Dou Yugui, Wang Yanling, Sun Wei, Cao Yongqin, Zhu Xiaonan, Zheng Jing
Gansu Center for Disease Prevention and Control, Lanzhou 730020, China.
Wei Sheng Yan Jiu. 2018 Jan;47(1):56-61.
To assess the iodine nutrition and thyroid function of lactatingwomen in different iodine nutrition level of children in Gansu Province, and provide a scientific basis for iodine supplementation.
Liangzhou district( the median urinary iodine was greater than or equal to 300 g/L), Linze county( the median urinary iodine was from 200 to 299 g/L) and Huating county( the median urinary iodine was from100 to 199 g/L) were selected according to 8-10 years old children urinary iodine in2009. Huating county, Liangzhou district and Linze county were as iodine excessive area, iodine suitable area 1 and iodine suitable area 2, respectively in 2014. One township was randomly selected from the east, west, south, north and middle parts of each research point, 10 lactating women were randomly collected in each township, who was tested urine samples and thyroid function. Salt intake was surveyed in 3 townships. 2 samples were collected in centralized water supplies, 1 sample was collected in its coverage by the east, west, south, north and middle parts; 1 sample was collected by the east, west, south, north and middle parts in decentralized water supplies, which were tested of water iodine.
The medians of water iodine were 2. 32, 0. 70 and 6. 18 μg/L and the medians of salt iodine were 25. 3, 25. 0 and 28. 6 mg/kg for iodine excessive area, iodine suitable area 1 and iodine suitable area 2, respectively. Per capita daily intake of salt were 15. 0, 11. 3 and 4. 7 g for iodine excessive area, iodine suitable area 1 and iodine suitable area 2 respectively, there were statisticant differences. The median urinary iodine of lactating women were 181. 8, 143. 1 and 104. 9 μg/L for iodine excessive area, iodine suitable area 1 and iodine suitable area 2, respectively. The medians of thyroidstimulating hormone( TSH) were 2. 3, 2. 2 and 1. 9 mIU/L, mean values of free thyroxine( FT4) were 15. 0, 13. 9 and 14. 6 pmol/L, mean values of free triidothyronine( FT3) were 5. 0, 4. 8 and 4. 6 pmol/L for iodine excessive area, iodine suitable area 1 and iodine suitable area 2 respectively, there were not statistically differences. The positive rate of thyromicrosomal antibody( Tm Ab) were 3. 6 %, 11. 3 % and 13. 2 % and the positive rate of thyroglobulin antibody( Tg Ab) were 3. 6 %, 11. 3 % and 11. 3 % for iodine excessive area, iodine suitable area 1 and iodine suitable area 2 respectively( P >0. 05). Prevalence of thyroid function disorders were 14. 3 %, 21. 0 % and 9. 4 % and prevalence of low-FT4 syndrome were 7. 1 %, 4. 8 % and 1. 9 %, prevalence of subclinical hypothyroidism were 3. 6 %, 11. 3 % and 3. 8 % for iodine excessive area, iodine suitable area 1 and iodine suitable area 2 respectively( P > 0. 05).
Iodine nutrition level was appropriate for lactating women in 3 areas, but some lactating women were iodine deficiency or iodine excess. There were occurred thyroid function disorders in some lactating women in 3 areas. The lactating women's iodine nutrition and thyroid function should be monitored and the normal reference value of thyroid function on lactating women should be established also.
评估甘肃省不同儿童碘营养水平地区哺乳期妇女的碘营养状况及甲状腺功能,为碘补充提供科学依据。
根据2009年8 - 10岁儿童尿碘水平,选取凉州区(尿碘中位数大于或等于300μg/L)、临泽县(尿碘中位数为200~299μg/L)和华亭县(尿碘中位数为100~199μg/L)。2014年,华亭县、凉州区和临泽县分别作为碘过量地区、适宜碘地区1和适宜碘地区2。每个研究点东、西、南、北、中部各随机抽取1个乡,每个乡随机抽取10名哺乳期妇女,检测尿样和甲状腺功能。对3个乡进行盐摄入量调查。集中式供水采集2份样品,东、西、南、北、中部覆盖范围各采集1份;分散式供水东、西、南、北、中部各采集1份,检测水碘含量。
碘过量地区、适宜碘地区1和适宜碘地区2的水碘中位数分别为2.32、0.70和6.18μg/L,盐碘中位数分别为25.3、25.0和28.6mg/kg。碘过量地区、适宜碘地区1和适宜碘地区2的人均每日盐摄入量分别为15.0、11.3和4.7g,差异有统计学意义。碘过量地区、适宜碘地区1和适宜碘地区2哺乳期妇女的尿碘中位数分别为181.8、143.1和104.9μg/L。碘过量地区、适宜碘地区1和适宜碘地区2促甲状腺激素(TSH)中位数分别为2.3、2.2和1.9mIU/L,游离甲状腺素(FT4)均值分别为15.0、13.9和14.6pmol/L,游离三碘甲状腺原氨酸(FT3)均值分别为5.0、4.8和4.6pmol/L,差异无统计学意义。碘过量地区、适宜碘地区1和适宜碘地区2甲状腺微粒体抗体(Tm Ab)阳性率分别为3.6%、11.3%和13.2%,甲状腺球蛋白抗体(Tg Ab)阳性率分别为3.6%、11.3%和11.3%(P>0.05)。碘过量地区、适宜碘地区1和适宜碘地区2甲状腺功能障碍患病率分别为14.3%、21.0%和9.4%,低FT4综合征患病率分别为7.1%、4.8%和1.9%,亚临床甲状腺功能减退患病率分别为3.6%、11.3%和3.8%(P>0.05)。
3个地区哺乳期妇女碘营养水平适宜,但部分哺乳期妇女存在碘缺乏或碘过量情况。3个地区部分哺乳期妇女出现甲状腺功能障碍。应监测哺乳期妇女碘营养和甲状腺功能,建立哺乳期妇女甲状腺功能正常参考值。