碘营养水平与甲状腺功能减退症关系的研究
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摘要
目的探讨碘营养水平与甲状腺功能减退症(临床甲减)和亚临床甲状腺功能减退症(亚临床甲减)发生的相关性。方法选取2015年3月至2017年12月沧州中西医结合医院内分泌科收治的255例临床甲减患者为临床甲减组,276例亚临床甲减患者为亚临床甲减组,同期选取130名健康体检者作为对照组,各组受试者均检测尿碘和甲状腺功能指标[血清游离三碘甲腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总甲状腺素(TT_4)、总三碘甲腺原氨酸(TT_3)和促甲状腺激素(TSH)]水平。结果各组尿碘水平比较差异无统计学意义(P> 0. 05);各组碘营养状态构成比较差异有统计学意义(P <0. 05),亚临床甲减组和临床甲减组碘缺乏比例高于对照组[31. 2%(86/276)、23. 1%(59/255)比16. 9%(22/130)],亚临床甲减组碘缺乏比例高于临床甲减组(P <0. 05)。临床甲减组尿碘水平与血清FT_3、FT_4、TT_3、TT_4呈负相关(P <0. 05);亚临床甲减组尿碘与血清FT_3、FT_4呈负相关(P <0. 05),与TSH呈正相关(P <0. 05)。结论临床甲减和亚临床甲减患者碘营养过量和碘营养缺乏现象仍较严重,其疾病的发生与尿碘密切相关,建议将限制患者碘的摄入作为治疗措施之一,加强对临床甲减和亚临床甲减患者尿碘的监测,以采取针对性的治疗和预防措施。
Objective To discuss the relationship between the iodine nutritional level and the hypothyroidism/subclinical hypothyroidism. Methods A total of 255 patients with hypothyroidism and 276 patients with subclinical hypothyroidism from the Department of Endocrinology of Cangzhou Traditional Chinese Medicine-Western Hospital during Mar. 2015 and Dec. 2017 were included in the study as a hypothyroidism group and a subclinical hypothyroidism group respectively. And 130 healthy controls from Physical Examination Center during the same period were included as a control group. Urinary iodine and thyroid function indexes[serum free triiodothyronine( FT_3),free thyroxine( FT_4),total thyroxine( TT_4),total triiodothyronine( TT_3) and thyroid stimulating hormone( TSH) ]of each group were measured and detected. Results There was no significant difference in urinary iodine level among the three groups( P > 0. 05); there were significant differences in iodine nutritional status among groups( P < 0. 05). The proportion of iodine deficiency in the subclinical hypothyroidism group and hypothyroidism group was higher than that in the control group[31. 2%( 86/276),23. 1%( 59/255) vs 16. 9%( 22/130) ],and the iodine deficiency rate in the subclinical hypothyroidism group was higher than that in the hypothyroidism group( P < 0. 05). The urine iodine was negatively correlated with serum FT_3,FT_4,TT_3 and TT_4 in hypothyroidism patients( P < 0. 05). There was a negative correlation between the urine iodine and serum FT_3 and FT_4( P < 0. 05) and a positive correlation between the urine iodine and TSH in the subclinical hypothyroidism patients( P < 0. 05). Conclusion The phenomenon of iodine excess and iodine deficiency is still serious in patients with clinical and subclinical hypothyroidism,the occurrence of which is closely related to urinary iodine. Iodine intake restriction is recommended as one of the treatment measures,and the monitoring of urine iodine should be strengthened to take targeted treatment and preventive measures.
