甲亢131I疗后TRAb变化规律与预后的临床分析

目的探讨甲亢131I疗后促甲状腺激素受体抗体（TRAb）变化规律与预后的关系。方法收集经131I治疗的甲亢（Graves病）患者317例,分别于131I治疗前、后3、6、9、12等月监测血清FT3、FT4、sTSH、TRAb等。按131I治疗前后TRAb升降变化规律分为八组。预后分为未愈（无效＋好转）、痊愈、甲减。结果131I治疗前后TRAb保持阴性不变组疗效最好,TRAb阳性疗后先降后升组疗效最差0131I疗前TRAb阴性各组较阳性各组疗效好。131I疗前TRAb阳性,疗后不变、升高或先降后升组较疗后降低组疗效较差。结论131I治疗前后TRAb升降变化规律可以较好地反映预后,对治疗有一定指导意义。     

黔南州2009年8～10岁学生碘营养水平调查

[目的]掌握黔南州8～10岁学生尿碘水平,为控制学生碘缺乏病采取相应措施。[方法]在黔南州各县(市)中,每县(市)按照东、西、南、北、中5个方位各抽取1个乡镇,每个乡镇抽取1所小学,每所小学抽取8～10岁学生20名随意一次性尿样,共计1200份尿样,检测其尿碘。[结果]黔南州8～10岁学生尿碘中位数属于碘营养水平中可能碘营养过量,在碘营养水平构成比中,碘营养不足占6.0%,适宜碘营养占42.5%,基本适宜碘营养占24.0%,可能碘营养过量占51.5%。[结论]根据每个学生的不同情况,进行减少或补充以及保持碘元素的摄入,保证学生适宜的碘营养。     

2009年甘肃省碘缺乏病健康教育效果评价

目的了解甘肃省小学生和育龄妇女碘缺乏病知晓率情况,评价健康教育在防治碘缺乏病中的作用。方法按照《中央补助地方甘肃省碘缺乏病健康教育技术方案》要求,在全省选取29个项目县（市、区）,在每个项目县（市、区）选择3个项目乡开展具体的健康教育活动;在项目实施前后,分别调查小学生和家庭主妇的碘缺乏病防治知识知晓率。结果各项目县（市、区）通过开展多种形式的健康教育活动后,小学生和育龄妇女碘缺乏病防治知识平均知晓率大幅度提高,小学生碘缺乏病防治知识平均知晓率由基线调查的70.82%上升为效果评价的94.14%,平均提高23.32个百分点;育龄妇女碘缺乏病防治知识平均知晓率由基线调查的60.53%上升为效果评价的87.38%,平均提高26.85个百分点。结论健康教育活动可有效地提高小学生、家庭主妇的碘缺乏病防治知识知晓率,增强群众的自我保健意识。     

兰州市碘缺乏病碘盐干预效果评价

目的评价碘盐干预,为进一步加强和完善消除碘缺乏病的长效工作机制提供科学依据。方法采用PPS抽样法,1995～2009年在兰州市8个县区随机抽取8～10岁儿童进行甲状腺肿大率、尿碘、盐碘监测。结果经食盐加碘干预,8～10岁儿童甲状腺肿大率呈下降趋势,近4年达到国家碘缺乏病消除标准;尿碘中位数波动在100～300μg/L,均满足国家学龄儿童碘营养评价标准（尿碘中位数〉100μg/L）,尿碘合格率波动在67.01%～97.22%;碘盐合格率连续7年稳定在90%以上,各年碘盐中位数均达到国家标准（碘盐20～50mg/kg）。结论普及碘盐是改善人群碘营养状况、防治碘缺乏病的有效措施。     

