不同水碘水平地区7-14岁儿童碘营养状况及甲状腺体积分析

发布时间：2018-02-25 08:50

本文关键词： 碘尿碘浓度尿碘排出量甲状腺体积甲状腺体积肿大率儿童　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:对临床工作者和研究者来说,尿样中反应人群或个体碘营养状况的相关指标的稳定性是十分重要的,本研究旨在通过两次重复采集随机尿样和24-h尿样以检测尿碘排出量(urinary iodine excretion,UIE)和尿碘浓度(urinary iodine concentration,UIC)的稳定度,以期找到一个更便捷和科学的尿碘指标去评价人群和个体的碘营养状况;摄入的碘约92%通过尿液排出,UIE可以反应近期的碘营养状况,国内外暂时没有针对儿童碘摄入量与甲状腺体积(thyroid volume,Tvol)和甲肿率(total goiter rate,TGR)变化趋势的研究,本研究拟通过24-h UIE评价儿童的碘营养状况,旨在阐明高水碘地区儿童碘营养状况与Tvol和TGR的关联,Tvol及TGR随碘摄入量增高的变化趋势,为建立儿童碘的安全上限值提供科学依据。对象方法:以山东省不同水碘分布地区的7-14岁学龄儿童为调查对象;采集水样、两次随机尿样和24小时尿样,记录尿样的体积,检测水碘浓度及UIC;现场进行体检,测量每个儿童的身高、体重及Tvol,计算体表面积(body surface area,BSA)和TGR,分析Tvol和TGR随着碘摄入量的变化趋势。结果:1)宁津县、陵县、高唐县及东昌府区四个地区的水碘水平均符合预期的标准,四次现场调查共采集水样1927份,分布梯度明显。四个地区学龄儿童2089人,其中1023名男生,1066名女生,男生的年龄、身高、体重、BSA均略大于女生(P0.05)。2)本调查第一次采集符合要求的24-h尿样1979份,随机尿样共1901份,24-h尿量为750(490-1140)ml,24-h UIC为381.1(203.5-649.4)μg/L,随机UIC为479.8(217.2-821.1)μg/L,且随机UIC大于24-h UIC(P0.001),第一次24-h UIE为275.3(139.3-480.7)μg/d;第二次采集符合要求的24h尿样1949份,随机尿样2006份,24-h尿量为780(540-1100)ml,24-h UIC为398.1(202.3-686.6)μg/L,随机UIC为420.1(196.2-760.9)μg/L,两者之间差异不具有统计学意义(P=0.115),第二次24-h UIE为285.3(141.3-523.7)μg/d。将两次24-h UIE结果转化为碘摄入量,最终的碘摄入量为298.2(186.4-437.0)μg/d。两次随机UIC呈中度相关(rs=0.579,P0.001),两次24-h UIC明显相关(rs=0.718,P0.001),两次24-h UIE高度相关(rs=0.655,P0.001),两次24-h UIC的kappa值为0.49,两次随机UIC的kappa值为0.36,两次碘摄入量的kappa值为0.39。3)男生的Tvol略大于女生(P=0.035),但是男生、女生之间的TGR没有差异(χ20.001,P=0.991)。4)水碘浓度、年龄、身高、体重、BSA等基础指标与碘摄入量和Tvol呈正相关的关联,其中,身高、体重及BSA与Tvol的相关性均大于年龄与Tvol的相关性,除去年龄外,TGR与其余的基础指标呈正相关的关联。5)学龄儿童的Tvol和TGR随着碘摄入量的升高而增大(rs=0.499,P0.001;χ2=99.293,P0.001),当碘摄入量在250-300μg/d组别时,TGR超过5%。按照年龄分组后,7-10岁儿童在碘摄入量达到200-250μg/d时,儿童的TGR超过5%;而11-14岁儿童在碘摄入量达到250-300μg/d时,儿童的TGR超过5%。阈值效应模型分析发现碘摄入量与Tvol和TGR间存在一个非线性的关系。结论:1)随机UIC和24-h UIC都可以反应人群近期的碘营养状况,相对于24小时尿样,随机尿更容易取得,但是随机UIC并不如想象中稳定,24小时UIC更稳定可靠,不同条件下的多次24小时尿样更科学、更准确。2)按照现行的标准分析,Tvol和TGR在碘摄入量大于110μg/d时风险开始增加,7-10岁儿童在碘摄入量达到200-250μg/d时TGR5%,11-14岁儿童在碘摄入量达到250-300μg/d时TGR5%,因此,推荐7-10岁儿童适宜的碘摄入量范围为110-250μg/d,11-14岁儿童适宜的碘摄入量范围为110-300μg/d,但是最终明确的上限值还有待于更深入的分析。3)我国现行的Tvol的判断标准是以年龄为依据进行划分的,在年龄、身高、体重三个基础指标中,身高和体重与Tvol的相关程度均大于年龄与Tvol的相关程度,BSA是一个结合了身高与体重的更为综合的指标,为了更利于对人群碘营养状况的监测,防治高碘对人群的危害,依据BSA建立一个甲状腺体积的标准必不可少。
[Abstract]:Objective: to clinical doctors and researchers, the stability indexes of population or individual reaction in urine iodine nutritional status is very important, this research aims at two times repeated collection of random urine and 24-h urine to detect urinary iodine excretion (urinary iodine excretion UIE (urinary iodine) and urinary iodine concentration concentration, UIC) the stability, to evaluate the iodine nutritional status of the population and individual to a more convenient and scientific index to find the iodine intake of iodine; about 92% is excreted through the urine, UIE can reflect the recent iodine nutritional status at home and abroad, not for children of iodine intake and thyroid volume (thyroid, volume, Tvol) and goiter rate (total goiter rate, TGR) to study trends, this study proposed by 24-h UIE evaluate the iodine nutritional status of children, to clarify the high iodine area of iodine nutritional status of children with Tvol and TGR The change trend of Tvol and TGR associated with increased iodine intake, and provide scientific basis for the establishment of safety limit children's iodine value. Methods: at the age of 7-14 school-age children in Shandong Province in different water iodine distribution area as the research object; the water samples collected two random urine and 24 hour urine, urine volume record, detection of water the iodine concentration and UIC; on-site examination, measurement of each child's height, weight and body surface area (body Tvol, surface area computing, BSA) and TGR, Tvol and TGR analysis of trend with iodine intake. Results: 1) in Ningjin County, Lingxian County, the water iodine level of four area of Gaotang county and Dongchangfu district are in line with the expected standard, four field surveys were collected 1927 water samples, four regional distribution gradient is obvious. 