不同水碘地区儿童碘营养调查及其碘安全摄入量上限值研究

发布时间：2018-05-19 10:27

本文选题：儿童 + 碘可耐受最高摄入量　；参考：《天津医科大学》2017年博士论文

【摘要】：目的:目前关于碘过量对儿童的危害研究尚不系统,也缺乏制定我国儿童碘安全摄入量上限值的研究证据。本研究旨在明确不同水碘水平地区儿童碘营养状况以及甲状腺功能水平;探讨不同碘摄入量水平对儿童的安全性,明确碘过量对儿童的危害以及我国儿童碘可耐受最高摄入量(Upper safe intake level, UL)。对象方法:我国山东不同水碘地区儿童的横断面流行病学调查。对调查儿童进行膳食问卷调查,并重复采集两次24-h尿样和一次性随机尿样,以准确评估儿童碘摄入量水平;测定儿童甲状腺体积并判断甲状腺肿大情况;采集儿童5ml非抗凝血样,测定其甲状腺功能相关指标。结果:本研究共调查了山东省宁津县、陵县、高唐县和东昌府的2224名儿童,包括1100 (49.5%)名男孩以及1114 (50.5%)名女孩,年龄为11 (7-14)岁,水碘中位数为181 (67.2-402)μg/L,四个地区水碘水平分别为30.5 (23.9-74.4) μg/L、112(37.3-168) μg/L、648 (515-753) μg/L 和 314 (184-385) μg/L。第一次采样的随机尿碘浓度(urinary iodine concentration, UIC)为 481 (218-818) μg/L,24-h 尿碘浓度(24-h UIC)为 380 (203-646)μg/L,第二次采样的的随机 UIC 为 417 (195-753)μg/L,24-h UIC为397 (200-682)μg/L,两次尿碘浓度中位数均显示调查儿童的碘营养过剩,并且高唐县儿童的尿碘浓度显著均高于其他地区(P0.0001)。儿童的游离三碘甲腺原氨酸(Free triiodothyronine, FT3)水平为5.8±0.7pmol/l,游离甲状腺素(Free thyroxine, FT4)水平为 16.4±2.1pmol/l,促甲状腺激素(thyroid stimulating hormone, TSH)水平为 2.9 (2.1, 4.0) mIU/L 以及甲状腺球蛋白(thyroidglobin, Tg)浓度为 16.0 (9.8, 26.1)μg/L,甲状腺体积(thyroid volume, Tvol)为 4.37ml (3.33, 5.75)ml,甲状腺肿大率(Total goiter rate, TGR)为9.7%。在所有调查儿童中发现,亚临床甲状腺功能减退(亚甲减,Subclinical hypothyroidism, SCH)儿童有237例(11.5%),甲状腺功能亢进儿童有5例(0.2%),亚临床甲状腺功能亢进有2例(0.1%),未见甲状腺功能减退儿童。四个地区的FT3未见统计学差异(P0.05),可是高唐县儿童的TSH、Tvol和Tg显著高于其他三个地区的儿童,此外高唐县儿童的SCH发病率为14.5%和TGR为21.8%,均明显高于其他三个地区。儿童甲状腺过氧化物酶抗体(thyroid peroxidase antibody, TPOAb)阳性率为6.8%,甲状腺球蛋白抗体(thyroglobulin antibodies, TGAb)阳性率有2.1%,四个地区TGAb阳性率未见统计学差异(P=0.06),但是四个地区TPOAb阳性率差异具有统计学意义(P0.0001)。TSH、Tg以及Tvol三者相互之间均存在正相关关系。本研究调查儿童的日常碘平均摄入量量(Best linear unbiased predicator,BLUP)为298 (186-437)μg/d,TSH随着碘摄入量的升高而升高(r=0.11,P0.0001),在200-300μg/d摄入量时SCH发病率为11.2%,并且随着摄入量的升高而SCH发病率保持在10%以上。儿童Tvol在碘摄入量150μ/d,出现明显增大(β=1.3 (1.1, 1.4),P0.001),儿童TGR在碘摄入量150μ/d发病风险明显增加(OR=5.1 (3.5, 7.4),P0.001),且 7-10 岁儿童在碘摄入量达到200-250μg/d 时,TGR超过5%; 11-14岁儿童碘摄入量达到250-300μg/d时,TGR超过5%。儿童Tg与碘摄入量之间存在曲线关系,经过年龄、性别、身高和体重的校正,阈值效应模型分析可知120μg/d为转折点,当碘摄入量大于120μg/d时,Tg随着碘摄入量增高有升高的风险(β=0.5 (0.4, 0.6),P0.001),儿童摄入量大于200μg/d时Tg40 μg/L的风险随着摄入量的增加而增加(OR= 4.0 (2.7, 5.8) , P0.001)。多元分析发现,经过年龄、性别、身高和体重以及甲状腺相关指标校正后,Logistic回归分析发现,7-10岁儿童在250-300μg/d的发生TGR风险显著明显增大,而11-14岁儿童在300-4000μg/d的发生TGR风险显著明显增大,并且随着碘摄入量的增加而增加;但是儿童SCH和Tg40 μg/L在不同碘摄入量组之间的发病风险未见统计学差异(P0.05)。结论:1.高水碘地区儿童碘营养过剩,儿童尿碘水平随着水碘水平升高而升高;2.高水碘地区儿童的TSH、Tvol和Tg均明显升高,SCH和TGR的发病率也显著高于其他地区;3.多因素校正下,儿童Tvol和Tg水平随着碘摄入量增加而增加,而碘摄入量对儿童TSH水平未见显著作用,且SCH和Tg40μg/L在不同碘摄入量组之间发病风险未见统计学差异;4.结合儿童TGR的发病风险变化,推荐7-10岁儿童的碘摄入量不宜超过250μg/d,11-14岁儿童的碘摄入量不宜超过3 000μg/d。
[Abstract]:Objective: at present, the study on the harm of iodine excess to children is not systematic and there is no evidence to establish the upper limit of iodine intake of children in China. The purpose of this study is to clarify the iodine nutrition status and thyroid function level in children with different iodine levels, and to explore the safety of different iodine intake levels for children and to clear the iodine excess of iodine excess. The harm of children and the highest iodine tolerable intake of children in our country (Upper safe intake level, UL). Object method: a cross-sectional epidemiological survey of children in different water and iodine areas in Shandong, China. A questionnaire survey on children was conducted, and two 24-h urine samples and one-time random urine samples were collected to evaluate the iodine intake of children accurately. The thyroid volume of children was measured and the thyroid enlargement was judged. 5ml non anticoagulant blood samples of children were collected and their thyroid function related indexes were measured. Results: 2224 children in Ningjin, Lingxian County, Gaotang county and Dongchangfu in Shandong province were investigated, including 1100 (49.5%) boys and 1114 (50.5%) girls, and the age was 11 (7-14). The median of water iodine was 181 (67.2-402) mu g/L, and the water iodine levels in four regions were 30.5 (23.9-74.4) mu g/L, 112 (37.3-168), g/L, 648 (515-753) mu g/L and 314 (184-385) mu g/L. for the first sampling (urinary iodine concentration, UIC) was 481 (218-818) mu, 380 (203-64). 