不同水碘地区人群碘营养与食盐补碘措施的应用研究

目的了解不同的水碘地区人群碘营养状况,食用盐盐碘含量,为科学补碘提供依据。方法每个乡（镇）按东、西、南、北、中不同的方位随机抽取5个村,每个村依据水源数量抽取1～5份饮用水样,测定水碘含量;不同的水碘地区（水碘值〈10μg/L、10～μg/L、20～μg/L 7、5～μg/L1、50～μg/L3、00～μg/L、600～μg/L）随机抽取3～5个乡200名以上（男、女各半）8～10岁儿童测定尿碘含量,每个乡随即采取儿童家庭食用盐40份,测定盐碘含量;在水碘值150μg/L以下的乡,随机抽取育龄妇女20名测定尿碘含量;水碘和尿碘浓度检测采用砷铈催化分光光度测定法,盐碘含量检测采用直接滴定法。结果共监测190个乡（镇）水样919份,碘含量在0.15～2840.4μg/L之间,水碘中位数66.38μg/L。水碘值〈10μg/L、10～μg/L 2、0～μg/、75～μg/L、150～μg/L、300～μg/L、600～μg/L地区的儿童尿碘中位数、儿童家庭食用盐碘中位数分别是：174.38μg/L、25.41㎎/㎏;145.22μg/L7、.45㎎/㎏;229.58μg/L、16.50㎎/㎏;197.44μg/L、4.45㎎/㎏;257.26μg/L8、.21㎎/㎏;388.40μg/L、3.83㎎/㎏;1506.30μg/L、0㎎/㎏;水碘值〈10μg/L、10～μg/L、20～μg/7、5～μg/L地区的育龄妇女尿碘中位数分别是139.61μg/L、131.22μg/L2、25.53μg/L、192.42μg/L。结论在非高碘地区,碘盐是影响人群碘营养的重要因素,盐碘浓度应根据饮用水的碘含量而不同,在水碘小于20μg/L的地区盐碘浓度在20～30㎎/㎏比较适宜;在水碘为20～150μg/L的此区盐碘浓度在10～20㎎/㎏比较适宜。高碘地区应停供碘盐,改水降碘。     

不同碘水平对哺乳期大鼠碘代谢及甲状腺功能的影响

目的通过实验了解碘摄入水平对哺乳期大鼠碘营养及甲状腺功能的影响以及是否存在保护子代免受碘缺乏及碘过量危害的机制。方法选择体重80～100 g的雌性Wistar大鼠96只,按体重分层后,再随机分为6组。饲养3个月后先测定尿碘,然后将前5组雌鼠与雄鼠合笼交配,在其产后5、10 d时,每组每批分别处死8只大鼠及其子鼠,取大鼠的血清和子鼠胃里的乳汁。第6组除不与雄鼠交配外,其他处理同前5组。测定大鼠尿碘、血清碘、血清甲状腺激素T3、T4水平及子鼠胃里乳汁碘水平。结果 （1）低碘组大鼠的尿碘、血清碘水平低于对照组,而高碘组、未孕对照组大鼠的尿碘、血清碘水平高于对照组,差异均有统计学意义（P〈0.05）;（2）低碘组乳汁碘水平明显低于对照组,而高碘组明显高于对照组;另外,低碘1组乳汁碘水平明显高于低碘2组,差异有统计学意义（P〈0.01）;（3）低碘组大鼠T3、T4水平均低于对照组,且T3/T4水平明显高于对照组;高碘组大鼠T3、T3/T4水平低于对照组,T4水平高于对照组,差异均有统计学意义（P〈0.01）;（4）各组产后5 d和10 d的数据比较差异无统计学意义。结论不同碘摄入水平导致哺乳期大鼠体内碘营养水平及甲状腺功能发生了改变,且大鼠能够通过哺乳调节对子代的碘供应,以尽量减轻低碘或高碘对子代带来的危害。     