Objective To discuss the relationship between the iodine nutritional level and the hypothyroidism/subclinical hypothyroidism. Methods A total of 255 patients with hypothyroidism and 276 patients with subclinical hypothyroidism from the Department of Endocrinology of Cangzhou Traditional Chinese Medicine-Western Hospital during Mar. 2015 and Dec. 2017 were included in the study as a hypothyroidism group and a subclinical hypothyroidism group respectively. And 130 healthy controls from Physical Examination Center during the same period were included as a control group. Urinary iodine and thyroid function indexes[serum free triiodothyronine( FT_3),free thyroxine( FT_4),total thyroxine( TT_4),total triiodothyronine( TT_3) and thyroid stimulating hormone( TSH) ]of each group were measured and detected. Results There was no significant difference in urinary iodine level among the three groups( P > 0. 05); there were significant differences in iodine nutritional status among groups( P < 0. 05). The proportion of iodine deficiency in the subclinical hypothyroidism group and hypothyroidism group was higher than that in the control group[31. 2%( 86/276),23. 1%( 59/255) vs 16. 9%( 22/130) ],and the iodine deficiency rate in the subclinical hypothyroidism group was higher than that in the hypothyroidism group( P < 0. 05). The urine iodine was negatively correlated with serum FT_3,FT_4,TT_3 and TT_4 in hypothyroidism patients( P < 0. 05). There was a negative correlation between the urine iodine and serum FT_3 and FT_4( P < 0. 05) and a positive correlation between the urine iodine and TSH in the subclinical hypothyroidism patients( P < 0. 05). Conclusion The phenomenon of iodine excess and iodine deficiency is still serious in patients with clinical and subclinical hypothyroidism,the occurrence of which is closely related to urinary iodine. Iodine intake restriction is recommended as one of the treatment measures,and the monitoring of urine iodine should be strengthened to take targeted treatment and preventive measures.
引文
[1]张蓉,史海霞.血清FT3、FT4、TSH及Hcy联合检测诊断甲状腺功能减退的临床价值[J].国际检验医学杂志,2017,38(17):2478-2480.
[2]邓英英,邱琳,雒晓春.亚临床甲状腺功能减退症与2型糖尿病血管并发症的关系[J].医学综述,2017,23(1):120-124.
[3]王洪亮,刘亚明.亚临床甲状腺功能异常患者甲功五项水平与血脂的变化[J].贵州医药,2017,41(6):590-592.
[4]李阳桦,张静波,韩玉梅,等. 2009—2013年北京市成年女性尿碘水平与甲状腺结节检出情况分析[J].中国预防医学杂志,2015,16(6):410-413.
[5]钟宁,王海琴.碘与亚临床甲状腺功能减退症的关系[J].医学综述,2014,19(2):298-300.
[6]单忠艳.《中国甲状腺疾病诊治指南》导读[J].中国实用内科杂志,2008,28(4):260-261.
[7]WHO/UNICEF/ICCIDD. Assessment of the iodine deficiency disorders and monitoring their elimination. A Guide for Programme Managers[R]. Geneva:WHO,2007:32-34.
[8]单忠艳,滕卫平,李玉姝,等.碘致甲状腺功能减退症的流行病学对比研究[J].中华内分泌代谢杂志,2001,17(2):71-74.
[9]崇巍,孙炜,滕卫平.碘摄入量与甲状腺功能障碍关系的多因素分析[J].中国现代医学杂志,2005,15(9):1285-1287.
[10]王培桦,周永林,张庆兰.碘过量地区居民甲状腺功能减退症患病情况调查[J].中华地方病学杂志,2007,26(6):669-672.
[11]窦瑜贵,王燕玲,李洪波.甘肃省武威市城市与农村成人碘营养状况及甲状腺功能调查[J].中华地方病学杂志,2015,34(1):45-48.
[12]张立岩,赵秀芬,周晓.山东省青岛地区妊娠早期妇女碘营养状况与甲状腺功能减退症的相关性分析[J].中国基层医药,2016,23(15):2248-2251.
[13]朱素娟,徐卫民,金行一,等.孕早期妇女低碘摄入量与患低甲状腺素血症相关性研究[J].中国预防医学杂志,2016,17(5):361-364.
[14]韩改玲,王锐,鲁娜,等.沿海地区妊娠期妇女的尿碘水平与其甲状腺功能降低的关系[J].南昌大学学报(医学版),2017,57(5):50-53.
[15]魏亚红,王燕玲,马鹏程.某地区妊娠早期妇女碘营养状况与甲状腺功能减退症的相关性分析[J].国外医学(医学地理分册),2017,38(2):151-153.
[16]树林一,李子玲.尿碘与结节性甲状腺肿关系的研究进展[J].河北医药,2017,38(18):2841-2843.
[17]宋向欣,郭艳英,马晓庆.新疆住院维族和汉族患者甲状腺功能与碘营养状态分析[J].海南医学,2016,27(24):3994-3997.
[18]黄淑玉,晏益民,吴敏,等.孝感地区初诊甲状腺疾病患者尿碘水平分析[J].广东微量元素科学,2015,22(1):24-26.
