發(fā)布時間：2018-05-19 10:27

  本文選題：兒童 + 碘可耐受最高攝入量��； 參考：《天津醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的:目前關(guān)于碘過量對兒童的危害研究尚不系統(tǒng),也缺乏制定我國兒童碘安全攝入量上限值的研究證據(jù)。本研究旨在明確不同水碘水平地區(qū)兒童碘營養(yǎng)狀況以及甲狀腺功能水平;探討不同碘攝入量水平對兒童的安全性,明確碘過量對兒童的危害以及我國兒童碘可耐受最高攝入量(Upper safe intake level, UL)。對象方法:我國山東不同水碘地區(qū)兒童的橫斷面流行病學(xué)調(diào)查。對調(diào)查兒童進行膳食問卷調(diào)查,并重復(fù)采集兩次24-h尿樣和一次性隨機尿樣,以準確評估兒童碘攝入量水平;測定兒童甲狀腺體積并判斷甲狀腺腫大情況;采集兒童5ml非抗凝血樣,測定其甲狀腺功能相關(guān)指標。結(jié)果:本研究共調(diào)查了山東省寧津縣、陵縣、高唐縣和東昌府的2224名兒童,包括1100 (49.5%)名男孩以及1114 (50.5%)名女孩,年齡為11 (7-14)歲,水碘中位數(shù)為181 (67.2-402)μg/L,四個地區(qū)水碘水平分別為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。第一次采樣的隨機尿碘濃度(urinary iodine concentration, UIC)為 481 (218-818) μg/L,24-h 尿碘濃度(24-h UIC)為 380 (203-646)μg/L,第二次采樣的的隨機 UIC 為 417 (195-753)μg/L,24-h UIC為397 (200-682)μg/L,兩次尿碘濃度中位數(shù)均顯示調(diào)查兒童的碘營養(yǎng)過剩,并且高唐縣兒童的尿碘濃度顯著均高于其他地區(qū)(P0.0001)。兒童的游離三碘甲腺原氨酸(Free triiodothyronine, FT3)水平為5.8±0.7pmol/l,游離甲狀腺素(Free thyroxine, FT4)水平為 16.4±2.1pmol/l,促甲狀腺激素(thyroid stimulating hormone, TSH)水平為 2.9 (2.1, 4.0) mIU/L 以及甲狀腺球蛋白(thyroidglobin, Tg)濃度為 16.0 (9.8, 26.1)μg/L,甲狀腺體積(thyroid volume, Tvol)為 4.37ml (3.33, 5.75)ml,甲狀腺腫大率(Total goiter rate, TGR)為9.7%。在所有調(diào)查兒童中發(fā)現(xiàn),亞臨床甲狀腺功能減退(亞甲減,Subclinical hypothyroidism, SCH)兒童有237例(11.5%),甲狀腺功能亢進兒童有5例(0.2%),亞臨床甲狀腺功能亢進有2例(0.1%),未見甲狀腺功能減退兒童。四個地區(qū)的FT3未見統(tǒng)計學(xué)差異(P0.05),可是高唐縣兒童的TSH、Tvol和Tg顯著高于其他三個地區(qū)的兒童,此外高唐縣兒童的SCH發(fā)病率為14.5%和TGR為21.8%,均明顯高于其他三個地區(qū)。兒童甲狀腺過氧化物酶抗體(thyroid peroxidase antibody, TPOAb)陽性率為6.8%,甲狀腺球蛋白抗體(thyroglobulin antibodies, TGAb)陽性率有2.1%,四個地區(qū)TGAb陽性率未見統(tǒng)計學(xué)差異(P=0.06),但是四個地區(qū)TPOAb陽性率差異具有統(tǒng)計學(xué)意義(P0.0001)。TSH、Tg以及Tvol三者相互之間均存在正相關(guān)關(guān)系。本研究調(diào)查兒童的日常碘平均攝入量量(Best linear unbiased predicator,BLUP)為298 (186-437)μg/d,TSH隨著碘攝入量的升高而升高(r=0.11,P0.0001),在200-300μg/d攝入量時SCH發(fā)病率為11.2%,并且隨著攝入量的升高而SCH發(fā)病率保持在10%以上。兒童Tvol在碘攝入量150μ/d,出現(xiàn)明顯增大(β=1.3 (1.1, 1.4),P0.001),兒童TGR在碘攝入量150μ/d發(fā)病風(fēng)險明顯增加(OR=5.1 (3.5, 7.4),P0.001),且 7-10 歲兒童在碘攝入量達到200-250μg/d 時,TGR超過5%; 11-14歲兒童碘攝入量達到250-300μg/d時,TGR超過5%。兒童Tg與碘攝入量之間存在曲線關(guān)系,經(jīng)過年齡、性別、身高和體重的校正,閾值效應(yīng)模型分析可知120μg/d為轉(zhuǎn)折點,當?shù)鈹z入量大于120μg/d時,Tg隨著碘攝入量增高有升高的風(fēng)險(β=0.5 (0.4, 0.6),P0.001),兒童攝入量大于200μg/d時Tg40 μg/L的風(fēng)險隨著攝入量的增加而增加(OR= 4.0 (2.7, 5.8) , P0.001)。多元分析發(fā)現(xiàn),經(jīng)過年齡、性別、身高和體重以及甲狀腺相關(guān)指標校正后,Logistic回歸分析發(fā)現(xiàn),7-10歲兒童在250-300μg/d的發(fā)生TGR風(fēng)險顯著明顯增大,而11-14歲兒童在300-4000μg/d的發(fā)生TGR風(fēng)險顯著明顯增大,并且隨著碘攝入量的增加而增加;但是兒童SCH和Tg40 μg/L在不同碘攝入量組之間的發(fā)病風(fēng)險未見統(tǒng)計學(xué)差異(P0.05)。結(jié)論:1.高水碘地區(qū)兒童碘營養(yǎng)過剩,兒童尿碘水平隨著水碘水平升高而升高;2.高水碘地區(qū)兒童的TSH、Tvol和Tg均明顯升高,SCH和TGR的發(fā)病率也顯著高于其他地區(qū);3.多因素校正下,兒童Tvol和Tg水平隨著碘攝入量增加而增加,而碘攝入量對兒童TSH水平未見顯著作用,且SCH和Tg40μg/L在不同碘攝入量組之間發(fā)病風(fēng)險未見統(tǒng)計學(xué)差異;4.結(jié)合兒童TGR的發(fā)病風(fēng)險變化,推薦7-10歲兒童的碘攝入量不宜超過250μg/d,11-14歲兒童的碘攝入量不宜超過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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R153.2

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