不同水碘地区居民碘营养状况和甲状腺相关疾病的研究进展
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摘要
目的综述不同水碘地区居民碘营养状况和甲状腺相关疾病的研究进展。方法归纳和总结近几年国内外相关文献。结果我国外环境普遍缺碘,居民生活饮用水碘含量大多偏低,通过食盐加碘策略,我国人群碘营养总体达到适宜水平,但在不同水碘地区,特需人群碘营养存在不足或过高的风险;碘缺乏相关疾病得到有效防控的同时,高碘与甲状腺疾病之间的关系引起了人们的关注,高碘可引起甲状腺肿和甲状腺功能减退,但高碘与甲状腺功能亢进、自身免疫性甲状腺炎和甲状腺癌之间的关系还需进一步探讨。结论关注碘摄入来源和人群碘营养,寻找最佳碘摄入范围,为不同人群制定个性化补碘方案,同时应从大样本流行病学调查和基础研究等多方面入手,弄清碘与机体之间关系及相关疾病的致病机制,为疾病的预防和治疗提供依据。
Objective To summarize the study advance of iodine nutritional status and thyroid related diseases of residents in regions with different water iodine. Methods The relevant literatures at home and abroad in recent years were reviewed and summarized. Results Iodine deficiency is common in the external environment of China, and the iodine content in drinking water of residents is generally low. The iodine nutrition level of Chinese people is generally appropriate after implementing salt iodization strategy. However, in the areas with different content of water iodine, the risk of inadequate or excessive iodine nutrition existed in the people with special needs. The iodine deficiency disorders were effectively prevented and controlled. Much attention was paid to the correlation between excessive iodine and thyroid diseases. The goiter and hypothyroidism could be caused by excessive iodine, but the relationships between iodine excess and hyperthyroidism,autoimmune thyroiditis and thyroid cancer needed further studies. Conclusions Attention should be paid to the sources of iodine intake and the iodine nutrition of the population to find out the best range of iodine intake so as to provide reference for the formulation of individualized iodine supplement schemes for different populations. At the same time, the relationship between iodine and the body, and the pathogenesis of iodine and related diseases should be clarified from the aspects of largescale of epidemiological investigation and basic research, so as to provide basis for disease prevention and treatment.
Objective To summarize the study advance of iodine nutritional status and thyroid related diseases of residents in regions with different water iodine. Methods The relevant literatures at home and abroad in recent years were reviewed and summarized. Results Iodine deficiency is common in the external environment of China, and the iodine content in drinking water of residents is generally low. The iodine nutrition level of Chinese people is generally appropriate after implementing salt iodization strategy. However, in the areas with different content of water iodine, the risk of inadequate or excessive iodine nutrition existed in the people with special needs. The iodine deficiency disorders were effectively prevented and controlled. Much attention was paid to the correlation between excessive iodine and thyroid diseases. The goiter and hypothyroidism could be caused by excessive iodine, but the relationships between iodine excess and hyperthyroidism,autoimmune thyroiditis and thyroid cancer needed further studies. Conclusions Attention should be paid to the sources of iodine intake and the iodine nutrition of the population to find out the best range of iodine intake so as to provide reference for the formulation of individualized iodine supplement schemes for different populations. At the same time, the relationship between iodine and the body, and the pathogenesis of iodine and related diseases should be clarified from the aspects of largescale of epidemiological investigation and basic research, so as to provide basis for disease prevention and treatment.
引文
[1]2018年碘与甲状腺疾病大会工作组.2018年全国第三届碘与甲状腺疾病大会共识[J].中华地方病学杂志,2018,37(11):861-862.
[2]孙玮,王燕玲,窦瑜贵,等.甘肃省不同碘营养水平地区儿童碘盐摄入量调查[J].疾病预防控制通报,2018,33(3):84-85,93.
[3]张翼.部分市县碘缺乏病防治工作的流行病学调查[J].中西医结合心血管病杂志,2017,5(34):195.
[4]高巍,黄醒华.不同程度碘缺乏孕妇甲低的发生率及对围产结局的影响[J].中国妇幼保健,2010,25(20):2783-2787.
[5]CUI S L,LIU P,SU X H,et al.Surveys in areas of high risk of iodine deficiency and iodine excess in China,2012-2014:current status and examination of the relationship between urinary iodine concentration and goiter prevalence in children aged 8-10 years[J].Biomed Environ Sci,2017,30(2):88-96.
[6]CHEN W,LI X,WU Y,et al.Associations between iodine intake,thyroid volume,and goiter rate in school-aged Chinese children from areas with high iodine drinking water concentrations[J].Am J Clin Nutr,2017,105(1):228-233.
[7]TENG X,SHAN Z,CHEN Y,et al.More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis:A cross-sectional study based on two Chinese communities with different iodine intake levels[J].Eur J Endocrinol,2011,164(6):943-950.
[8]PEDERSEN I B,KNUDSEN N,CARLéA,et al.Acautious iodization programme bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population[J].Clin Endocrinol,2011,75(1):120-126.
[9]毕文,聂春磊,张杰武.碘通过影响细胞自噬参与甲状腺炎发病机制的研究[J].国际免疫学杂志,2018,41(6):599-603.
[10]HONG A.STOKES B,OTAHAL P,et al.Temporal trends in thyroid-stimulating hormone(TSH)and thyroid peroxidase antibody(ATPO)testing across two phases of iodine fortification in Tasmania(1995-2013)[J].Clin Endocrinol,2017,87(4):386-393.
[11]VITHANAGE M,HERATH I,ACHINTHYA S S,et al.Iodine in commercial edible iodized salts and assessment of iodine exposure in Sri Lanka[J].Arch Public Health,2016,74(1):21.
