摘要目的 了解沧州市不同水碘地区儿童甲状腺结节患病情况.方法 2015年10月至2017年1月,在沧州市选择15个村作为监测村,每个监测村采集饮用水水样2份(均是集中供水),测定水碘含量;抽取8~10岁儿童100名(男女各半)检查甲状腺,抽取其中不少于50名儿童(男女各半)检测尿碘含量.在水源性高碘村,居民食用盐监测按《全国碘缺乏病监测方案》进行;在非高碘村,采集检测尿碘的学生家庭食用盐盐样,进行盐碘监测.高碘村盐碘检测采用半定量法,非高碘村盐碘检测采用直接滴定法,川盐及其他强化食用盐检测采用仲裁法(GB/T 13025.7-2012).水碘和尿碘检测采用砷铈催化分光光度测定法.结果 共调查15个村,水碘含量范围为28.2~1128.0 μg/L.共检测尿样1066份,各调查村尿碘中位数在102.6~1162.0 μg/L.共检查8~10岁儿童1575人,检出甲状腺结节患者125例,甲状腺结节检出率为7.9%.男性检出率为7.0% (61/871),女性检出率为9.1%(64/704),不同性别甲状腺结节检出率比较差异无统计学意义(χ2=2.07,P>0.05);尿碘处于适宜水平(100 ~ < 200 μg/L),超过适宜水平(200 ~ < 300 μg/L)、碘过量(≥300 μg/L)监测村的儿童甲状腺结节检出率为4.5%(23/508)、7.8%(4/51)、11.6%(59/507),不同尿碘水平儿童甲状腺结节检出率比较差异有统计学意义(χ2=17.30,P<0.01).水碘含量在10~<100、100~<300、≥300 μg/L的监测村8 ~ 10岁儿童甲状腺结节检出率比较差异有统计学意义[2.9%(13/448)、7.9%(25/317)、10.7%(87/810), χ2=23.86,P<0.05].甲状腺结节单侧患病占64.8%(81/125),多发结节占58.4%(73/125),其中,水碘 <300和≥300 μg/L的监测村多发结节占34.2%(13/38)和69.0%(60/87),二者比较差异有统计学意义(χ2=13.14,P<0.01).水源性高碘监测村共采集居民食用盐1800份,检出无碘食盐1779份,无碘食盐率为98.8%;供碘盐村共采集学生家庭食用盐190份,盐碘中位数均为0.0 mg/kg.结论 沧州市8~10岁儿童甲状腺结节患病可能与高水碘有关,水碘≥300 μg/L的地区儿童甲状腺结节的多发率也明显增高.

abstractsObjective To understand the prevalence of thyroid nodules of children lived in different water iodine areas in Cangzhou City. Methods From Oct. 2015 to Jan. 2017, 15 villages were selected as monitoring sites in Cangzhou,two drinking water samples were collected from each survey site(all had centralized water supply), and the water iodine content was determined. A total of 100 children aged 8 to 10 (half male and female) were examined for thyroid nodules, and at least 50 children (half male and half female) were selected to detect urinary iodine content. In the high iodine water counties, the monitoring sites of iodine salt was according to "National Iodine Deficiency Monitoring Program"; in the monitoring sites of iodine salt supplied counties, students in the monitored village were asked to detect urinary iodine and household salt samples were collected to monitor salt iodine. In the high iodine area, the salt iodine test was carried out by semi-quantitative method. In the non-high iodine area, the salt iodine content of the iodized salt monitoring sites was determined by direct titration, the salt iodine content of Chuan salt and other intensified edible salt was tested by arbitration(GB/T 13025.7-2012). Water iodine and urinary iodine were tested by arsenic and cerium catalytic spectrophotometry. Results Water iodine content was 28.2 - 1 128.0 μg/L in 15 villages; a total of 1 066 urine samples were examined, the median of uriary iodine in each village was 102.6-1 162.0 μg/L;a total of 1 575 children aged 8 to 10 years were examined,among them,125 cases of thyroid nodules were detected; thyroid nodules detection rate was 7.9%. The prevalence of male was 7.0% (61/871), and the prevalence of female was 9.1% (64/704), there was no significant difference in the detection rate of thyroid nodules between different sex (χ2=2.07,P>0.05); The detection rate of thyroid nodules were 4.5%(23/508),7.8%(4/51), 11.6%(59/507)in children with urinary iodine at the appropriate level (100 - <200 μg/L), the appropriate level (200 - < 300 μg/L) and iodine excess level (≥300 μg/L), the difference of thyroid nodules in children with different levels of urinary iodine detection rate was statistically significant (χ2=17.30, P < 0.01). The difference of prevalence of thyroid nodules in children aged 8 to 10 years with water iodine concentrations of 10 - < 100, 100 - < 300 and ≥300 μg/L was statistically significant[2.9%(13/448),7.9%(25/317), 10.7%(87/810),χ2=23.86,P<0.05].The patients with unilateral thyroid nodule accounted for 64.8% (81/125); the patients with multiple thyroid nodules counted for 58.4% (73/125), and 34.2%(13/38),69.0%(60/87)in areas with iodine content less than 300 μg/L and no less than 300 μg/L,the difference between the two was statistically significant (χ2= 13.14, P < 0.01). A total of 1 800 salt samples were collected from the high water iodine counties,of which 1 779 were iodine-free salt, the rate of iodine-free salt was 98.8%; a total of 190 salt samples were collected in student family, in the 4 iodized salt monitoring sites, the salt iodine median of resident's edible salt was 0.0 mg/kg. Conclusion The prevalence of thyroid nodules in children aged 8 - 10 years may be related to high water iodine in Cangzhou City; children with multiple thyroid nodules is also significantly higher in water iodine content greater than 300 μg/L areas.