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基于GEE模型的2022—2024年北京市某区8～10岁在校小学生碘摄入水平及其对甲状腺容积影响

Influence of iodine intake on thyroid volume among students aged 8–10 years in a district of Beijing from 2022 to 2024 based on a generalized estimating equation model

    摘要
  • 摘要:
    目的 评估2022—2024年北京市某区8～10岁儿童碘摄入水平及其对甲状腺容积的影响。
    方法 于2022—2024年，每年从当地随机抽取5个乡镇中8～10岁非寄宿学生200人，3年共计600人，收集其尿样、家庭食盐样本、B超测定的甲状腺容积等相关信息，通过广义估计方程（GEE）模型分析其年度变化趋势并按性别进行敏感性分析。
    结果 2022—2024年8～10岁儿童平均尿碘浓度中位数分别为170.96、157.35、163.10 g/L，尿碘浓度总体稳定，但男童尿碘随年度略有增加趋势（P=0.032）。2022—2024年盐碘含量均值分别为（17.76±7.96）、（16.78±11.48）、（16.27±9.08）mg/kg，含量均值不同年度略有差异。GEE模型结果显示，在控制其他因素后，男童的甲状腺容积大于女童（β=0.32，95%CI=0.10～0.49）；年龄增加对甲状腺容积的影响为正向且显著（β=0.56，95%CI=0.46～0.64）。相比女童，男童的平均尿碘浓度高于女童（β=5.68，95%CI=3.10～7.79）；盐碘含量对尿碘浓度的影响显著且为正向（β=0.08，95%CI=0.02～0.14）；不同性别敏感性分析显示，盐碘含量对尿碘浓度的影响在男童组（β=0.56，95%CI=0.27～0.86）和女童组（β=1.20，95%CI=0.01～0.80）均显著且为正向，而盐碘对甲状腺容积的直接影响在男童组（β=0.17，95%CI= – 0.40～0.60）和女童组（β=0.19，95%CI= – 0.50～0.80）均不显著。
    结论 在碘营养充足的环境中，甲状腺容积主要受年龄和性别等生理性因素影响，盐碘摄入对甲状腺容积无显著影响，但盐碘含量与尿碘浓度正相关。碘监测可侧重于尿碘浓度的测定，而甲状腺容积在碘充足条件下的变化相对较小。

     

    Abstract:
    Objective To assess iodine intake levels and their impact on thyroid volume in children aged 8–10 years in a district of Beijing city from 2022 to 2024.
    Methods From 2022 to 2024, 200 non-boarding students aged 8–10 years were randomly selected annually from five townships in the district, totaling 600 participants over the three years. Urine samples, household salt samples, and ultrasound-measured thyroid volumes were collected. Generalized estimating equations (GEE) models were used to analyze annual trends and conduct sensitivity analyses by sex.
    Results The median urinary iodine concentrations (UICs) in children aged 8–10 years from 2022 to 2024 were 170.96, 157.35, and 163.10 µg/L, respectively, indicating overall stability in UICs. However, a slight increasing trend in UICs was observed in boys over the years (P = 0.032). The mean salt iodine content (SIC) from 2022 to 2024 was (17.76 ± 7.96), (16.78 ± 11.48), and (16.27 ± 9.08) mg/kg, respectively, showing slight variations across the years. GEE model results showed that, after controlling for other factors, boys had larger thyroid volumes than girls (β = 0.32, 95%CI: 0.10–0.49); increasing age had a positive and significant effect on thyroid volume (β = 0.56, 95%CI: 0.46–0.64). Compared to girls, boys had higher mean UICs (β = 5.68, 95%CI: 3.10–7.79); SIC had a significant positive effect on UICs (β = 0.08, 95%CI: 0.02–0.14). Sensitivity analyses by sex revealed that the effect of SIC on UICs was significant and positive in both boys (β = 0.56, 95%CI: 0.27–0.86) and girls (β = 1.20, 95%CI: 0.01–0.80), while the direct effect of SIC on thyroid volume was not significant in either boys (β = 0.17, 95%CI: –0.40–0.60) or girls (β = 0.19, 95%CI: –0.50–0.80).
    Conclusions In iodine-sufficient environments, thyroid volume is primarily influenced by physiological factors such as age and sex, with salt iodine intake having no significant effect on thyroid volume. However, SIC is positively correlated with UIC. Iodine monitoring can focus on UIC measurements, as changes in thyroid volume are relatively small under iodine-sufficient conditions.

     

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