本文選題：水碘 + 尿碘　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:本文通過對(duì)山東省不同水碘地區(qū)的人群進(jìn)行現(xiàn)場調(diào)查,描述血流變指標(biāo)分布情況;分析引起血流變異常的影響因素,對(duì)制定心血管疾病防控策略具有重要指導(dǎo)意義;探討不同水碘水平對(duì)血液流變性的作用,為高碘致血管損傷和動(dòng)脈粥樣硬化的機(jī)制研究提供科學(xué)依據(jù)。方法:在山東省調(diào)查現(xiàn)場,取水碘濃度不同的4個(gè)調(diào)查點(diǎn):低碘組(LI):水碘濃度小于10μg/L;適碘組(NI):水碘濃度50～150μg/L;高碘組(HI):水碘濃度150～300μg/L;碘過量組(EI):水碘濃度大于300μg/L。采用分層抽樣的方法,每個(gè)調(diào)查點(diǎn)隨機(jī)選擇3～5個(gè)調(diào)查村,選擇符合納入標(biāo)準(zhǔn)的成年人作為調(diào)查對(duì)象。此次調(diào)查內(nèi)容共有問卷調(diào)查、體格檢查、實(shí)驗(yàn)室檢查三部分內(nèi)容。問卷調(diào)查包括個(gè)人基線調(diào)查和3天24小時(shí)膳食問卷調(diào)查;體格檢查包括身高、體重、血壓。實(shí)驗(yàn)室檢查包括尿碘、血脂、血流變等指標(biāo)。3天24小時(shí)膳食調(diào)查問卷由《營養(yǎng)計(jì)算V2.65》軟件錄入,采用Epidata3.1建立數(shù)據(jù)庫,SPSS20.0軟件進(jìn)行數(shù)據(jù)分析。結(jié)果:1.一般情況此次現(xiàn)場調(diào)查共完成有效問卷1984份,其中LI組409人,NI組325人,HI組478人,EI組772人。男女各占總數(shù)的37.30%和62.70%,各組間性別、年齡分布無顯著性差異,各調(diào)查組年齡呈負(fù)偏態(tài)分布。各組間文化水平、職業(yè)分布不同(P0.05),職業(yè)分布比例最高的均為農(nóng)民。各組間飲酒狀況分布未見顯著性差異。各組間吸煙狀況分布不同(P0.05),LI組過去吸煙比例組間最高;NI組從未吸煙的比例組間最高,現(xiàn)在吸煙比例組間最低;HI組從未吸煙比例組間最低,現(xiàn)在吸煙比例組間最高;EI組過去吸煙比例組間最低。2.不同水碘地區(qū)膳食營養(yǎng)素?cái)z入狀況對(duì)調(diào)查對(duì)象各膳食營養(yǎng)素?cái)z入情況和達(dá)標(biāo)率(膳食營養(yǎng)素?cái)z入量大于等于RNI或AI的80%,小于UL的人群占總?cè)藬?shù)的比例)進(jìn)行評(píng)價(jià)。各組間能量、蛋白質(zhì)、維生素A、維生素E、硫胺素、煙酸、維生素C、鈣、磷、鉀、鎂、鐵、鋅、硒、銅、錳的攝入量和碳水化合物供能比、脂肪供能比的達(dá)標(biāo)率不同(P0.05)。各組間核黃素、維生素B6、維生素B12、葉酸、鈉、碘的攝入量的達(dá)標(biāo)率組間無顯著性差異(P0.05)。3.體格檢查各組間身高、體重、BMI分布無顯著性差異。各組間收縮壓分布無顯著性差異。各組間舒張壓分布不同(P0.05),LI組、HI組、EI組間舒張壓分布無顯著性差異且均低于NI組(P0.05)。4.實(shí)驗(yàn)室檢測4.1不同水碘地區(qū)尿碘分布情況LI組、NI組、HI組、EI組尿碘中位數(shù)依次為93.10μg/L、235.60μg/L、291.50μg/L和807.25μg/L,各組間尿碘分布不同(P0.05)。根據(jù)WHO、UNICEF、ICCIDD共同制定的以尿碘濃度中位數(shù)監(jiān)測群體碘營養(yǎng)水平的流行病學(xué)評(píng)價(jià)標(biāo)準(zhǔn),LI組人群處于碘缺乏狀態(tài);NI組和HI組人群碘攝入量大于碘需要量但未達(dá)到碘過量的標(biāo)準(zhǔn);EI組人群處于碘過量狀態(tài)。4.2不同水碘地區(qū)血脂分布情況各組間甘油三酯(TG)、高密度脂蛋白膽固醇、載脂蛋白B分布無顯著性差異。各組間總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-CH)、載脂蛋白A Ⅰ(ApoAⅠ)、ApoA Ⅰ/ApoB分布不同(P0.05)。LI組和NI組TC高于HI組和EI組(P0.05);LI 組 LDL-CH 高 NI 組和 HI 組(P=0.05),EI 組 LDL-CH 組間最低(P0.05)。EI 組 ApoA Ⅰ 高于 LI 和 HI 組(P0.05),NI 組 ApoA Ⅰ 組間最低(P0.05)。EI組ApoaⅠ/ApoB組間最高(p0.05),LI組、NI組、HI組間無顯著性差異。4.3不同水碘地區(qū)血流變分布情況各組間紅細(xì)胞壓積、全血粘度低切(ηb-Lγ)、全血粘度中切(ηb-Mγ)分布無顯著性差異(P0.05),各組其他各指標(biāo)分布不同(P0.05)。組間兩兩比較,HI組和EI組全血粘度高切(ηb-Hγ)高于LI組和NI組(P0.05)。LI組血漿表觀粘度水平高于NI組、HI組和EI組(P0.05)。LI組紅細(xì)胞剛性指數(shù)、細(xì)胞變形指數(shù)低于NI組、HI組和EI組(P0.05)。EI組紅細(xì)胞聚集指數(shù)、紅細(xì)胞電泳指數(shù)低于LI組、NI組和HI組(P0.05)。5.血流變指標(biāo)異常Logistic回歸分析多分類logistic回歸分析得出性別、年齡、舒張壓(DBP)、水碘、TG、TC、ApoAⅠ、ApoB、膳食維生素A和鐵攝入量均為全血粘度異常分布的影響因素。男性出現(xiàn)低ηb-Lγ、低ηb-Mγ和低ηb-Hγ的風(fēng)險(xiǎn)顯著低于女性,出現(xiàn)高ηb-Lγ、高ηb-Mγ和高ηb-Hγ的風(fēng)險(xiǎn)顯著高于女性。年齡表現(xiàn)有升高ηb-Mγ的趨勢,是低ηb-Mγ的保護(hù)因素。隨著DBP水平升高,出現(xiàn)高ηb-Lγ高ηb-Mγ和高ηb-Hγ的風(fēng)險(xiǎn)顯著增加。隨著TG水平的升高,出現(xiàn)高ηb-Mγ、高ηb-Hγ的風(fēng)險(xiǎn)顯著增加。隨著TC水平的升高,出現(xiàn)低ηb-Hγ的風(fēng)險(xiǎn)顯著降低。