摘要目的 了解山西省水源性高碘地区居民碘营养及高碘性甲状腺肿流行现况.方法 2014年,在山西省10个高碘县(市、区)辖区内划分高碘和非高碘两个片区,在高碘片区内按东、西、南、北、中各抽取1个乡镇(若高碘片区内高碘乡镇≤5个,则全部抽取),每个乡镇抽取4个行政村,每个行政村抽取15户居民,采集其家中食用盐盐样.采用半定量法判定盐样是否为不加碘食盐.全省10个高碘县(市、区)选择5个县(市、区),其中水碘在150～ 300μg/L的3个县,水碘＞300 μg/L的2个县,每个县(市、区)各选择1个行政村,采集居民家庭饮用水水样,进行水碘检测;并在村小学抽取8～ 10岁儿童100人,采用B超法测定其甲状腺容积,同时抽取其中30人,采集尿样,检测尿碘含量.结果 ①在10个高碘县(市、区)的高碘片区共检测居民户盐样1 680份,无碘食盐率为89.2％(1 499/1 680).②在5个高碘县(市、区)共采集水样14份,水碘含量为155.7～467.3μg/L.③在5个高碘县(市、区)共收集8～ 10岁儿童尿样197份,尿碘中位数为466.5μg/L;水碘＞300μg/L组儿童尿碘中位数(650.1μg/L)明显高于水碘150～300 μg/L组(332.5 μg/L,Z=-6.164,P＜ 0.05);儿童尿碘水平与其所在村水碘呈正相关(r=0.543,P＜0.05).④在5个高碘县(市、区)共测定8～ 10岁儿童甲状腺容积543人,甲状腺肿大率为6.8％(37/543);水碘值＞300 μg/L组儿童甲状腺肿大率[9.0％(28/311)]明显高于水碘值150～300 μg/L组[3.9％(9/232),x2=5.494,P＜0.05].结论 山西省水源性高碘地区停供碘盐措施落实良好,高碘地区人群碘营养水平及儿童甲状腺肿大率仍为较高,高碘干预措施可重点考虑改水.

abstractsObjective To investigate resident iodine nutrition level in waterborne high iodine areas and prevalence of high iodine goiter in Shanxi Province.Methods In 2014,in Shanxi Province,in all the 10 high iodine counties (cities,districts),the jurisdiction area of each county (city,district) was divided into two blocks,high iodine and not high iodine districts,and in high iodine area of each county (city,area) according to their sub-area positions of east,south,west,north and center,a township was randomly selected (if the number of high iodine area in iodine excessive township ≤5,all townships were selected);four administrative villages in each monitoring township were randomly selected;in each administrative village,the edible salt samples of 15 randomly selected households were collected for detection of iodine content.Five counties (cities,districts) were selected from the province's 10 high iodine counties (cities,districts),water iodine content of 3 counties (cities,districts) was 150-300 μg/L,and 2 were ＞ 300 μg/L,one administrative village was selected from each county (city,area),household drinking water samples were collected to detect iodine content;and 100 elementary school children aged 8-10 were selected from the village where the monitoring stations located in for thyroid volume ultrasound measurement,and 30 of them were randomly selected for urinary iodine content detection.Results ① In the 10 high iodine counties (cities,districts),1 680 households salt samples were detected,and the rate of no iodine salt samples was 89.2％(1 499/1 680).② Fourteen water samples were collected in 5 counties (cities,districts),and the water iodine content was 155.7-467.3 μg/L.③ In the five high iodine counties (cities,districts),197 urine samples were collected from children aged 8 to 10.The median of urinary iodine was 466.5 μg/L;the median urinary iodine was 650.1 μg/L in water iodine≥300 μg/L children group which was significantly higher than that of the group with 150-300 μg/L water iodine content 332.5 μg/L (Z =-6.164,P ＜ 0.05);urinary iodine level of children and the water iodine of the corresponding village was positively correlated (r =0.543,P ＜ 0.05).④ In the five high iodine counties (cities,districts),543 children aged 8-10 were measured with their thyroid volume,the thyroid goiter rate was 6.8％(37/543);the goiter rate of water iodine ≥300 μg/L children group was [9.0％(28/311)] which was significantly higher than that in the iodine content of drinking water 150-300 μg/L group [3.9％(9/232),x2 =5.494,P ＜ 0.05].Conclusion The measurement of stopping iodized salt supply in high iodine areas in Shanxi Province is well implemented,iodine nutrition level and thyroid goiter rate in those areas are still too high,high iodine intervention measures can be focused on changing of the drinking water.