新疆住院维族和汉族患者甲状腺功能与碘营养状态分析

目的：了解新疆住院维吾尔族(简称维族)和汉族患者的甲状腺功能与碘营养状态的特点。方法纳入2015年1~5月在新疆维吾尔自治区人民医院内分泌科住院的患者1098例，其中汉族620例，维族478例，所有患者均完善甲状腺功能及尿碘检测，了解维族、汉族患者各甲状腺功能组的分布情况，以及各甲状腺功能亚组自身抗体阳性率上的差异，并分析总体和各亚组促甲状腺激素(TSH)的受影响因素及其在碘营养状态上的差异。结果住院维族、汉族患者尿典在各甲状腺功能组分布情况(甲亢组/甲减组/甲功正常组)组间比较差异无统计学意义(P>0.05)，且维族、汉族患者的尿碘中位数(MUI)均处于碘足量范围(MUI维：167.5μg/L，MUI汉：159.2μg/L)，组间比较差异无统计学意义(P>0.05)；总样本的TSH与甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)滴度呈正相关(偏相关系数分别为0.109、0.136)；根据甲状腺功能分层，临床甲功异常组与亚临床甲功异常组组间自身抗体阳性率比较差异无统计学意义(P>0.05)，但均显著高于甲功正常组(P<0.01)；临床甲亢组患者的碘营养状态构成(碘缺乏/足量/超足量/过量)与甲功正常组比较差异有显著统计学意义(P<0.01)；此外，各甲状腺功能异常亚组MUI (MUI甲亢：132.9μg/L， MUI亚甲亢：158.4μg/L，MUI甲减：146.3μg/L，MUI亚甲减：165.1μg/L)与甲功正常组的MUI (MUI正常：165.1μg/L)比较差异均无统计学意义(P>0.05)；而不同甲状腺功能亚组的TSH受影响因素不同。结论住院维族、汉族患者的MUI处于碘足量状态，民族间甲状腺功能异常的分布情况相似，临床甲亢患者的碘缺乏比例较正常组高，这与甲亢患者低碘饮食的干预可能有关。TSH的水平在不同亚组中受影响因素不同，有待扩大样本控制混杂因素后进一步证实。

Analysis of thyroid function and the iodine nutrition status of Uygur and Han hospitalized patients in Xinjiang

Objective To analyze the characteristics of thyroid function and iodine nutrition status of Uygur and Han patients in a hospital of Xinjiang. Methods From January 2015 to May 2015, 1 098 hospitalized patients (478 Uygur patients and 620 Han patients) in Department of Endocrinology of People's Hospital of Xinjiang Uygur Autono-mous Region were enrolled in the study. All patients underwent thyroid function and urinary iodine detection to under-stand the distribution of each thyroid function group between Uygur and Han patients and the difference on autoantibody positive rate in each thyroid function subgroup. Additionally, factors that affected thyroid stimulating hormone (TSH) and the difference in iodine nutrition status in overall or between subgroups were analyzed. Results There was no sta-tistically significant difference in distribution of each thyroid function group (hyperthyroidism group/hypothyroidism group/control group) between Uygur and Han inpatients (P>0.05), and the median urinary iodine concentration (MUI) of Uygur and Han inpatients were in adequate iodine nutrition status with no statistically signisicant difference (MUIUygur:167.5μg/L, MUIHan:159.2μg/L, P>0.05). TSH was positively correlated with thyroid peroxidase (TPOAb), antithyro-globulin (TGAb) titer, and the partial correlation coefficient was 0.109, 0.136 respectively. The autoantibodies positive rates had no statistically significant difference between the clinical thyroid dysfunction patients and subclinical thyroid dysfunction patients (P>0.05), but the rates were significantly higher than that in normal controls (P<0.01). The distribu-tion of iodine nutrition status (insufficiency/adequate/above recommended intakes/excessive) in clinical hyperthyroidism patients, indicating higher proportion of iodine insufficiency, was different from that of the control group (P<0.01), and MUI (MUIhyperthyroidism:132.9μg/L, MUIsubclinical hyperthyroidism:158.4μg/L, MUIhypothyroidism:146.3μg/L, MUIsubclinical hypothyroidism:165.1μg/L, MUIcontrol:165.1μg/L) showed no statistically significant difference among any of two subgroups (P>0.05). TSH of differ-ent subgroups was affected by different factors. Conclusion In hospital, the MUI in Uygur and Han patients was in ade-quate iodine nutrition status, and the distribution of thyroid dysfunction is similar between Uygur and Han patients. The proportion of iodine insufficiency in clinical hyperthyroidism patients is higher than that in control group, and this might be related to the intervention of low iodine diet in patients with hyperthyroidism. TSH levels in different subgroups are affected by different factors, and further confirmation is needed to verify these conclusions in larger sample after con-founding factors were controlled.