碘过量对实验性自身免疫性甲状腺炎大鼠骨代谢的影响

目的 探讨碘过量对实验性自身免疫性甲状腺炎(EAT)大鼠骨代谢的影响.方法 雌性Lewis大鼠36只,体质量为(131±15)g,按体质量随机分为3组:对照组、EAT组和EAT+高碘组,每组12只.以不同含碘量(0.9、0.9、18.0 mg/kg)的饲料喂养各组大鼠,并用猪甲状腺球蛋白(pTG)和完全弗氏佐剂(CFA)对EAT组和EAT+高碘组大鼠进行免疫以建立EAT模型.2周后观察大鼠甲状腺病理改变,测定血清甲状腺自身抗体[甲状腺球蛋白抗体(TGAb)、甲状腺微粒体抗体(TMAb)]和甲状腺激素[三碘甲腺原氨酸(T3)、甲状腺素(T4)]以及骨代谢相关指标[骨钙素(BGP)、抗酒石酸盐酸性磷酸酶(TRAP)、Ⅰ型前胶原羧基末端前肽(PICP)、Ⅰ型胶原羧基吡啶并啉交联肽(ICTP)、胰岛素样生长因子-1(IGF-1)、护骨素(OPG)、核因子κB受体活化因子配体(RANKL)]水平.结果 EAT组和EAT+高碘组大鼠甲状腺组织均呈现炎细胞浸润,局部滤泡结构破坏,其中EAT+高碘组以甲状腺滤泡扩张、融合为主.EAT组和EAT+高碘组大鼠血清TGAb、TMAb、T3和T4水平[(63.01±12.36)%、(60.62±11.24)%,(3.78±1.43)、(125.12±16.00)pmol/L和(75.00±15.44)%、(72.15±15.00)%,(3.69±0.91)、(149.40±20.67)pmol/L]高于对照组[(4.47±1.04)%、(5.73±1.01)%,(0.75±0.12)、(76.91±9.30)pmol/L,P均＜0.05],EAT+高碘组大鼠血清TGAb、TMAb和T4水平较EAT组升高(P均＜0.05).EAT组大鼠血清BGP、PICP和IGF-1水平[(1.70±0.31)、(11.31±1.52)μg/L,(0.31±0.06)mg/L]较对照组[(8.60±0.33)、(14.28±3.10)μg/L,(1.16±0.02)mg/L]降低(P均＜0.05),血清TRAP、ICTP、OPG和RANKL水平[(19.88±3.60)ng/L,(2.43±0.82)、(22.36±2.80)、(1.35±0.23)μg/L]较对照组[(14.57±3.56)ng/L,(0.50±0.20)、(1.61±0.34)、(0.10±0.02)μg/L]升高(P均＜0.05);与EAT组比较,EAT+高碘组大鼠血清PICP和OPG水平[(8.03±1.84)、(16.80±3.79)μg/L]明显降低(P均＜0.05).结论 EAT时大鼠的破骨细胞分化与成熟增强,导致骨吸收增强.碘过量可抑制EAT大鼠成骨细胞和破骨细胞活性,呈现低转化型骨质疏松.

Abstract：

Objective To explore the effect of iodine excess on bone metabolism in experimental autoimmune thyroiditis (EAT) rats. Methods We selected 36 female Lewis rats with body weight of (131 ± 15)g,and divided them into 3 groups randomly: control group, EAT group and EAT + high iodine group, assuring 12 rats in every group. These rats were fed fodder with different concentration of iodine(0.9,0.9, 18.0 mg/kg), and rats in EAT group and EAT + high iodine group were immunized with pig thyroglobulin(pTG) and complete Freund's adjuvant(CFA) to create EAT model. After two weeks, the pathological changes of the thyroid tissues were observed,and the serum thyroid autoantibody[thyroglobulin antibody(TGAb) and thyroid microsomal antibody(TMAb)], the thyroid hormone levels[triiodo thyronine(T3) and thyrine(T4)] and some relevant data of bone metabolism[bone gla protein (BGP), tartrate-resistant acid phosphatase (TRAP), C-terminal propeptide of type Ⅰ procollagen (PICP),C-terminal telopeptide of type Ⅰ collagen (ICTP), insulin-like growth factor- 1 ( IGF- 1 ), osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL)] were measured. Results Inflammatory cell infiltration and local follicular structural damage were observed in the thyroid tissues of EAT rats in EAT group and EAT + high iodine group, and the pathological changes of EAT + high iodine group were mainly thyroid follicular expansion and integration. The level of serum TGAb, TMAb, T3 and T4 of EAT rats in EAT group and EAT + high iodine group[ (63.01 ± 12.36)%, (60.62 ± 11.24)%, (3.78 ± 1.43), (125.12 ± 16.00)pmol/L and (75.00 ± 15.44)%,(72.15 ± 15.00)%, (3.69 ± 0.91 ), (149.40 ± 20.67)pmol/L] were higher than those of the control group[ (4.47 ±1.04)%, (5.73 ± 1.01 )%, (0.75 ± 0.12), (76.91 ± 9.30)pmol/L, all P ＜ 0.05], and the level of serum TGAb,TMAb and T4 of EAT rats in EAT + high iodine group were higher than those of the EAT group(all P ＜ 0.05).The level of serum BGP, PICP and IGF- 1 in EAT group[ ( 1.70 ± 0.31 ), ( 11.31 ± 1.52) μg/L, (0.31 ± 0.06 ) mg/L]were lower than those of the control group[ (8.60 ± 0.33), (14.28 ± 3.10)μg/L, (1.16 ± 0.02)mg/L, all P ＜0.05], and the level of serum TRAP, ICTP, OPG and RANKL[ ( 19.88 ± 3.60)ng/L, (2.43 ± 0.82), (22.36 ± 2.80),( 1.35 ± 0.23 )μg/L] were higher than those of the control group[ ( 14.57 ± 3.56)ng/L, (0.50 ± 0.20), (1.61 ± 0.34),(0.10 ± 0.02)μg/L, all P ＜ 0.05]; compared with EAT group, the level of PCIP and OPG in EAT + high iodine group [ (8.03 ± 1.84), ( 16.80 ± 3.79)μg/L] were obviously decreased(all P ＜ 0.05). Conclusions The reinforcement of differentiation and maturation of osteoblast in the EAT rats results in the increasing of bone resorption. The activity of osteoblast and osteoclast of the EAT rats are inhibited by excessive iodine, showing a low conversion-type osteoporosis.     

