本文選題：泰沂山區(qū) + 碘缺乏病　； 參考：《山東大學(xué)》2013年碩士論文

【摘要】：目的 通過水碘采樣調(diào)查,了解泰沂山區(qū)碘缺乏地區(qū)居民生活飲用水含碘量現(xiàn)狀；通過碘營養(yǎng)狀況調(diào)查,評價泰沂山區(qū)碘缺乏地區(qū)重點(diǎn)人群營養(yǎng)狀況,以期了解當(dāng)前鹽碘水平對碘缺乏病防治的效果；針對泰沂山區(qū)在消除碘缺乏病的過程中所面臨的問題探討防控對策,提出建議。 方法 整個研究分為兩個部分：第一部分為山東省泰沂山區(qū)碘缺乏地區(qū)分布特征研究,依據(jù)《山東省實施食鹽加碘消除碘缺乏危害管理條例辦法》,調(diào)查了泰沂山區(qū)所含蓋的58個碘缺乏縣(市、區(qū))中的28個縣(市、區(qū)),包括泰安、臨沂、日照和萊蕪的全部縣(市、區(qū))以及濟(jì)寧、淄博和濰坊的部分縣(市、區(qū))。以自然村為單位進(jìn)行采樣調(diào)查,如為集中供水村,采集1個水樣；如為非集中供水村,按照飲用人數(shù)的多少,選擇飲用人數(shù)最多的3個水源進(jìn)行采樣。水碘測定采用生活飲用水標(biāo)準(zhǔn)檢驗方法。地區(qū)劃分標(biāo)準(zhǔn)：水碘含量10μg/L為缺碘地區(qū),水碘150μg/L為高碘地區(qū),水碘含量在10μg/L～150μg/L之間本文稱之為水碘適宜(適碘)地區(qū)。采用地理信息系統(tǒng)(GIS)繪制山東省泰沂山區(qū)碘缺乏地區(qū)水碘分布圖。第二部分為山東省泰沂山區(qū)碘缺乏地區(qū)重點(diǎn)人群碘營養(yǎng)狀況調(diào)查研究,選擇具有代表性的臨沂蒙陰縣、泰安岱岳區(qū)和日照莒縣作為調(diào)查縣,每個縣(區(qū))選擇1個鄉(xiāng)(鎮(zhèn))作為調(diào)查點(diǎn)。食用鹽含量的檢測采用直接滴定法,采用砷-鈰催化分光光度法檢測2歲以內(nèi)嬰幼兒、8-10歲兒童、妊娠期婦女、哺乳期婦女和20-45歲育齡婦女5種重點(diǎn)人群的尿碘水平,采用觸診法和B超法對8-10歲的兒童甲狀腺進(jìn)行檢查以及采用《瑞文智力測驗聯(lián)合型中國農(nóng)村版圖冊》(CRT-RC)對其進(jìn)行智力測試。全部數(shù)據(jù)輸入計算機(jī)進(jìn)行處理,采用SPSS16.0軟件對數(shù)據(jù)進(jìn)行統(tǒng)計處理。各種率的比較采用卡方檢驗,各縣(區(qū))尿碘和鹽碘的比較采用Kruskal-Wallis非參數(shù)檢驗,定量資料比較采用單因素方差分析(ANOVA)和多重比較分析(LSD-t檢驗),顯著性差異的判定標(biāo)準(zhǔn)為P0.05。 結(jié)果 1.水碘分布情況：共采集水樣24880份,水碘平均值6.905μg/L,水碘最小值0.2μg/L(最低檢出量),最大值為546.97μg/L,中位數(shù)為5.4μg/L。在縣級層面上,在所調(diào)查的28個縣(市、區(qū))中,東平縣的水碘值存在10ug/L和10～150μg/L兩種情況,即低碘和適碘并存；其余17個縣(市、區(qū))全部水碘值10μg/L,即屬于低碘。在鄉(xiāng)鎮(zhèn)層面上,情況大致相似,目前按碘缺乏對待的392個鄉(xiāng)鎮(zhèn)中,有369個符合碘缺乏病地區(qū)標(biāo)準(zhǔn)。 2.