ApoA Ⅰ是高ηb-Lγ、高ηb-Mγ的保護(hù)因素。ApoB是低ηb-Lγ、低ηb-Mγ的保護(hù)因素,是高ηb-Lγ、高ηb-MY的危險(xiǎn)因素。隨著膳食維生素A攝入量增加,出現(xiàn)高ηb-Lγ的風(fēng)險(xiǎn)顯著降低;隨著膳食鐵攝入量增加,出現(xiàn)高ηb-Lγ的風(fēng)險(xiǎn)顯著增加。低水碘地區(qū)的人群出現(xiàn)低ηb-Lγ、低ηb-Mγ和低ηb-Hγ的風(fēng)險(xiǎn)顯著高于適碘地區(qū)的人群;碘過量地區(qū)的人群出現(xiàn)低ηb-Hγ的風(fēng)險(xiǎn)顯著低于適碘地區(qū)的人群。結(jié)論:1.各組間紅細(xì)胞壓積、全血粘度低切、全血粘度中切分布無顯著性差異,各組其他各指標(biāo)分布不同。組間兩兩比較,HI組和EI組全血粘度高切高于LI組和NI組。LI組血漿表觀粘度水平高于NI組、HI組和EI組。LI組紅細(xì)胞剛性指數(shù)和紅細(xì)胞變形指數(shù)低于NI組、HI組和EI組。EI組紅細(xì)胞聚集指數(shù)和紅細(xì)胞電泳指數(shù)低于LI組、NI組和HI組。2..影響ηb異常分布的因素有性別、年齡、DBP、水碘、TG、TC、ApoAⅠ、ApoB、膳食維生素A和鐵攝入量。男性ηb水平顯著高于女性;年齡、DBP、TG、TC、ApoB、膳食鐵是ηb升高的危險(xiǎn)因素;ApoAⅠ、膳食維生素A是ηb升高的保護(hù)因素。3.低水碘可通過升高ApoA Ⅰ或(和)增加紅細(xì)胞變形性來降低血液黏度。水碘過量可降低紅細(xì)胞變形性,升高血液粘度。
[Abstract]:Objective: To investigate the distribution of blood rheology index in Shandong Province, to describe the distribution of blood rheology index, and to analyze the influencing factors of abnormal blood rheology. It has important guiding significance for developing the prevention and control strategy of cardiovascular disease, and the effect of different water iodide level on blood flow degeneration, and the damage and movement of high iodine induced blood vessel. A scientific basis for the mechanism study of atheromatous atherosclerosis. Methods: 4 survey sites with different iodine concentrations in the Shandong Province survey site: iodine concentration in low iodine group (LI): water iodine concentration is less than 10 mu; iodine concentration in iodine group (NI): iodine concentration 50~150 mu g/L; high iodine group (HI): iodine concentration 150~300 u g/L; iodine excess group (EI): iodine concentration greater than 300 u g/L. using stratified pumping The sample method, each survey site randomly selected 3~5 investigation villages, selected adults as the subject of inclusion criteria. The survey included questionnaire survey, physical examination, and laboratory examination in three parts. The questionnaire included individual baseline survey and 3 day 24 hour diet questionnaire survey; physical examination included height, weight, blood. The 24 hour dietary survey questionnaire, including urinary iodine, blood lipid and blood rheology, was recorded by "V2.65> software" for.3 days, using Epidata3.1 to establish database and SPSS20.0 software for data analysis. Results: 1. general cases were completed in 1984 cases, of which 409 in group LI, 325 in NI group, 478 in HI group, E In group I, 772 people were 37.30% and 62.70% of the total number of men and women. There was no significant difference in sex and age distribution among all groups. The age of each group was negatively biased. The cultural level of each group, the distribution of occupations were different (P0.05), the occupations were the highest among the farmers. There was