[12]YANG F,SHAN Z,TENG X,et al.Chronic iodine excess does not increase the incidence of hyperthyroidism:a prospective community-based epidemiological survey in China[J].Eur J Endocrinol,2007,156(4):403-408.
[13]LOFTUS J P,DEROSA S,STRUBLE A M,et al.Oneyear study evaluating efficacy of an iodine-restricted diet for the treatment of moderate-to-severe hyperthyroidism in cats[J].Vete Med,2019,12(10):9-16.
[14]KATAGIRI R,YUAN X,KOBAYASHI S,et al.Effect of excess iodine intake on thyroid diseases in different populations:A systematic review and meta-analyses including observational studies[J].PLoS One,2017,12(3):1-24.
[15]ALEXANDER E K,PEARCE E N,BRENT G A,et al.2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid,2017,27(3):315-389.
[16]BAJUK V,ZALETEL K,PIRNAT E,et al.Effects of adequate iodine supply on the incidence of iodine-induced thyroid disorders in Slovenia[J].Thyroid,2017,27(4):558-566.
[17]LI N,JIANG Y,SHAN Z,et al.Prolonged high iodine intake is associated with inhibition of type 2 deiodinase activity in pituitary and elevation of serum thyrotropin levels[J].Br J Nutr,2012,107(5):674-682.
[18]ZIMMERMANN M B,GALETTI V.Iodine intake as a risk factor for thyroid cancer:A comprehensive review of animal and human studies[J].Thyroid Res,2015,8(1):1-21.
[19]LV C,YANG Y,JIANG L,et al.Association between chronic exposure to different water iodine and thyroid cancer:A retrospective study from 1995 to 2014[J].Sci Total Environ,2017,609:735-741.
[2]孙玮,王燕玲,窦瑜贵,等.甘肃省不同碘营养水平地区儿童碘盐摄入量调查[J].疾病预防控制通报,2018,33(3):84-85,93.
[3]张翼.部分市县碘缺乏病防治工作的流行病学调查[J].中西医结合心血管病杂志,2017,5(34):195.
[4]高巍,黄醒华.不同程度碘缺乏孕妇甲低的发生率及对围产结局的影响[J].中国妇幼保健,2010,25(20):2783-2787.
[5]CUI S L,LIU P,SU X H,et al.Surveys in areas of high risk of iodine deficiency and iodine excess in China,2012-2014:current status and examination of the relationship between urinary iodine concentration and goiter prevalence in children aged 8-10 years[J].Biomed Environ Sci,2017,30(2):88-96.
[6]CHEN W,LI X,WU Y,et al.Associations between iodine intake,thyroid volume,and goiter rate in school-aged Chinese children from areas with high iodine drinking water concentrations[J].Am J Clin Nutr,2017,105(1):228-233.
[7]TENG X,SHAN Z,CHEN Y,et al.More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis:A cross-sectional study based on two Chinese communities with different iodine intake levels[J].Eur J Endocrinol,2011,164(6):943-950.
[8]PEDERSEN I B,KNUDSEN N,CARLéA,et al.Acautious iodization programme bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population[J].Clin Endocrinol,2011,75(1):120-126.
[9]毕文,聂春磊,张杰武.碘通过影响细胞自噬参与甲状腺炎发病机制的研究[J].国际免疫学杂志,2018,41(6):599-603.
[10]HONG A.STOKES B,OTAHAL P,et al.Temporal trends in thyroid-stimulating hormone(TSH)and thyroid peroxidase antibody(ATPO)testing across two phases of iodine fortification in Tasmania(1995-2013)[J].Clin Endocrinol,2017,87(4):386-393.
[11]VITHANAGE M,HERATH I,ACHINTHYA S S,et al.Iodine in commercial edible iodized salts and assessment of iodine exposure in Sri Lanka[J].Arch Public Health,2016,74(1):21.
[12]YANG F,SHAN Z,TENG X,et al.Chronic iodine excess does not increase the incidence of hyperthyroidism:a prospective community-based epidemiological survey in China[J].Eur J Endocrinol,2007,156(4):403-408.
[13]LOFTUS J P,DEROSA S,STRUBLE A M,et al.Oneyear study evaluating efficacy of an iodine-restricted diet for the treatment of moderate-to-severe hyperthyroidism in cats[J].Vete Med,2019,12(10):9-16.
[14]KATAGIRI R,YUAN X,KOBAYASHI S,et al.Effect of excess iodine intake on thyroid diseases in different populations:A systematic review and meta-analyses including observational studies[J].PLoS One,2017,12(3):1-24.
[15]ALEXANDER E K,PEARCE E N,BRENT G A,et al.2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid,2017,27(3):315-389.
[16]BAJUK V,ZALETEL K,PIRNAT E,et al.Effects of adequate iodine supply on the incidence of iodine-induced thyroid disorders in Slovenia[J].Thyroid,2017,27(4):558-566.
[17]LI N,JIANG Y,SHAN Z,et al.Prolonged high iodine intake is associated with inhibition of type 2 deiodinase activity in pituitary and elevation of serum thyrotropin levels[J].Br J Nutr,2012,107(5):674-682.
[18]ZIMMERMANN M B,GALETTI V.Iodine intake as a risk factor for thyroid cancer:A comprehensive review of animal and human studies[J].Thyroid Res,2015,8(1):1-21.
[19]LV C,YANG Y,JIANG L,et al.Association between chronic exposure to different water iodine and thyroid cancer:A retrospective study from 1995 to 2014[J].Sci Total Environ,2017,609:735-741.