[19]武志锋,梁援,陈小菁.甲状腺疾病患者尿碘调查研究[J].右江医学,2010,38(2):188-189.
[20]薛利敏,刘阁玲,杨晓琳,等.尿碘测定对甲状腺疾病的意义[J].临床医药文献杂志,2017,4(43):8371-8372.
[21]陈赟,马维青.尿碘与甲状腺疾病相关性研究进展[J].临床与病理杂志,2016,36(9):1423-1429.
[22]张颖,李俞莹,姚旋,等.碘与甲状腺疾病[J].生命科学,2012,24(8):901-908.
[2]邓英英,邱琳,雒晓春.亚临床甲状腺功能减退症与2型糖尿病血管并发症的关系[J].医学综述,2017,23(1):120-124.
[3]王洪亮,刘亚明.亚临床甲状腺功能异常患者甲功五项水平与血脂的变化[J].贵州医药,2017,41(6):590-592.
[4]李阳桦,张静波,韩玉梅,等. 2009—2013年北京市成年女性尿碘水平与甲状腺结节检出情况分析[J].中国预防医学杂志,2015,16(6):410-413.
[5]钟宁,王海琴.碘与亚临床甲状腺功能减退症的关系[J].医学综述,2014,19(2):298-300.
[6]单忠艳.《中国甲状腺疾病诊治指南》导读[J].中国实用内科杂志,2008,28(4):260-261.
[7]WHO/UNICEF/ICCIDD. Assessment of the iodine deficiency disorders and monitoring their elimination. A Guide for Programme Managers[R]. Geneva:WHO,2007:32-34.
[8]单忠艳,滕卫平,李玉姝,等.碘致甲状腺功能减退症的流行病学对比研究[J].中华内分泌代谢杂志,2001,17(2):71-74.
[9]崇巍,孙炜,滕卫平.碘摄入量与甲状腺功能障碍关系的多因素分析[J].中国现代医学杂志,2005,15(9):1285-1287.
[10]王培桦,周永林,张庆兰.碘过量地区居民甲状腺功能减退症患病情况调查[J].中华地方病学杂志,2007,26(6):669-672.
[11]窦瑜贵,王燕玲,李洪波.甘肃省武威市城市与农村成人碘营养状况及甲状腺功能调查[J].中华地方病学杂志,2015,34(1):45-48.
[12]张立岩,赵秀芬,周晓.山东省青岛地区妊娠早期妇女碘营养状况与甲状腺功能减退症的相关性分析[J].中国基层医药,2016,23(15):2248-2251.
[13]朱素娟,徐卫民,金行一,等.孕早期妇女低碘摄入量与患低甲状腺素血症相关性研究[J].中国预防医学杂志,2016,17(5):361-364.
[14]韩改玲,王锐,鲁娜,等.沿海地区妊娠期妇女的尿碘水平与其甲状腺功能降低的关系[J].南昌大学学报(医学版),2017,57(5):50-53.
[15]魏亚红,王燕玲,马鹏程.某地区妊娠早期妇女碘营养状况与甲状腺功能减退症的相关性分析[J].国外医学(医学地理分册),2017,38(2):151-153.
[16]树林一,李子玲.尿碘与结节性甲状腺肿关系的研究进展[J].河北医药,2017,38(18):2841-2843.
[17]宋向欣,郭艳英,马晓庆.新疆住院维族和汉族患者甲状腺功能与碘营养状态分析[J].海南医学,2016,27(24):3994-3997.
[18]黄淑玉,晏益民,吴敏,等.孝感地区初诊甲状腺疾病患者尿碘水平分析[J].广东微量元素科学,2015,22(1):24-26.
[19]武志锋,梁援,陈小菁.甲状腺疾病患者尿碘调查研究[J].右江医学,2010,38(2):188-189.
[20]薛利敏,刘阁玲,杨晓琳,等.尿碘测定对甲状腺疾病的意义[J].临床医药文献杂志,2017,4(43):8371-8372.
[21]陈赟,马维青.尿碘与甲状腺疾病相关性研究进展[J].临床与病理杂志,2016,36(9):1423-1429.
[22]张颖,李俞莹,姚旋,等.碘与甲状腺疾病[J].生命科学,2012,24(8):901-908.