no significant difference in the distribution of drinking among the groups. The distribution of smoking among groups was not distributed. (P0.05), group LI had the highest smoking ratio among groups in the past, the highest among the NI group never smoked, the lowest among the smoking proportions, the lowest in the HI group, and the highest among those in the proportion of smoking, and the lowest dietary intake of the EI in the past group of smoking in different water and iodine areas. Nutrients intake and standard rate (80% of RNI or AI, less than UL) were evaluated. Energy, protein, vitamin A, vitamin E, thiamine, nicotinic acid, vitamin C, calcium, phosphorus, potassium, magnesium, iron, zinc, selenium, copper, manganese, carbohydrate supply ratio, fat supply ratio, and fat supply ratio in each group. There was no significant difference (P0.05). There was no significant difference between groups of riboflavin, vitamin B6, vitamin B12, folic acid, sodium, and iodine. There was no significant difference in height, weight and BMI distribution between each group. The distribution of systolic pressure in each group was not significant. The distribution of diastolic pressure in each group was different (P0.05), LI, HI, E. There was no significant difference in diastolic pressure distribution in I group and lower than group NI (P0.05).4. laboratory to detect the distribution of urine iodine in 4.1 different iodine areas, NI, HI, and EI group, the median of urine iodine was 93.10 u g/L, 235.60 mu g/L, 291.50 mu g/L and 807.25 micron. The epidemiological evaluation standard of iodine nutrition level in the median concentration monitoring group, the group LI group was in iodine deficiency state; the iodine intake of group NI and HI group was higher than that of iodine need, but the EI group was in the iodine excess state, and the distribution of blood lipid in different iodine areas of.4.2 was TG, high density lipoprotein (HDL) There was no significant difference in the distribution of cholesterol and apolipoprotein B. The total cholesterol (TC), low density lipoprotein cholesterol (LDL-CH), apolipoprotein A I (ApoA I), and ApoA I /ApoB distribution were different (P0.05) in.LI group and NI group. A I was higher than group LI and HI (P0.05), and the lowest (P0.05).EI group Apoa I /ApoB group between group ApoA I group (P0.05), LI group, group, and group, there was no significant difference between groups of blood flow and distribution in different water iodine areas. The distribution of other indexes in each group was different (P0.05). The total blood viscosity of group HI and EI group was higher than that of group LI and NI group (P0.05), the apparent viscosity of plasma was higher than that of group NI, and the erythrocyte rigidity index of HI and EI group (P0.05) was lower than