辽宁省成人甲状腺疾病流行状况及影响因素

王健辉; 孙蕾; 冯晓伟; 王偲茜; 阚忠媛; 杨园园; 刘长晟; 高嵘; 苏孟; 白迪; 聂新宇; 王薇薇; 郭乃秋

doi:10.11847/zgggws1136437

辽宁省成人甲状腺疾病流行状况及影响因素

Prevalence and influencing factors of thyroid diseases among adults in Liaoning province: a community based survey

摘要

摘要:
目的了解成人甲状腺疾病的流行状况相关影响因素。
方法 2017 — 2018年在辽宁省沿海的营口市和内陆的沈阳市分别抽取1个社区和1个行政村，共计4个社区（村）作为调查点。按年龄和性别构成在调查点整群抽取住满5年 ≥ 18岁常住人口进行问卷调查，甲状腺超声检查，检测血碘、尿碘、盐碘和甲状腺功能及抗体促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT₃）、游离甲状腺素（fT₄）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb），评价碘营养及甲状腺疾病患病情况及影响因素。
结果共调查18～85岁成人2931人，尿碘中位数为167.6 µg /L，碘营养水平总体适宜；血碘中位数为62.1 µg /L，低血碘者125例，占4.3 %，高血碘186例，占6.4 %；成人甲状腺疾病患病率37.15 %，其中甲状腺结节、自身免疫性甲状腺炎、地方性甲状腺肿（地甲肿）、甲状腺功能减退症（甲减）、亚临床甲减、甲状腺功能亢进（甲亢）和亚临床甲亢患病率分别为20.37 ％、16.17 %、1.91 ％、1.43 %、5.53 ％、0.92 %和0.61 %。甲减、甲亢、AITD、甲状腺肿和甲状腺病患病率在不同血碘组间差异有统计学意义（P < 0.05）。甲状腺疾病发病与性别（OR = 2.03）、家族史（OR = 1.65）、年龄（OR = 1.33）、超重或肥胖（OR = 1.60）、血碘、富碘食品摄入及收入等因素密切相关。
结论辽宁地区成人甲状腺疾病患病率居于中等发病水平，性别、年龄、家族史、体质指数过高和碘营养状况与甲状腺病发病密切相关，女性及中老年人应为甲状腺疾病防治的重点人群，各地应结合人群碘营养状况，科学补碘，预防甲状腺病发生。

Abstract:
Objective To examine the prevalence and influencing factors of thyroid disease among adult residents in Liaoning province.
Methods Using age and sex stratified cluster sampling, we surveyed 2 931 residents aged 18 – 85 years and living in local regions at least 5 years in 2 villages and 2 communities from coastal Yingkou city and inland Shenyang city. Questionnaire interview, thyroid ultrasound examination, detections of serum iodine (SI), urine iodine (UI), iodine in table salt, thyroid function and antibodies, thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were conducted among the participants from 2017 through 2018. Iodine nutrition, prevalence of thyroid diseases and its influencing factors among the participants were analyzed.
Results For all the participants, the median of UI and SI were 167.6 µg/L and 62.1 µg/L, indicat-ing an appropriate overall iodine level; the proportions of the participants with lower (40 < µg /L) and higher (90 > µg /L) SI were 4.3% (n = 125) and 6.4% (n = 186). The overall detection rate of thyroid diseases was 37.15%, and the detection rates were 20.37% for thyroid nodules, 16.17% for autoimmune thyroiditis (AITD), 1.91% for endemic goiter, 1.43% for hypothyroidism, 5.53% for subclinical hypothyroidism, 0.92% for hyperthyroidism, and 0.61% for subclinical hyperthyroidism, respectively. The detection rate of hypothyroidism, hyperthyroidism, AITD, goiter and all thyroid diseases differed significantly among the participants with different SI (P < 0.05 for all). The results of multivariate logistic regression analysis revealed following risk factors for thyroid disease: female gender (odds ratio OR = 2.03), family history of thyroid disease (OR = 1.65), advanced age (OR = 1.33), and overweight or obesity (OR = 1.60); the results also indicated that SI, intake of iodine-rich foods and income were significant influencing factors of thyroid disease.
Conclusion The prevalence of thyroid disease is at a moderate level and closely influenced by gender, age, family history of thyroid disease, and body mass index among adult residents in Liaoning province. The results suggest that women and middle-aged/elderly people are key populations in thyroid disease prevention and treatment.

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