-perthyroidism,hypothyroidism with details of any investigations andtreatments. 1103 volunteers were sampled from 4343 for further examinations: thyroid physical exams (including weight^height^blood pressure,thyroid palpation) , thyroid ultrasonography and the measurement of blood and urinary samples. ( 3 ) Laboratory tests: The serum samples of all the 1103 subjects were collected for measurement of TSH,TPO-Ab,TGAb,TG which were assayed by IMMULITE methods. FT3,FT4 concentration were also assayed by IMMULITE methods if TSH levels were abnormal. TSH -receptor antibody (TRAb) concentration were assayed by RRA in those with abnormal TSH level and some normal control. Data were stored on the database in computer and analyzed u-sing SAS statistical package. The urinary iodine of the samples was measured with AS ( III ) - Ce4+ catalytic spectrophotometry method. (4) Thyroid ultrasonography; Thyroid volumn was estimated using real - time sonagraphy with a Koren SA - 600, using a 7. 2 MHz linear array transducer. The volumn of each lobe was calculated by the formula V(ml) = 0.479 x width × length × depth (cm). The thyroid volume was the sum of the volume of both lobes. The goiter was defined as volume above 25. 6ml( males) and 19.4ml( females).ResultsThe median urinary iodine excretion (MUIE) was 103. 15jxg/L in adults. Values lower than 100ug/L were found in 49. 8% of the subjects, and values lower than 50ug/L in 17. 71% of them. The prevalence of Overt hyperthyroidism was 18 of 1103 (16. 32‰) ,with no difference between males 14. 08‰ and females 17. 09‰. GD was found in 15 subjects and toxic nodular goiter in 1 subject. The other ones were classified as the unknown. 4 newly diagnosed hyperthyroid patients had no clinical symptoms, among them 3 patients were de-fined as 13 type hyperthyroidism. The prevalence of subclinical hyper-thyroidism was 41 of 1103(37. 17‰) with males 31. 69‰and females 39.07‰. Its causes were classified as follows: 2 with the history of hyperthyroidism; 3 with nodular goiter; 2 with thyroid adenoma; 2 with subclinical GD ;6 with silent thyroiditis, and 26 with non - classified type. The frequency of positive TRAb was higher in subclinical hyperthyroidism than that in euthyroidism (12. 20% vs 0. 69% ,P < 0.001),as well as TPOAb and TGAb (19.51% vs 7.27% ,P < 0. 01;17.07% vs6.67%,P < 0.05). The prevalence of overt hypot-hyroidism was 3 of 1103(2. 72‰) , with females 3.66‰. All of the 3 patients were newly diagnosed and females. 2 of them were previously subjected to partial thyroidectomy for hyperthyroidism. Both had a diffuse hypoechogenicity at ultrasound, and high serum TGAb and TPOAb liters (TPOAb > 500 IU/mL ,TGAb > 500 IU/mL). The other one had a diffuse goiter and high serum TGAb and TPOAb tilers ( TPOAb > 1000 lU/ml ,TGAb > 1000 IU/ml) , indicative of Hashimoto’s thyroiditis. So all of the 3 hypothyroid palienls were related to thyroid auloimmunily. The prevalence of subclinical hypolhyroidism was 10 of 1103(9. 07‰) , wilh no difference between males 7.更多还原