2007-2009年甘肃省碘缺乏病高危地区碘缺乏病防治现状调查

目的 掌握甘肃省碘缺乏病高危地区碘缺乏病防治现状,为制订碘缺乏病的防治策略提供依据.方法 2007 - 2009年选择12个碘缺乏病高危县,在全县范围内搜索所有1997年1月1日以后出生的疑似克汀病患者.在每个县抽取3个乡,在每个乡抽取2个村,在每个村小学,选择40名8～ 10岁儿童进行甲状腺检查、尿碘测定、智商测查;每个村选择30名育龄妇女进行尿碘测定,并对其家中食盐进行半定量检测,同时对当地碘盐相关情况进行调查.结果 12个县中,共搜索到120例疑似克汀病患者,确诊7例.儿童甲状腺B超肿大率为6.8％(290/4281),夏河县、临潭县、卓尼县、舟曲县和东乡县的肿大率均＞5.0％,其中夏河县、临潭县和东乡县均＞10.0％.儿童平均智商为82.38.儿童尿碘中位数为180.34 μg/L,尿碘＜50.00 μg/L的比例为11.0％(482/4383).育龄妇女尿碘中位数为175.91 μg/L,尿碘＜50μg/L的比例为16.5％(126/762).其中夏河县、东乡县育龄妇女尿碘中位数分别为95.24 μg/L和66.30 μg/L.12个县中有8个县的碘盐覆盖率在95.0％以上,其余4个县的碘盐碘盐覆盖率均＜85％,其中广河县和东乡县的碘盐覆盖率仅为39.2％(47/120)和66.7％(120/180).14.9％(206/1380)的群众认为购买碘盐不方便;87.7％(1210/1380)认为目前的碘盐价格超出可接受的范围;29.9％(413/1380)的家庭主妇知道预防缺碘的方法.结论 影响碘缺乏病高危地区防治的因素广泛存在,应加强碘缺乏病高危地区监测,适时采取有效措施,确保重点人群充足的碘营养.同时还应加强以碘盐为主的综合防治措施的落实,建立碘缺乏病防治长效机制.     

