山东省泰沂山区碘缺乏地区分布特征及重点人群碘营养状况研究

发布时间：2018-05-16 06:23

本文选题：泰沂山区 + 碘缺乏病　；参考：《山东大学》2013年硕士论文

【摘要】：目的通过水碘采样调查,了解泰沂山区碘缺乏地区居民生活饮用水含碘量现状；通过碘营养状况调查,评价泰沂山区碘缺乏地区重点人群营养状况,以期了解当前盐碘水平对碘缺乏病防治的效果；针对泰沂山区在消除碘缺乏病的过程中所面临的问题探讨防控对策,提出建议。方法整个研究分为两个部分：第一部分为山东省泰沂山区碘缺乏地区分布特征研究,依据《山东省实施食盐加碘消除碘缺乏危害管理条例办法》,调查了泰沂山区所含盖的58个碘缺乏县(市、区)中的28个县(市、区),包括泰安、临沂、日照和莱芜的全部县(市、区)以及济宁、淄博和潍坊的部分县(市、区)。以自然村为单位进行采样调查,如为集中供水村,采集1个水样；如为非集中供水村,按照饮用人数的多少,选择饮用人数最多的3个水源进行采样。水碘测定采用生活饮用水标准检验方法。地区划分标准：水碘含量10μg/L为缺碘地区,水碘150μg/L为高碘地区,水碘含量在10μg/L～150μg/L之间本文称之为水碘适宜(适碘)地区。采用地理信息系统(GIS)绘制山东省泰沂山区碘缺乏地区水碘分布图。第二部分为山东省泰沂山区碘缺乏地区重点人群碘营养状况调查研究,选择具有代表性的临沂蒙阴县、泰安岱岳区和日照莒县作为调查县,每个县(区)选择1个乡(镇)作为调查点。食用盐含量的检测采用直接滴定法,采用砷-铈催化分光光度法检测2岁以内婴幼儿、8-10岁儿童、妊娠期妇女、哺乳期妇女和20-45岁育龄妇女5种重点人群的尿碘水平,采用触诊法和B超法对8-10岁的儿童甲状腺进行检查以及采用《瑞文智力测验联合型中国农村版图册》(CRT-RC)对其进行智力测试。全部数据输入计算机进行处理,采用SPSS16.0软件对数据进行统计处理。各种率的比较采用卡方检验,各县(区)尿碘和盐碘的比较采用Kruskal-Wallis非参数检验,定量资料比较采用单因素方差分析(ANOVA)和多重比较分析(LSD-t检验),显著性差异的判定标准为P0.05。结果 1.水碘分布情况：共采集水样24880份,水碘平均值6.905μg/L,水碘最小值0.2μg/L(最低检出量),最大值为546.97μg/L,中位数为5.4μg/L。在县级层面上,在所调查的28个县(市、区)中,东平县的水碘值存在10ug/L和10～150μg/L两种情况,即低碘和适碘并存；其余17个县(市、区)全部水碘值10μg/L,即属于低碘。在乡镇层面上,情况大致相似,目前按碘缺乏对待的392个乡镇中,有369个符合碘缺乏病地区标准。 2.家庭食用盐含碘量检测结果：共检测了295份食用盐,盐碘均值为28.517mg/kg,其中莒县的盐碘均值最高,为31.518mg/kg.碘盐覆盖率93.9%,合格碘盐食用率为88.47%,但蒙阴的碘盐覆盖率(85.29%)和合格碘盐食用率(75.49%)均未达到90%。 3.人均日盐摄入量结果共调查了297名学生人均日盐摄入量,均值为13.87g,中位数为13.34g,范围在7.5-23.3g之间,三个地区儿童的人均日盐摄入量均明显高于我国推荐的食盐摄入量6g的标准。 4.重点人群尿碘检测结果：8-10岁儿童、2岁以内婴幼儿、哺乳期妇女、妊娠期妇女和育龄妇女的尿碘中位数分别为222μg/L、270.5μg/L、169.7μg/L、175.4μg/L和234μt/L。从5类重点人群尿碘检测结果看,尿碘中位数值均在100μg/L以上,3个县区5类重点人群的15个中位数值提示碘摄入不足的有1个适宜碘摄入的有8个,碘摄入大于适宜量的有5个,碘摄入过量的有1个。 5.甲状腺肿大检查结果：共检测298名8-10岁儿童甲状腺,触诊法和B超法检查儿童甲状腺肿大率均为1.37%(4/298),B超法测得学龄儿童甲状腺容积范围为1.13-7.50ml,平均容积为3.061ml。经过单因素方差分析,不同调查地区儿童甲状腺容积有差异,且差异具有统计学意义(F=7.662,P=0.0010.05)。 6.儿童智商测查结果：智商平均水平为107.94,各县(市、区)儿童智商均值在102.19-110.86之间,其中蒙阴县为102.19,岱岳区为110.86,经单因素方差分析,各地区儿童智商差异无统计学意义(F=11.951,P0.05)。各县(市、区)儿童智商频数分布：落后者占1.68%,边缘者占2.35%,中下者占5.7%,中等者占45.3%,中上者占20.81%,优秀者占18.12%,超优者占6.04%。经Kruskal-Wallis检验分析,各县(市、区)儿童智商频数分布无统计学差异(x2=0.024,P0.05)。结论与建议 1、泰沂山区碘缺乏地区依然大范围存在,仍将是现在及今后采取碘缺乏病防治措施的重点区域。 2、居民户盐碘普及较广,合格碘盐检出率较高,本次监测提供了《食用盐碘含量》新标准执行前泰沂山区碘缺乏地区的基线数据,为下一步调整碘盐浓度提供了依据。 3、调查地区儿章人均日盐摄入量偏高,需要采取适宜的干预措施。 4、调查地区5类重点人群的尿碘中位数偏高,在防控碘缺乏危害的同时要注意防控碘过量。 5、儿童甲状腺肿大率降低,儿童的碘营养比较适宜,以食盐加碘为主的防控措施成果显著,处于持续可消除状态。
[Abstract]:objective
Through the water iodine sampling survey, the iodine content of drinking water in the iodine deficiency area of the mountain area is understood. Through the investigation of iodine nutrition, the nutritional status of the key population in the iodine deficiency area of the mountain area is evaluated in order to understand the effect of the current salt and iodine level on the prevention and control of iodine deficiency disease. The problems faced with the prevention and control countermeasures are discussed and suggestions are put forward.
