Hubaveshki S, Powles J, Lozanov B
Clinical Centre of Endocrinology and Gerontology, Sofia, Bulgaria.
Cent Eur J Public Health. 1997 Dec;5(4):205-7.
Iodine supplementation programmes began in designated high risk mountainous districts in Bulgaria in 1958. The prevalence of goitre fell. But the programmes became less effective and by the mid 1980s there were strong indications that goitre was resurgent. Ten villages that had been surveyed in 1956 and 1974 were re-surveyed between 1986 and 1989. All persons available were examined (not just residents)--at home, workplace or school--by a trainee or specialist endocrinologist. Goitres were graded according to the WHO/ICCIDD system. 2,901 females and 1,885 males were examined. Diffuse, stage 1 enlargements were common in males and females under 35, with prevalences exceeding 20% in several age/sex groups. Nodular stage 1 and 2 enlargements became commoner at ages above 45, with prevalences exceeding 15% in females over 55. Overall prevalences were 28% in females and 14% in males. 6 cretins were identified. In recognised endemic areas of Bulgaria, epidemiological surveillance of IDD should be maintained. Detailed studies are required to determine why iodine supplementation became less effective after the mid 1970s and to develop and test new, cost-effective public health strategies appropriate to the changed socio-political circumstances.
保加利亚于1958年在指定的高风险山区启动了碘补充计划。甲状腺肿的患病率有所下降。但这些计划的效果逐渐减弱，到20世纪80年代中期，有强烈迹象表明甲状腺肿正在复发。对1956年和1974年调查过的10个村庄在1986年至1989年期间进行了重新调查。所有能找到的人（不仅仅是居民）——在家中、工作场所或学校——由实习或专业内分泌学家进行检查。甲状腺肿根据世界卫生组织/国际控制碘缺乏病理事会系统进行分级。共检查了2901名女性和1885名男性。35岁以下的男性和女性中弥漫性1期肿大很常见，在几个年龄/性别组中患病率超过20%。45岁以上的人群中结节性1期和2期肿大更为常见，55岁以上女性的患病率超过15%。总体患病率女性为28%，男性为14%。发现了6名克汀病患者。在保加利亚公认的地方性病区，应持续开展碘缺乏病的流行病学监测。需要进行详细研究，以确定为何20世纪70年代中期之后碘补充计划的效果变差，并制定和测试适合不断变化的社会政治环境的、具有成本效益的新公共卫生策略。
