摘要
目的了解江苏省句容市儿童青少年碘营养状况、甲状腺结节流行状况及其分布特征,探讨儿童青少年甲状腺结节的危险因素。方法2021年采用整群抽样法在句容市城区、乡镇各抽取中、小学校1所,每所学校以班级为单位抽取≥150名儿童青少年作为调查对象,其中小学抽取三年级儿童、中学抽取七年级青少年。采用调查问卷和儿童焦虑性情绪障碍筛查表(SCARED)收集调查对象的基本信息及心理健康情况;采集调查对象所在学校和学校所在乡镇的水样,检测水碘含量;收集家庭食用盐盐样和尿样,检测盐碘和尿碘含量;采用B超法检查所有调查对象的甲状腺,测量甲状腺容积,分析甲状腺肿大(甲肿)及甲状腺结节情况。应用Cochran-Armitage趋势检验法进行趋势分析,采用多因素logistic回归模型分析甲状腺结节的危险因素。结果共调查儿童青少年710人(男性370人、女性340人),其中儿童347人(男性169人、女性178人)、青少年363人(男性201人、女性162人)。共采集水样14份,水碘含量范围为8.98~10.82μg/L,水碘中位数为9.98μg/L。共检测食用盐盐样710份,盐碘含量为(20.94±1.94)mg/kg,碘盐覆盖率为100.00%,合格碘盐食用率为97.46%(692/710)。共检测尿样710份,尿碘中位数为288.13μg/L,男性、女性尿碘中位数分别为310.29、245.12μg/L,二者比较差异有统计学意义(Z=-5.91,P<0.001)。经B超检查发现,2021年句容市儿童青少年的甲肿率为2.25%(16/710),甲状腺结节检出率为25.07%(178/710),随着年龄增长甲状腺结节检出率未见明显上升趋势(χ^(2)_(趋势)=0.45,P=0.651);男性、女性甲状腺结节检出率分别为20.00%(74/370)和30.59%(104/340),二者比较差异有统计学意义(χ^(2)=10.57,P<0.001)。多因素logistic回归分析表明,女性、近1个月参加课外补习/兴趣班与儿童青少年发生甲状腺结节有关(OR=1.76、1.54,95%CI:1.25~2.49、1.09~2.17,均P<0.05)。结论2021年句容市儿童青少年碘盐覆盖率、合格碘盐食用率和甲肿率均达到碘缺乏病消除标准,碘营养处于超适宜量,但句容市外环境仍缺碘。儿童青少年甲状腺结节检出率处于较高水平,女性和近1个月参加课外补习/兴趣班是儿童青少年发生甲状腺结节的危险因素。
Objective To investigate the iodine nutritional status,prevalence and distribution characteristics of thyroid nodules among children and adolescents in Jurong City,Jiangsu Province,and study the risk factors for thyroid nodules in children and adolescents.Methods In 2021,a cluster sampling method was used to select one primary and one secondary school in the urban and rural areas of Jurong City,≥150 children and adolescents were selected as survey respondents from each school on a class-by-class basis,including third-grade children in primary schools and seventh-grade adolescents in secondary schools.The basic information and mental health status of survey respondents were collected by basic information questionnaires and Children's Anxiety Related Emotional Disorders Screening Form(SCARED).Water samples were collected from schools where survey respondents were enrolled and from townships where schools were located,and the iodine content in the water were tested.At the same time,household salt and urine samples from survey respondents were collected to test the salt iodine and urine iodine.Thyroid volume and thyroid nodules were measured using B-ultrasound method to analyze goiter(swelling of the thyroid gland)and thyroid nodules.The Cochran-Armitage trend test method was applied for trend analysis,and a multivariate logistic regression model was used to analyze the risk factors for thyroid nodules.Results A total of 710 children and adolescents(370 males and 340 females)were surveyed,including 347 children(169 males and 178 females)and 363 adolescents(201 males and 162 females).A total of 14 water samples were collected,with an iodine content range of 8.98 to 10.82μg/L and a median iodine content of 9.98μg/L.A total of 710 edible salt samples were tested,with a salt iodine content of(20.94±1.94)mg/kg,an iodine salt coverage rate of 100.00%,and a qualified iodine salt consumption rate of 97.46%(692/710).A total of 710 urine samples were tested,with a median urine iodine of 288.13μg/L,median urinary iodine for boys and girls was 310.29 and 245.12μg/L,respectively,and the difference between the two was statistically significant(Z=-5.91,P<0.001).A total of 710 children and adolescents were tested by B-ultrasound,and the detection rate of goiter and thyroid nodules was 2.25%(16/710)and 25.07%(178/710).There was no significant upward trend in the detection rate of thyroid nodules with age(χ^(2)_(trend)=0.45,P=0.651).The detection rates of thyroid nodules in boys and girls were 20.00%(74/370)and 30.59%(104/340),respectively,and the difference between the two was statistically significant(χ^(2)=10.57,P<0.001).Multivariate logistic regression analysis indicated that female students who participated in extracurricular tutoring/interest classes in the past month were two influencing factors for thyroid nodules in children and adolescents(OR=1.76,1.54,95%CI:1.25-2.49,1.09-2.17,P<0.05).Conclusions The iodized salt coverage rate,qualified iodized salt consumption rate,and goiter rate in children and adolescents in Jurong City have all reached the elimination standard for iodine deficiency disorders,and their iodine nutrition is at a super-appropriate level.However,the external environment of Jurong City is still iodine-deficient.The detection rate of thyroid nodules in children and adolescents is at a high level.Female students and those who have participated in extracurricular tutoring/interest classes in the past month are risk factors for thyroid nodules in children and adolescents.
作者
赵庆华
张予晗
曹俊
侯金花
武丹
江成功
Zhao Qinghua;Zhang Yuhan;Cao Jun;Hou Jinhua;Wu Dan;Jiang Chenggong(Department for Schistosomiasis,Parasitic and Endemic Diseases Control,Jurong Center for Disease Control and Prevention,Jurong 212400,China)
出处
《中华地方病学杂志》
CAS
北大核心
2024年第5期376-382,共7页
Chinese Journal of Endemiology
基金
镇江市社会发展指导性科技计划项目(FZ2023036)
