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目的了解水源性高碘不同水碘分型地区育龄妇女甲状腺疾病患病情况,探讨水碘分型与妇女甲状腺功能和甲状腺疾病的关系。方法采用描述流行病学横断面对比研究方法,2014年在山西省高碘地区水碘含量150-300μg/L、>300μg/L两个范围各选水碘含量相同但碘分型不同(I~-、IO_3~-)的2个村作为调查点,4村共抽取18-45岁育龄妇女180例,记录一般资料,采集随机1次尿样、家庭生活饮用水水样及静脉血。实验室以砷铈催化分光光度法检测水碘、尿碘含量,全自动化学发光免疫分析法检测血清游离三碘甲状腺原氨酸(FT_3)、游离甲状腺激素(FT_4)、促甲状腺素(TSH),放射免疫法检测血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)。结果 (1)相同水碘水平不同碘分型组间比较:IO3-150组育龄妇女尿碘值≥300μg/L者比例高于I-150组妇女(χ~2=6.352,P<0.05);IO3-300组育龄妇女的尿碘水平、尿碘值≥800μg/L者比例及血甲状腺自身抗体总阳性率均高于I-300组(Z=-1.995,P<0.05;χ~2=6.116,P<0.05;χ~2=3.829,P<0.05)。(2)不同水碘水平相同碘分型组间比较:I-300组育龄妇女的尿碘水平、尿碘值≥300μg/L者比例均高于I-150组(Z=-4.045,P<0.01;χ~2=7.988,P<0.01);IO3-300组育龄妇女的尿碘水平、尿碘值≥800μg/L者比例均高于IO3-150组(Z=-4.973,P<0.01;χ2=14.239,P<0.01),且妇女甲功TSH异常值率、甲状腺自身抗体阳性率、亚临床甲减患病率高于IO3-150组妇女(χ~2分别为5.490、6.501、3.936,P<0.05)。结论水源性高碘地区育龄妇女的甲状腺功能异常可能与生活饮用水水碘分型有关,水碘总量和水碘分型两者对妇女甲状腺功能可能存在叠加作用,建议加强高碘地区妇女碘营养及甲状腺功能监测。
Objective To understand the prevalence of thyroid disease among women of childbearing age in water-rich iodine-iodine-free areas and to investigate the relationship between water iodine type and thyroid function and thyroid disease in women. Methods Using the cross-sectional comparative descriptive epidemiological method, the iodine content of the two watersheds with the same iodine content of 150-300μg / L and 300μg / L in the high-iodine area of Shanxi Province in 2014 was the same 2 villages of 10 ~ ~, IO_3 ~ - were selected as survey sites. Four villages were recruited 180 women of childbearing age from 18 to 45 years old. The general data were recorded and a random sample of urine samples, domestic drinking water samples and venous blood samples were collected. Laboratory arsenic cerium catalytic spectrophotometry for detection of water iodine, urinary iodine content, automatic chemiluminescence immunoassay for serum free triiodothyronine (FT_3), free thyroid hormone (FT_4), thyrotropin (TSH) Serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were detected by radioimmunoassay. Results (1) Compared with Iodine group, the proportion of Iodine iodine value≥300μg / L in women of childbearing age in IO3-150 group was higher than that in I-150 group (χ ~ 2 = 6.352, P <0.05) The urinary iodine level, urinary iodine value≥800μg / L, and the total positive rate of thyroid autoantibodies in IO3-300 women of childbearing age were higher than those in I-300 group (Z = -1.995, P <0.05; χ ~ 2 = 6.116 , P <0.05; χ ~ 2 = 3.829, P <0.05). (2) Comparison of Iodine groups with different iodine levels: I-300 group of women of childbearing age had higher levels of urinary iodine and urinary iodine≥300μg / L than I-150 group (Z = -4.045, P < 0.01; χ ~ 2 = 7.988, P <0.01). The levels of urinary iodine and urinary iodine≥800μg / L were higher in IO3-300 group than in IO3-150 group (Z = -4.973, P <0.01; χ2 = 14.239, P <0.01). The prevalence of thyroid TSH abnormality, the positive rate of thyroid autoantibodies and the prevalence of subclinical hypothyroidism in women were higher than those in IO3-150 women (χ ~ 2 = 5.490,6.501,50.936, P <0.05). Conclusions The abnormal thyroid function of women of childbearing age in water-rich areas may be related to the water iodine type of drinking water. Both water iodine and water iodine types may have superimposed effects on thyroid function. It is suggested that iodine Nutrition and thyroid function monitoring.