Method
The whole study is divided into two parts: the first part is the study of the distribution characteristics of iodine deficiency areas in the Tai Yi mountain area of Shandong province. According to the measures for the implementation of the regulations for the elimination of iodine deficiency hazards in Shandong Province, 28 counties (cities and districts) of the 58 iodine deficiency counties (cities and districts) covered by the Tai Yi mountain area are investigated, including Tai'an, Linyi, sunshine and Laiwu. All counties (cities and districts) and some counties (cities and districts) of Jining, Zibo and Weifang are sampled and investigated by natural villages. For example, 1 water samples are collected for the centralized water supply village. For example, 3 water sources with the most drinking number are selected according to the number of drinking water, and the water iodine determination adopts the standard test of drinking water. Method. Area division standard: water iodine content 10 mu g/L is iodine deficiency area, water iodine 150 mu g/L is high iodine area, water iodine content between 10 mu g/L ~ 150 mu g/L is called water iodine suitable (suitable iodine) area. Geographical information system (GIS) is used to draw water iodine distribution map of iodine deficiency area of Tai Yi mountain area of Shandong province. The second part is Tai Yi mountain area of Shandong province. The iodine nutrition status of key population in iodine deficiency area was investigated and studied. The representative Linyi Mengyin County, Daiyue District of Tai'an and Rizhao Juxian were selected as investigation counties. 1 townships (towns) were selected as investigation points in each county (District). Direct titration was used to detect the content of edible salt, and the arsenic cerium catalytic spectrophotometric method was used to detect infants within 2 years, 8-10 The urine iodine levels of 5 key groups of age children, pregnant women, breast-feeding women and 20-45 year old women of childbearing age were examined by palpation and B-mode ultrasonography on the thyroid gland of children aged 8-10 years and using the Raven intelligence test combined with Chinese rural edition (CRT-RC) to carry out the intelligence test. The data were statistically processed with SPSS16.0 software. The comparison of various rates adopted chi square test. The comparison of urine iodine and salt iodine in each county (area) was compared with Kruskal-Wallis nonparametric test. The quantitative data was compared with single factor analysis of variance (ANOVA) and multiple comparison analysis (LSD-t test), and the criteria for determining the significant difference were P0.05.
