Brzozowska Małgorzata, Kretowski Adam, Podkowicz Krystyna, Szmitkowski Maciej, Borawska Maria, Kinalska Ida
Akademia Medyczna w Białymstoku, Klinika Endokrynologii, Diabetologii i Chorób Wewnetrznych.
Pol Merkur Lekarski. 2006 Jun;20(120):672-7.
Proper diet with regard to quantity and quality of meals is of vital importance for normal development and functioning of the organism. There are many proofs that environmental factors play an important role in the pathogenesis of goiter. Iodine deficit in diet is best known of all factors contributing to goiter. Deficit of other elements like, iron, selenium, copper and zinc is also essential. The purpose of this study was to evaluate the influence of chosen environmental factors, i.e., iron and trace elements of selenium, zinc and copper--essential for the thyroid functioning on the development of goiter in school children aged 6-13 years with normal ioduria in the Polish population.
In 2002, the study was performed in 4 elementary schools chosen randomly in Białystok and in the Children's Outpatient Clinic of Endocrinology of the Specialist Regional Hospital. The study included 400 children aged 7-13 years from schools and 120 patients at the same age treated with KJ and/or tyroxine for minimum 12 months due to goiter in the Out-patient Clinic of Endocrinology. Basing on the assessment of the thyroid size as well as the criteria of WHO from 1997 year for body surface and sex, children were divided into 2 subgroups: with goiter and the thyroid gland within the norm. Children aged 9-11 years were qualified and chosen from subgroups to further examinations. In both subgroups, blood samples were taken to determine concentrations of iron, selenium, copper and zinc.
The mean concentration of selenium in the blood was statistically significantly lower in children with goiter in comparison with children with the thyroid gland within the norm (44.4 +/- 7.8 microg/L vs. 49.2 +/- 9.1 microg/L, p = 0.044) in the study population of school children and the Outpatient Clinic of Endocrinology. No differences of serum iron concentrations were observed in children with goiter and with the thyroid gland within the norm. However, nearly the half (45.5%) of patients with the lower serum concentration of iron (< 60 microg/dL) had goiter despite average 22-month therapy with KJ and/or tyroxine.
Observed, in spite of proper iodine prophylaxis, 7% rate of goiter occurring in school children suggests other than iodine deficiency factors that influence goiter development. The study proved that the low concentration of iron and/or selenium deficit found in the serum of children with goiter in spite of their treatment with KJ and/or tyroxine may be additional factors influencing the effectiveness of this treatment.
饮食在量和质方面是否合理,对机体的正常发育和功能至关重要。有许多证据表明,环境因素在甲状腺肿的发病机制中起重要作用。饮食中碘缺乏是所有导致甲状腺肿的因素中最为人熟知的。铁、硒、铜和锌等其他元素的缺乏也至关重要。本研究的目的是评估特定环境因素,即对甲状腺功能至关重要的铁以及硒、锌和铜等微量元素,对波兰人群中尿碘正常的6 - 13岁学龄儿童甲状腺肿发生发展的影响。
2002年,在比亚韦斯托克随机选取的4所小学以及地区专科医院儿童内分泌门诊进行了该研究。研究包括400名7 - 13岁的在校儿童以及120名因甲状腺肿在内分泌门诊接受至少12个月KJ和/或甲状腺素治疗的同年龄段患者。根据甲状腺大小评估以及1997年世界卫生组织关于体表面积和性别的标准,将儿童分为2个亚组:患有甲状腺肿的和甲状腺正常的。从亚组中选取9 - 11岁的儿童进行进一步检查。在两个亚组中均采集血样以测定铁、硒、铜和锌的浓度。
在学龄儿童和内分泌门诊的研究人群中,患有甲状腺肿的儿童血液中硒的平均浓度与甲状腺正常的儿童相比,在统计学上显著降低(44.4±7.8微克/升对49.2±9.1微克/升,p = 0.044)。在患有甲状腺肿和甲状腺正常的儿童中未观察到血清铁浓度的差异。然而,尽管平均接受了22个月的KJ和/或甲状腺素治疗,但血清铁浓度较低(<60微克/分升)的患者中近一半(45.5%)患有甲状腺肿。
尽管进行了适当的碘预防,但在学龄儿童中仍观察到7%的甲状腺肿发生率,这表明除碘缺乏外还有其他因素影响甲状腺肿的发展。该研究证明,尽管接受了KJ和/或甲状腺素治疗,但患有甲状腺肿的儿童血清中铁浓度低和/或硒缺乏可能是影响该治疗效果的额外因素。