2089 school-age children, including 1023 boys and 1066 girls, boys age, height, weight, BSA were slightly more than girls (P0.05).2) the survey The first collected urine samples of 1979 in accordance with 24-h requirements, a total of 1901 random urine, 24-h urine volume was 750 (490-1140) ml, 24-h UIC 381.1 (203.5-649.4) g/L, UIC (217.2-821.1) were 479.8 g/L, and random UIC greater than 24-h (P0.001), UIC 24-h UIE 275.3 (the first time 139.3-480.7 g/d; second) collected urine samples of 1949 in accordance with 24h requirements, randomly 2006 urine samples, 24-h urine volume was 780 (540-1100) ml, 24-h UIC 398.1 (202.3-686.6) g/L, UIC (196.2-760.9) were 420.1 g/L, the difference was not statistically significant (P=0.115), second 24-h UIE 285.3 (141.3-523.7) g/d. two 24-h UIE results into iodine intake, the iodine intake was 298.2 (186.4-437.0) g/d. two UIC were moderately correlated (rs=0.579, P0.001), two 24-h UIC was significantly correlated (rs=0.718, P0.001), two 24-h (rs=0.655 UIE highly correlated P0.001, two, 2) 4-h UIC kappa is 0.49 and two times of random UIC kappa value is 0.36, two times of iodine intake value of kappa is 0.39.3) is slightly larger than the boys Tvol girls (P=0.035), but no difference between girls and boys, TGR (20.001, P=0.991).4) water iodine concentration, age, height, weight BSA, positive basic indicators of iodine intake and Tvol related association, the height, weight and correlation of BSA and Tvol were greater than Tvol and age, except the age,.5 TGR index was positively related to basic) the rest of the school-age children of Tvol and TGR increased with increasing iodine intake (rs=0.499, P0.001; X 2=99.293, P0.001), when the iodine intake in 250-300 g/d group, TGR more than 5%. according to age group, 7-10 children aged up to 200-250 g/d in iodine intake, TGR more than 5% children; and 11-14 year old son Tong Zaidian intake reached 250-300 g/d, children TGR more than 5%. threshold effect model analysis showed that there is a nonlinear relationship between iodine intake and Tvol and TGR. Conclusion: 1) UIC and 24-h UIC can be randomly iodine nutritional status of recent population relative to the 24 hours of reaction, urine, random urine more readily available, but random UIC is not stable, more stable and reliable 24 hours UIC, under the condition of different times of 24 hours urine is more scientific, more accurate).2 analysis according to the current standard, Tvol and TGR in iodine intake is more than 110 g/d when the risk began to increase, 7-10 year old children in iodine intake reached 200-250 g/ D TGR5%, 11-14 year old children in iodine intake reached 250-300 g/d TGR5%, therefore, recommended 7-10 year old children suitable iodine intake range is 110-250 g/d, 11-14 year old children for iodine intake is within 110-300 g/d, but eventually clear the upper limit value needs to be more in-depth analysis of.3) in China The current standard of judge Tvol is classified according to the age, age, height, weight, three basic indexes, related to the degree of correlation degree of height and weight were greater than Tvol with age and Tvol, BSA is a combination of the height and weight of the more comprehensive indicators, in order to more conducive to monitoring the nutritional status of iodine, hazard prevention and control of iodine on the population, according to the BSA to establish a standard of thyroid volume is essential.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R153.2

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