6) mu g/L, the random UIC of the second sampling was 417 (195-753) g/L, 24-h UIC was 397 (200-682) mu g/L, and the median concentration of two urine iodine showed an investigation of iodine excess in children, and the urine iodine concentration of children in Gaotang county was significantly higher than that of other regions (P0.0001). The free three iodide adenosine (Free triiodothyronine, FT3) of children. The level of the free thyroxine (Free thyroxine, FT4) was 16.4 + 2.1pmol/l, the level of thyroid stimulating hormone (thyroid stimulating hormone, TSH) was 2.9 (2.1, 4) mIU/L and the concentration of thyroid globulin (thyroidglobin, Tg) was 16 (9.8, 26.1) and 3.3 (3.3) (3.3) (3.3) (3.3). 3, 5.75) ml, the goiter rate (Total goiter rate, TGR) was found in all children surveyed by 9.7%., subclinical hypothyroidism (subhypothyroidism, Subclinical hypothyroidism, SCH) in 237 children (11.5%), 5 hyperthyroidism children (0.2%), and 2 subclinical hyperthyroidism (0.1%), and no thyroid dysfunction. There was no statistical difference in the FT3 of the four regions (P0.05), but the TSH, Tvol and Tg of children in Gaotang county were significantly higher than those of other three regions. In addition, the incidence of SCH in children was 14.5% and TGR was 21.8%, which were significantly higher than those of the other three regions. The thyroid peroxidase antibody (thyroid peroxidase antibody, TPOAb) in children was significantly higher. The positive rate was 6.8%, the positive rate of thyroid globulin antibody (thyroglobulin antibodies, TGAb) was 2.1%, and the positive rate of TGAb was not statistically different in four regions (P=0.06), but the difference of TPOAb positive rate in four regions was statistically significant (P0.0001).TSH, Tg and Tvol three were positively correlated with each other. This study investigated children The average daily iodine intake (Best linear unbiased predicator, BLUP) was 298 (186-437) mu g/d, TSH increased with the increase of iodine intake (r=0.11, P0.0001). The SCH incidence was 11.2% at 200-300 mu g/d intake, and the incidence of SCH was kept above 10% with the increase of intake. 150 mu of iodine intake appeared in children. Significantly increased (beta =1.3 (1.1, 1.4), P0.001), children TGR increased the risk of iodine intake 150 mu /d significantly (OR=5.1 (3.5, 7.4), P0.001), and 7-10 years old children in iodine intake reached 200-250 g/d, TGR exceeded 5%; 11-14 years old children's iodine intake reached 250-300 u g/d, TGR exceeded 5%. children Tg and iodine intake between the curve relationship. After the correction of age, sex, height and weight, the threshold effect model showed that 120 mu g/d was a turning point. When iodine intake was greater than 120 mu g/d, Tg increased with the increase of iodine intake (beta =0.5 (0.4, 0.6), P0.001), and the risk of Tg40 u g/L increased with the increase of intake (OR= 4 (2.7, 5.8) (2.7, 5.8) when the intake of children was greater than 200 UX. P0.001). Multivariate analysis found that after the correction of age, sex, height, weight and thyroid related indexes, the Logistic regression analysis showed that the risk of TGR increased significantly in 7-10 years old children at 250-300 mu g/d, while the risk of TGR in 11-14 year old children increased significantly in 300-4000 mu g/d, and increased with the increase of iodine intake. But there was no statistical difference between children SCH and Tg40 mu g/L in different iodine intake groups (P0.05). Conclusion: 1. the iodine excess of children in high iodine areas and the increase of iodine level in children were increased with the increase of iodine level, and the TSH, Tvol and Tg in 2. high iodine areas were significantly higher, and the incidence of SCH and TGR was also significantly higher. In other areas, children's Tvol and Tg levels increased with the increase of iodine intake, while iodine intake increased with iodine intake, while iodine intake had no significant effect on TSH levels in children, and there was no statistical difference between SCH and Tg40 g/L in different iodine intake groups. 4. combined with the risk of TGR in children, iodine intake of 7-10 year old children was recommended. It should not exceed 250 g/d, and the iodine intake of children aged 11-14 should not exceed 3000 g/d.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R153.2

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