在碘缺乏病评估中，本地甲状腺体积参考值与世界卫生组织/国际碘缺乏病控制理事会推荐的参考值之比较

Local versus WHO/International Council for Control of Iodine Deficiency Disorders-recommended thyroid volume reference in the assessment of iodine deficiency disorders.

作者信息

Foo L C, Zulfiqar A, Nafikudin M, Fadzil M T, Asmah A S

机构信息

Institute for Medical Research, Kuala Lumpur, Malaysia.

出版信息

Eur J Endocrinol. 1999 Jun;140(6):491-7. doi: 10.1530/eje.0.1400491.

DOI:10.1530/eje.0.1400491

PMID:10366404

Abstract

OBJECTIVE

Iodine deficiency endemia is defined by the goitre prevalence and the median urinary iodine concentration in a population. Lack of local thyroid volume reference data may bring many health workers to use the European-based WHO/International Council for Control of Iodine Deficiency Disorders (ICCIDD)-recommended reference for the assessment of goitre prevalence in children in different developing countries. The present study was conducted in non-iodine-deficient areas in Malaysia to obtain local children's normative thyroid volume reference data, and to compare their usefulness with those of the WHO/ICCIDD-recommended reference for the assessment of iodine-deficiency disorders (IDD) in Malaysia.

DESIGN AND METHODS

Cross-sectional thyroid ultrasonographic data of 7410 school children (4004 boys, 3406 girls), aged 7-10 years, from non-iodine-deficient areas (urban and rural) in Peninsular Malaysia were collected. Age/sex- and body surface area/sex-specific upper limits (97th percentile) of normal thyroid volume were derived. Thyroid ultrasonographic data of similar-age children from schools located in a mildly iodine-deficient area, a severely iodine-deficient area, and a non-iodine-deficient area were also collected; spot urines were obtained from these children for iodine determination.

RESULTS

The goitre prevalences obtained using the local reference were consistent with the median urinary iodine concentrations in indicating the severity of IDD in the areas studied. In contrast, the results obtained using the WHO/ICCIDD-recommended reference showed lack of congruency with the median urinary iodine concentrations, and grossly underestimated the problem. The local sex-specific reference values at different ages and body surface areas are not a constant proportion of the WHO/ICCIDD-recommended reference. A further limitation of the WHO/ICCIDD-recommended reference is the lack of normative values for children with small body surface areas (<0.8m2) commonly found in the developing countries.

CONCLUSION

The observations favour the use of a local reference in the screening of children for thyroid enlargement.

摘要

目的

碘缺乏病由人群中的甲状腺肿患病率和尿碘中位数浓度来定义。缺乏当地甲状腺体积参考数据可能导致许多卫生工作者在评估不同发展中国家儿童的甲状腺肿患病率时使用基于欧洲的世界卫生组织/国际碘缺乏病控制理事会（ICCIDD）推荐的参考标准。本研究在马来西亚的非碘缺乏地区开展，以获取当地儿童甲状腺体积的标准参考数据，并将其在评估马来西亚碘缺乏病（IDD）时的实用性与世界卫生组织/ICCIDD推荐的参考标准进行比较。

设计与方法

收集了来自马来西亚半岛非碘缺乏地区（城市和农村）的7410名7至10岁学童（4004名男孩，3406名女孩）的横断面甲状腺超声数据。得出了按年龄/性别以及体表面积/性别划分的正常甲状腺体积上限（第97百分位数）。还收集了来自轻度碘缺乏地区、重度碘缺乏地区和非碘缺乏地区学校的同龄儿童的甲状腺超声数据；采集了这些儿童的随机尿样进行碘测定。

结果

使用当地参考标准得出的甲状腺肿患病率与尿碘中位数浓度一致，能够表明所研究地区碘缺乏病的严重程度。相比之下，使用世界卫生组织/ICCIDD推荐的参考标准得出的结果与尿碘中位数浓度不一致，且严重低估了问题。不同年龄和体表面积的当地性别特异性参考值并非世界卫生组织/ICCIDD推荐参考标准的固定比例。世界卫生组织/ICCIDD推荐参考标准的另一个局限性是缺乏发展中国家常见的小体表面积（<0.8平方米）儿童的标准值。