尿碘的低砷量砷铈催化分光光度测定方法

目的 改进现行的尿中碘砷铈催化分光光度测定标准方法,减少含砷剧毒试剂的用量以减少环境污染,并使新方法仍具有良好的测定精密度和准确度.方法 将尿碘测定现行标准法检测每份样品的亚砷酸溶液用量由0.100 mol/L(其中含氯化钠25异/L)、2.5 ml改变为0.025 mol/L(其中含氯化钠40 g/L)、2.5 nd;硫酸铈铵溶液用量由O.076 mol/L、0.30 ml改变为0.025 mol/L、0.30 ml;吸光度(A)测定波长由420 nm改为400 nm.实验此新方法的标准曲线线性关系及线性范围、样品测定检测限、精密度、准确度,与现行标准法比较尿碘测定结果及测定过程的A值变化速率;并实验此新方法在20～35℃范围内砷铈反应温度与反应时间的适宜组合.结果 改进后的新方法砷铈反应在20～35℃范围内选择任一稳定的温度及固定的反应时间都有碘质量浓度(C)与测定A值定量关系C=a+blgA,标准曲线线性范围为0～300μg/L(r=-0.9998),最低检测限为4μg/L(取样量为0.25 ml);精密度:测定尿碘为66.0、76.0、147.5、265.5μg/L时,变异系数(CV)分别为1.7%(1.1/66.0)、1.8%(1.4/76.0)、2.0%(3.0/147.5)、1.6%(4.2/265.5);准确度:对低、中、高含碘最4份尿样加碘标平均回收率分别为101.0%(40.4/40.0)、100.4%(100.4/100.0)、100.5%(60.3/60.0)、100.4%(100.4/100.0),总平均回收率为100.6%,回收率范围为95.0%(57.0/60.0)～103.7%(62.2/60.0);分别在20、25、30、35℃反应温度下测定低、高两种尿碘标准物质,其结果均在给定值的不确定度范围内,且相对偏差分别<5.0%和<2.0%;与现行标准法同时测定48份尿样,二者比较差异无统计学意义(t=0.634,P>0.05).新方法的反应温度与时间适宜组合系列数据为20℃和53 min、25 ℃和40 min、30 ℃和30 min等.与标准法比较,新方法砷铈反应的铈A值变化更加缓慢,进一步减少了测定过程温度波动或测定时间操作偏差所引起的测定误差.结论 改进后的新方法比现行标准方法大大减少了废液含砷量,减少了环境污染、节省了试剂,简便易操作,并提高了尿碘测定精密度和准确度,适合推广应用.

Abstract：

Objective To improve the current standard method of measuring urinary iodine by As (Ⅲ)-Ce4+catalytic spectrophotometry, reducing the amount of arsenic toxic reagent used to decrease environmental pollution,and make the modified method with good precision and accuracy. Methods For improving the current standard method of measuring urinary iodine, amount of arsenious acid solution was reduced from 0.100 mol/L H3AsO3(which contains NaCl 25 g/L) 2.5 ml to 0.025 mol/L H3AsO3(which contains NaCl 40 g/L) 2.5 ml;amount of ceric ammonium sulfate solution was reduced from 0.076 mol/L 0.30 ml to 0.025 mol/L 0.30 ml;photometric wavelength was changed from 420 nm to 400 nm. The new modified method was evaluated by standard curve linearity and linear range, sample detection limit, precision, accuracy, and urinary iodine values, and the rates of absorbance change in the test process were compared with the current standard method. Results The calibration relation of C= a + blgA (C: iodine concentration, A : measuring absorbance) in the new modified method existed when As3+-Ce4+ catalytic reaction was kept at a certain stable temperature range between 20 - 35 ℃ and in certain stable reacting time. The linear range of the calibration curve was 0 - 300 μg/L and the linear correlative coefficient was - 0.9998. The detection limit for iodine was 4 μg/L(0.25 ml of urine was tested). The test coefficient of variations(CV) were 1.7%(1.1/66.0), 1.8%(1.4/76.0), 2.0%(3.0/147.5), 1.6%(4.2/265.5) when measuring urine samples with iodine concentration of 66.0, 76.0, 147.5, 265.5 μg/L, respectively. The average recovery was 100.6% with a range of 95.0% (57.0/60.0) - 103.7% (62.2/60.0) when measuring 4 urine samples containing different iodine concentration, and average recovery was 101.0% (40.4/40.0), 100.4% (100.4/I00.0), 100.5% (60.3/60.0),100.4% (100.4/100.0), respectively. The test results of two national standard urinary iodine were all within the given value range and the relative deviation(RD) was < 5.0% and < 2.0% in 20, 25, 30, 35 ℃ test temperature,respectively. No significant difference was found between the results of the 48 urine samples determined by the new modified method and the current standard method(t = 0.634, P > 0.05). The table of suitable combination of As3+-Ce4+ reaction temperature and time for this method was obtained(such as 20 ℃ and 53 min, 25 ℃ and 40 min, 30 ℃and 30 min, etc. ). Compared with the standard method, the rates of absorbanee change of As ( Ⅲ )-Ce4+ reaction in the new modified method were more slowly, which further reducing the determination deviation caused by the temperature fluctuations or measuring time deviation in measurement process. Conclusions This new modified method greatly reduces the amount of arsenic in waste, reduces pollution, saving reagents, and this method is easier to operate with better precision and accuracy, which is suitable for application of measuring iodine in urine.     