that in the group of HI and EI group (P0.05). The index of cell electrophoresis was lower than that of LI group, NI and HI group (P0.05).5. blood rheology index abnormal Logistic regression analysis. The multiple classification logistic regression analysis showed that sex, age, diastolic pressure (DBP), water iodine, TG, TC, ApoA I, ApoB, dietary vitamin and iron intake were all the factors affecting the abnormal distribution of whole blood viscosity. The risk of low ETA b-H gamma is significantly lower than that of women. The risk of high ETA b-L gamma, high ETA b-M gamma and high ETA b-H gamma is significantly higher than that of women. Age shows an increase in the trend of ETA b-M gamma, which is a protective factor for low ETA b-M gamma. The risk of high ETA b-L gamma, high ETA b-M gamma and high ETA b-H gamma increases with the increase of DBP level. The higher ETA b-M gamma appears with the increase of TG level. The risk of high ETA b-H gamma increased significantly. With the increase of TC level, the risk of low ETA b-H gamma was significantly reduced,.ApoA I was high ETA b-L gamma, and the protective factor of high ETA b-M y.ApoB was low ETA b-L gamma, and the protection factor of low ETA b-M gamma was the risk factor of high ETA b-L gamma and high ETA b-MY. Low; with the increase of dietary iron intake, the risk of high ETA b-L gamma increased significantly. The risk of low ETA b-L gamma, low ETA b-M gamma and low ETA b-H gamma in low iodine areas was significantly higher than those in the iodide region; the risk of low b-H gamma in iodine excess areas was significantly lower than that of the population in the iodide area. Conclusion: 1. There was no significant difference in the distribution of whole blood viscosity and whole blood viscosity, and the distribution of other indexes in all groups was different. The total blood viscosity of group HI and EI group was higher than that of group LI and group NI, and the plasma apparent viscosity level of group HI and group NI was higher than that of group NI, and the erythrocyte rigidity index and erythrocyte deformability index in group.LI and EI group were lower than that of NI group, HI group and EI group. Erythrocyte aggregation index and erythrocyte electrophoresis index were lower than that of LI group, and.2.. And HI group.2.. Affected the abnormal distribution of ETA B, including sex, age, DBP, water iodine, TG, TC, ApoA I, ApoB, dietary vitamin A and iron intake. A is a protective factor for the increase of ETA B,.3. low water iodine can reduce blood viscosity by increasing ApoA I or (and) to increase erythrocyte deformability. Excess iodine can reduce erythrocyte deformability and increase blood viscosity.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R54

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