Objective: To investigate the prevalence of thyroid disorders, iodine nutritional status and relevant risk factors among adults in Chengdu city on the basis of two population-based surveys, one conducted between 2016 and 2017 and the other, between 2019 and 2020, and to provide references for making health-related administrative decisions.
Methods: Two population-based sampling surveys were conducted. The first one was done between October 2016 and December 2017, using stratified cluster random sampling to select subjects from 2 urban and 2 rural communities in Chengdu. Then, between December 2019 and February 2020, sequential cluster sampling was used to select subjects from communities in the peripheral regions of Longquanyi District, Chengdu. Both surveys covered natural populations of people who were 18 or older and who met the inclusion criteria. In the first survey, questionnaires, physical examination, thyroid ultrasound, and examinations of serum thyroid biochemical markers and urine iodine were performed, while in the second survey, only questionnaire concerning thyroid disorders and physical examination were performed. Statistical analysis of the nutritional status of iodine, the prevalence of thyroid disorders, and potential risk factor was conducted.
Results: A total of 1859 subjects were enrolled for the first survey and 16152 for the second. According to the results of the first survey, the median urine iodine concentration was 172.10 μg/L, and the group with adequate or more than adequate iodine accounted for more than 60% of the surveyed population. The prevalence of thyroid disorders was found to be 0.48% for overt hyperthyroidism, 0.43% for subclinical hyperthyroidism, 0.43% for Grave's disease, 1.34% for overt hypothyroidism, 16.62% for subclinical hypothyroidism, 16.73% for positive thyroid antibody, 12.96% for TPOAb positive, 10.06% for TGAb positive, 0.81% for goiter, 14.85% for single nodule, 14.42% for multi-nodules, and 29.26% for thyroid nodules. Excess iodine is a risk factor for subclinical hypothyroidism ( OR=1.50, 95% confidence interval [ CI]: 1.07-2.10, P<0.05), and iodine deficiency is a risk factor for multiple thyroid nodules ( OR=1.45, 95% CI: 1.02-2.05, P<0.05). The total prevalence of hyperthyroidism, hypothyroidism and Hashimoto's thyroiditis in the two surveys was 6.58% and 5.95%, respectively, showing no significant difference. The second survey lacked accurate data on thyroid nodules.
Conclusion: The iodine nutritional status of adults in Chengdu in recent years was appropriate. The total prevalence of hyperthyroidism, hypothyroidism and Hashimoto's thyroiditis remained stable, while that of thyroid nodule increased in recent years. We should continue with the implementation of the universal salt iodization policy and reinforce efforts in monitoring. Furthermore, we should make an active effort to look into the etiology of thyroid nodules.
目的: 通过2016–2017年及2019–2020年两次人群调查，了解成都市甲状腺疾病患病率及碘营养状况及相关危险因素数据，为卫生行政决策提供依据。
方法: 分别于2016年10月–2017年12月、2019年12月–2020年2月进行人群抽样调查。第一次调查采用分层整群随机抽样方法，选择成都市城市和农村各2个社区居民为调查对象；第二次调查采用序贯整群抽样选择成都市龙泉驿区周边社区居民。两次均选择18岁以上符合入选标准的自然人群为调查对象，第一次进行问卷调查、体格检查、甲状腺超声、血清甲状腺功能和尿碘检查，第二次仅进行甲状腺疾病患病情况问卷及一般情况的调查。统计分析碘营养状况、甲状腺疾病患病率及可能的危险因素。
结果: 第一次纳入受试者1859人、第二次纳入16152人。第一次调查结果显示成人尿碘中位质量浓度为172.10 μg/L，碘足量或超足量人群占调查人数60%以上。甲状腺疾病患病率：显性甲亢（0.48%）、亚临床甲亢（0.43%）、Grave’s病（0.43%）、显性甲减（1.34%）、亚临床甲减（16.62%）、甲状腺抗体阳性（16.73%）、甲状腺过氧化物酶抗体阳性（12.96%）、甲状腺球蛋白抗体阳性（10.06%）、甲状腺肿（0.81%）、单个结节（14.85%）、多个结节（14.42%）、甲状腺结节（29.26%）。碘过量是亚临床甲减的危险因素（比值比=1.50， 95%可信区间：1.07～2.10，P<0.05），碘缺乏是多个甲状腺结节的危险因素（比值比=1.45，95%可信区间：1.02～2.05，P<0.05）。两次调查甲亢、甲减、桥本氏甲状腺炎三种甲状腺疾病总患病率分别为6.58%和5.95%，没有明显差异。第二次调查缺乏甲状腺结节的准确数据。
结论: 近年来成都市居民碘营养水平适宜，甲亢、甲减、桥本氏甲状腺炎三种甲状腺疾病患病率保持稳定，甲状腺结节患病率上升。应该继续实施食盐加碘政策并做好监测，同时积极寻找甲状腺结节的病因。
Keywords: Iodine nutrition; Prevalence; Risk factors; Thyroid disorders.
Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).