王凤玲 侯振江 刘玉枝

[摘要] 目的 探討沧州地区甲状腺功能异常患者的碘营养状态特点。 方法 收集2015年3月～2017年12月河北省沧州中西医结合医院（以下简称“我院”）内分泌科收治的1024例甲状腺功能异常患者作为研究组，依据甲状腺疾病诊断标准分为四组：甲状腺功能亢进症（临床甲亢）组、亚临床甲状腺功能亢进症（亚临床甲亢）组、甲状腺功能减退症（临床甲减）组和亚临床甲状腺功能减退症（亚临床甲减）组。同时选取我院同期成人健康体检者130名作为对照组，测定尿碘和甲状腺功能[游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）]，分析研究组各亚组和对照组的碘营养状态。 结果 亚临床甲亢组、临床甲亢组、对照组、临床甲减组和亚临床甲减组的尿碘中位数（MUI）依次增高，研究组和对照组人群整体均处于碘营养适宜状态，但患者的尿碘水平波动范围较大，个体差异大。临床甲亢组和亚临床甲亢组患者MUI>200 μg/L，处于碘营养超量状态。临床甲亢组与亚临床甲亢组碘缺乏、碘适量、碘过量构成比分别与临床甲减组、亚临床甲减组比较差异均有统计学意义（P < 0.05），研究组各亚组碘缺乏、碘适量、碘超量构成比和对照组比较差异均有统计学意义（P < 0.05）。 结论 碘营养水平与甲状腺功能有关，甲状腺功能异常患者和健康者都需关注碘营养状态，应依据尿碘测定结果指导个体化碘摄入，避免盲目补碘，对预防和治疗甲状腺疾病有重要意义。

[关键词] 尿碘；碘营养状态；临床甲亢；亚临床甲亢；临床甲减；亚临床甲减

[中图分类号] R581 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0063-04

[Abstract] Objective To explore the characteristics of iodine nutritional status in patients with abnormal thyroid function in Cangzhou. Methods A total of 1024 patients with abnormal thyroid function in Department of Endocrinology in Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine in Hebei Province （"our hospital for short"） from March 2015 to December 2017 were selected as study group. They were divided into 4 groups according to the diagnostic criteria of thyroid diseases， which were hyperthyroidism group， ubclinical hyperthyroidism group， hypothyroidism group and subclinical hypothyroidism group. At the same time， 130 normal adults taken physical examination in our hospital at the same time were collected as control group. The urine iodine and thyroid function [free triiodothyronine （FT3）， free thyroxine （FT4） and thyrotropic hormone （TSH）] were detected. The iodine nutritional status in all subgroups of study group and control group was analyzed. Results The levels of median urinary iodine （MUI） in all subgroups in ascending order were subclinical hyperthyroidism group， hyperthyroidism group， control group， hypothyroidism group and subclinical hypothyroidism group. The iodine nutrition in study group and control group were in the proper state. But the range of urine iodine levels was large， and the difference of urine iodine levels among different individuals was large. The levels of MUI in hyperthyroidism group and subclinical hyperthyroidism group were more than 200 μg/L， and the patients were in a state of excess iodine nutrition. The percentage of iodine deficiency， proper iodine， iodine excess in hyperthyroidism group and subclinical hyperthyroidism group had statistically significant differences compared with those of hypothyroidism group and subclinical hypothyroidism group （P < 0.05）， the percentage of iodine deficiency， proper iodine， iodine overbalance in all subgroups of study group had statistically significant differences compared with those of control group （P < 0.05）. Conclusion Iodine nutrition levels are associated with thyroid function. Both patients with abnormal thyroid function and healthy people need to pay attention to the state of iodine nutrition. Individualized iodine intake should be guided by the results of urine iodine. Blind iodine supplementation should be avoided. It is of great significance for the prevention and treatment of thyroid diseases.

[Key words] Urinary iodine； Iodine nutrition status； Hyperthyroidism； Subclinical hyperthyroidism； Hypothyroidism； Subclinical hypothyroidism

自1996年我国开始普遍实施食盐加碘（USI）以来，在全国范围内，人群碘营养水平得到了显著改善，解决了多数碘摄入不足的问题，然而甲状腺疾病的患病率却呈逐渐增加的趋势。虽然目前许多地区处于碘充足、碘超量甚至碘过量的碘营养状态，但仍有部分人群存在碘营养缺乏的问题。碘……