Result
1. water iodine distribution: a total of 24880 samples of water samples were collected, the average iodine value of water iodine was 6.905 mu g/L, the minimum value of water iodine was 0.2 mu g/L (the minimum detection amount), the maximum value was 546.97 mu g/L, the median of 5.4 mu g/L. at the county level, and in the 28 counties (cities and regions) investigated, there were two cases of 10ug/L and 10~150 mu g/L in Dongping County, that is, low iodine and suitable iodine. In the remaining 17 counties (cities and districts), the total iodine value of the water is 10 g/L, that is, low iodine. At the township level, the situation is roughly similar, and at present, 369 of the 392 villages and towns which are treated with iodine deficiency are in accordance with the standard of iodine deficiency diseases.
2. test results of iodine content in family salt: a total of 295 edible salt was detected, the average of salt iodine was 28.517mg/kg, of which the average salt iodine in Juxian was the highest, the coverage rate of 31.518mg/kg. iodized salt was 93.9%, the edible rate of qualified iodized salt was 88.47%, but the coverage rate of iodized salt (85.29%) and the edible rate of qualified iodized salt (75.49%) were not 90%.
The daily salt intake of 3. per capita was a total of 297 students' daily salt intake, with a mean of 13.87g, the median of 13.34g, and the range of 7.5-23.3g. The daily salt intake of children in three regions was significantly higher than that of the recommended standard of salt intake 6G in China.
4. key population urine iodine test results: 8-10 year old children, infants within 2 years of age, breast-feeding women, pregnant women and women of childbearing age, the median urine iodine number is 222 mu g/L, 270.5 mu g/L, 169.7 mu g/L, 175.4 mu g/L and 234 mu t/L., the urine iodine value is more than 100 mu g/L and 5 key people in 3 counties. The 15 median values of the group indicated that there were 1 iodine intakes with 8 iodine intake, 5 with iodine intake larger than the appropriate amount, and 1 with excessive iodine intake.
5. examination results of thyroid enlargement: the thyroid gland of 298 8-10 year old children was detected. The thyroid enlargement rate of children was 1.37% (4/298) by palpation and B-ultrasound. The range of thyroid volume of school-age children was 1.13-7.50ml, and the average volume was 3.061ml. through single factor analysis of variance. The thyroid volume of children in different areas was different, The difference was statistically significant (F=7.662, P=0.0010.05).
6. children's IQ test results: the average IQ level was 107.94. The average IQ of children in all counties (cities and districts) was between 102.19-110.86, 102.19 in Mengyin and 110.86 in Daiyue. The difference in IQ of children was not statistically significant (F=11.951, P0.05) by single factor analysis of variance. The number of children's IQ in each county (city, district) was 1 .68%, 2.35% in the marginal, 5.7% in the middle and lower, 45.3% in the middle, 20.81% in the middle and 18.12% for the excellent, and the super superior was analyzed by the Kruskal-Wallis test. There was no statistical difference in the frequency distribution of children's IQ in each county (city, district) (x2=0.024, P0.05).
Conclusions and suggestions
1, the iodine deficiency area in Tai Yi mountain still exists in a wide range, and will still be a key area for the prevention and treatment of iodine deficiency disorders.
2, the prevalence of salt iodine was widely used in residents, and the detection rate of qualified iodized salt was high. This monitoring provided the baseline data of the iodine deficiency area in the Taiyi mountain area before the implementation of the new standard, which provided the basis for the next step to adjust the iodized salt concentration.
3, the average daily intake of salt per capita in the survey area is high, and appropriate intervention measures should be taken.
4, the median urine iodine level of the 5 groups of key people in the survey area is high.
5, children's thyroid enlargement rate is reduced, children's iodine nutrition is relatively suitable, and the prevention and control measures mainly based on salt iodization are notable and are in a state of continuous elimination.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R151

【参考文献】