家庭食用鹽含碘量檢測結(jié)果：共檢測了295份食用鹽,鹽碘均值為28.517mg/kg,其中莒縣的鹽碘均值最高,為31.518mg/kg.碘鹽覆蓋率93.9%,合格碘鹽食用率為88.47%,但蒙陰的碘鹽覆蓋率(85.29%)和合格碘鹽食用率(75.49%)均未達(dá)到90%。 3.人均日鹽攝入量結(jié)果共調(diào)查了297名學(xué)生人均日鹽攝入量,均值為13.87g,中位數(shù)為13.34g,范圍在7.5-23.3g之間,三個地區(qū)兒童的人均日鹽攝入量均明顯高于我國推薦的食鹽攝入量6g的標(biāo)準(zhǔn)。 4.重點(diǎn)人群尿碘檢測結(jié)果：8-10歲兒童、2歲以內(nèi)嬰幼兒、哺乳期婦女、妊娠期婦女和育齡婦女的尿碘中位數(shù)分別為222μg/L、270.5μg/L、169.7μg/L、175.4μg/L和234μt/L。從5類重點(diǎn)人群尿碘檢測結(jié)果看,尿碘中位數(shù)值均在100μg/L以上,3個縣區(qū)5類重點(diǎn)人群的15個中位數(shù)值提示碘攝入不足的有1個適宜碘攝入的有8個,碘攝入大于適宜量的有5個,碘攝入過量的有1個。 5.甲狀腺腫大檢查結(jié)果：共檢測298名8-10歲兒童甲狀腺,觸診法和B超法檢查兒童甲狀腺腫大率均為1.37%(4/298),B超法測得學(xué)齡兒童甲狀腺容積范圍為1.13-7.50ml,平均容積為3.061ml。經(jīng)過單因素方差分析,不同調(diào)查地區(qū)兒童甲狀腺容積有差異,且差異具有統(tǒng)計學(xué)意義(F=7.662,P=0.0010.05)。 6.兒童智商測查結(jié)果：智商平均水平為107.94,各縣(市、區(qū))兒童智商均值在102.19-110.86之間,其中蒙陰縣為102.19,岱岳區(qū)為110.86,經(jīng)單因素方差分析,各地區(qū)兒童智商差異無統(tǒng)計學(xué)意義(F=11.951,P0.05)。各縣(市、區(qū))兒童智商頻數(shù)分布：落后者占1.68%,邊緣者占2.35%,中下者占5.7%,中等者占45.3%,中上者占20.81%,優(yōu)秀者占18.12%,超優(yōu)者占6.04%。經(jīng)Kruskal-Wallis檢驗分析,各縣(市、區(qū))兒童智商頻數(shù)分布無統(tǒng)計學(xué)差異(x2=0.024,P0.05)。 結(jié)論與建議 1、泰沂山區(qū)碘缺乏地區(qū)依然大范圍存在,仍將是現(xiàn)在及今后采取碘缺乏病防治措施的重點(diǎn)區(qū)域。 2、居民戶鹽碘普及較廣,合格碘鹽檢出率較高,本次監(jiān)測提供了《食用鹽碘含量》新標(biāo)準(zhǔn)執(zhí)行前泰沂山區(qū)碘缺乏地區(qū)的基線數(shù)據(jù),為下一步調(diào)整碘鹽濃度提供了依據(jù)。 3、調(diào)查地區(qū)兒章人均日鹽攝入量偏高,需要采取適宜的干預(yù)措施。 4、調(diào)查地區(qū)5類重點(diǎn)人群的尿碘中位數(shù)偏高,在防控碘缺乏危害的同時要注意防控碘過量。 5、兒童甲狀腺腫大率降低,兒童的碘營養(yǎng)比較適宜,以食鹽加碘為主的防控措施成果顯著,處于持續(xù)可消除狀態(tài)。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R151

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