Kretowski Adam, Brzozowska Małgorzata, Kinalska Ida
Z Kliniki Endokrynologii, Diabetologii i Chorób Wewnetrznych Akademii Medycznej w Białymstoku.
Wiad Lek. 2006;59(9-10):639-43.
Up-to-date observations in the regions where effective food iodine supplementation was introduced confirm a significant decrease in goiter incidence. However, in some regions the incidence of goiter remains unchanged or even the increase in the frequency of autoimmunological diseases of the thyroid like, Grave's-Basedov disease and chronic/subacute lymphocytic thyroiditis is observed. The purpose of the study was to evaluate the prevalence of autoimmunological diseases of the thyroid in children aged 6-13 years in the Polish population after 5 years of obligatory iodine supplementation program. The study included 480 school children from 4 elementary schools chosen randomly in the city of Białystok and 120 patients at the same age treated due to goiter with KI and/or thyroxin for minimum 12 months in the Regional Specialist Outpatient Clinic of Endocrinology. All children underwent physical examination with palpation of goiter and USG of the thyroid. Iodine concentration was assessed in the morning urine by the catalytic method of Sandell-Költhoff. The concentrations ofTSH and antibodies against TSH, thyroid-peroxidase (TPO) and thyroglobulin (Tg) were also determined. The mean concentrations of anti-Tg antibodies were statistically significantly higher in children with goiter in comparison with children with the thyroid gland within the norm (155.8 IU/ml vs. 24.4 IU/ml, p = 0.045). In children with goiter the incidence of'positive' titre of anti-Tg antibodies was 4-fold as high as in children without goiter (33.3% vs. 8.7%, p = 0.0147). High incidence of antibodies against thyroglobulin in the population of children with goiter and a positive correlation between the titre of anti-Tg antibodies and the size of the thyroid in this group suggest a significant role of autoimmunological disorders in the pathogenesis of goiter in the studied population.
在实施有效补碘措施的地区，最新观察结果证实甲状腺肿发病率显著下降。然而，在一些地区，甲状腺肿发病率保持不变，甚至观察到甲状腺自身免疫性疾病（如格雷夫斯 - 巴塞多夫病和慢性/亚急性淋巴细胞性甲状腺炎）的发病频率有所增加。本研究的目的是评估在波兰人群中实施强制性碘补充计划5年后，6至13岁儿童甲状腺自身免疫性疾病的患病率。该研究纳入了从比亚韦斯托克市随机挑选的4所小学的480名学童，以及在地区内分泌专科门诊因甲状腺肿接受碘化钾和/或甲状腺素治疗至少12个月的120名同龄患者。所有儿童均接受了甲状腺触诊的体格检查和甲状腺超声检查。采用桑德尔 - 科尔托夫催化法测定晨尿中的碘浓度。还测定了促甲状腺激素（TSH）以及抗TSH、甲状腺过氧化物酶（TPO）和甲状腺球蛋白（Tg）抗体的浓度。与甲状腺正常的儿童相比，甲状腺肿儿童的抗Tg抗体平均浓度在统计学上显著更高（155.8 IU/ml对24.4 IU/ml，p = 0.045）。甲状腺肿儿童中抗Tg抗体“阳性”滴度的发生率是无甲状腺肿儿童的4倍（33.3%对8.7%，p = 0.0147）。甲状腺肿儿童人群中抗甲状腺球蛋白抗体的高发生率以及该组中抗Tg抗体滴度与甲状腺大小之间的正相关表明，自身免疫性疾病在该研究人群甲状腺肿发病机制中起重要作用。