2001-2009年河北省张家口市碘盐监测结果

目的 综合分析张家口市2001-2009年度碘盐监测数据,为制订碘缺乏病防治策略提供依据.方法 按照卫生部<全国碘缺乏病监测方案>碘盐监测的要求,在张家口市17个县(区)中.各县区每月对本辖区内碘盐加工(批发)企业抽取1批9份盐样;每县(区)每年度按东、南、西、北方位各抽取2个乡(镇、街道办事处),中区抽取1个乡(镇、街道办事处),每乡(镇、街道办事处)抽取4个村(居委会),每村(居委会)抽取8份户盐,采用直接滴定法定量测定含碘量.结果 碘盐加工(批发)企业:2001-2009年全市共监测1728批次,合格1689批次,批质量合格率为97.74%;检测盐样15 552份,合格15 357份,碘盐合格率为98.75%.居民户:2001-2009年全市共监测1305个乡(镇、街道办事处),5297个村(居委会);采集盐样44 316份,其中合格43274份,碘盐合格率为98.04%(43 274/44 141),碘盐覆盖率为99.61%(44 141/44 316),合格碘盐食用率为97.65%(43 274/44 316),非碘盐率为0.40%(260/44 316),盐碘中位数为30.02 mg/kg.结论 9年中张家口市各项碘盐质量指标均位于国家控制指标以内,且保持在相对较为稳定的水平,各年度波动范围较小.非碘盐历年都有检出,成为影响碘缺乏病防治效果的主要因素,应加大监测、监督力度,普及健康教育知识.遏止非碘盐的泛滥.

Abstract：

Objective To analyze comprehensively the monitoring data of iodized salt in Zhangjiakou city during 2001 to 2009, and to provide basic information for working out control strategies of the iodine deficiency disorders. Methods According to the iodized salt monitoring requirements in "National Iodine Deficiency Disorders Monitoring Program" of Ministry of Health, a batch of nine salt samples were taken from each processing (wholesale)company of each county or district of the seventeen counties(districts) of Zhangjiakou once a month. Two townships (towns, street offices) were selected by their location of east, south, west and north in each county(district), and a township in central area each year. Four villages(neighborhoods) were selected in each township(town, street office),and eight household salt samples were collected in each village(neighborhood), and quantitatively determined by direct titration of iodine. Results Iodized salt processing(wholesale) : during 2001 to 2009, a total of 1728 batches was monitored, 1689 batch qualified, batch qualification rate 97.74%;15552 salt samples were tested, 15 357 qualified, iodized salt qualification rate 98.75 %. Household salt levels : 5297 villages (neighborhoods) of 1305 townships(towns, street offices) were monitored, 44 316 salt samples were collected, 43 274 qualified, iodized salt qualification rate 98.04%(43 274/44 141 ), iodized salt coverage rate 99.61%(44 141/44 316), qualified iodized salt consumption rate 97.65%(43 274/44 316). Rate of non-iodized salt was 0.40%(260/44 316), and salt median iodine was 30.02 mg/kg. Conclusions The iodized salt quality indicators are within the state-controlled range in Zhangjiakou city for nine years which remaines at relatively stable levels with a smaller range of annual fluctuations.Detection of non-iodized salt over the years has become the main factors affecting the effectiveness of the prevention and control measures.We should increase monitoring,supervision,and universal health education,and prevent the spread of non-iodized salt.