钞虹, 李喜春, 刘军, 张天阳. 水源性高碘、高氟及高砷环境的学龄儿童尿中碘、氟、砷水平及甲状腺肿患病情况[J]. 环境与职业医学, 2020, 37(7): 685-689. DOI: 10.13213/j.cnki.jeom.2020.20048
引用本文: 钞虹, 李喜春, 刘军, 张天阳. 水源性高碘、高氟及高砷环境的学龄儿童尿中碘、氟、砷水平及甲状腺肿患病情况[J]. 环境与职业医学, 2020, 37(7): 685-689. DOI: 10.13213/j.cnki.jeom.2020.20048
CHAO Hong, LI Xi-chun, LIU Jun, ZHANG Tian-yang. Urinary iodine, fluorine, and arsenic levels and goiter prevalence of school-age children exposed to water-source environment with high iodine, high fluorine, and high arsenic concentrations[J]. Journal of Environmental and Occupational Medicine, 2020, 37(7): 685-689. DOI: 10.13213/j.cnki.jeom.2020.20048
Citation: CHAO Hong, LI Xi-chun, LIU Jun, ZHANG Tian-yang. Urinary iodine, fluorine, and arsenic levels and goiter prevalence of school-age children exposed to water-source environment with high iodine, high fluorine, and high arsenic concentrations[J]. Journal of Environmental and Occupational Medicine, 2020, 37(7): 685-689. DOI: 10.13213/j.cnki.jeom.2020.20048

水源性高碘、高氟及高砷环境的学龄儿童尿中碘、氟、砷水平及甲状腺肿患病情况

Urinary iodine, fluorine, and arsenic levels and goiter prevalence of school-age children exposed to water-source environment with high iodine, high fluorine, and high arsenic concentrations

  • 摘要: 背景

    碘、氟、砷在自然界中的不均匀分布,使得我国某些农村地区出现生物地球化学性疾病。

    目的

    了解水源性高碘、高氟及高砷地区学龄儿童体格发育状况,尿碘、尿氟、尿砷的相关性以及甲状腺肿大的影响因素。

    方法

    采用整群抽样的方法,抽取山西省清徐县3个自然村8~12岁共208名(男101名,女107名)学龄儿童进行身高、体重的现场测量,采用甲状腺B超法进行甲状腺容积和结节的检查,同时采集日间随机尿液进行尿碘、尿氟和尿砷的检测。

    结果

    儿童尿碘中位数为541.85 μg·L-1,尿氟中位数为1.82 mg·L-1,尿砷中位数为0.11 mg·L-1;该地区8~12岁学龄儿童身高、体重、体重指数(BMI)的均数分别为145.74 cm、35.95 kg和16.50 kg·m-2;各年龄组的尿碘含量差异无统计学意义(H尿碘=9.11,P尿碘=0.06),而各年龄组的尿氟含量和尿砷含量差异均有统计学意义(H尿氟=10.97,P尿氟=0.03;H尿砷=11.12,P尿砷=0.03);校正年龄因素进行偏相关分析发现,尿碘与尿氟存在正相关关系(r=0.44,P < 0.001),尿碘与尿砷存在正相关关系(r=0.32,P < 0.001),尿氟与尿砷之间存在正相关关系(r=0.40,P < 0.001)。儿童甲状腺肿大检出率为10.58%;8~12岁各年龄组学龄儿童甲状腺肿大的检出率分别为13.33%、8.33%、14.70%、19.05%和3.84%,差异无统计学意义(χ2=8.42,P=0.06)。B超结果显示高碘甲状腺肿大的类型主要为弥漫型(9.13%)和混合型(1.44%),不存在单纯结节型。多因素logistic回归分析发现,BMI大是甲状腺肿大发生的可疑危险因素,OR值及其95%CI为1.17(1.03~1.33),尿氟含量高是甲状腺肿大发生的可疑危险因素,OR值及其95%CI为2.67(1.72~4.14)。

    结论

    水源性高碘、高氟和高砷的地区,甲状腺肿大的检出率较高,其类型以弥漫型和混合型为主;8~12岁学龄儿童的体格发育基本正常;尿碘与尿氟、尿碘与尿砷、尿氟与尿砷之间存在正相关关系;BMI数值大、尿氟含量高是甲状腺肿大发生的可疑危险因素。

     

    Abstract: Background

    The imbalanced distribution of iodine, fluorine, and arsenic in nature causes biogeochemical diseases in some rural areas of China.

    Objective

    This study investigates the physical development status of school-age children in areas with high iodine, high fluorine, and high arsenic in drinking water, explores the relationships among urinary iodine, urinary fluorine, and urinary arsenic, and analyzes the influencing factors of goiter in this group.

    Methods

    Using cluster sampling, 208 children aged from 8 to 12 years (101 males and 107 females) were selected from three villages in Qingxu County, Shanxi Province. The height and weight of the children were measured on the spot. Thyroid volume and nodules were examined by ultrasound. Meanwhile, random urine samples were collected during the day for the detection of urinary iodine, fluorine, and arsenic levels.

    Results

    In the selected school-age children, the median urinary iodine, fluorine, and arsenic levels were 541.85 μg·L-1, 1.82 mg·L-1, and 0.11mg·L-1, respectively. The mean height, weight, and body mass index (BMI) were 145.74 cm, 35.95kg, and 16.50 kg·m-2, respectively. Except urinary iodine (Hurinary iodine=9.11, Purinary iodine=0.06), there were significant differences in urinary fluorine and arsenic levels among different age groups (Hurinary fluorine=10.97, Purinary fluorine=0.03; Hurinary arsenic=11.12, Purinary arsenic=0.03). Based on the partial correlation analysis adjusting for age, there were positive correlations between urinary iodine and urinary fluorine (r=0.44, P < 0.001), between urinary iodine and urinary arsenic (r=0.32, P < 0.001), and between urinary fluorine and urinary arsenic (r=0.40, P < 0.001). The positive rate of goiter was 10.58% in total participants, and the positive rate of goiter in each age stratum of the children aged 8 to 12 years was 13.33%, 8.33%, 14.70%, 19.05%, and 3.84%, respectively (χ2=8.47, P=0.06). The thyroid ultrasound results showed that the goiters were mainly diffuse type (9.13%) and mixed type (1.44%), and there was no simple nodule type. In the multivariate logistic regression analysis, large BMI (OR=1.17, 95%CI:1.03-1.33) and high urinary fluorine level (OR=2.67, 95% CI:1.72-4.14) were risk factors for positive goiter detection.

    Conclusion

    The positive rate of goiter is high in the study areas with high iodine, high fluorine, and high arsenic in drinking water. Types of goiter are mainly diffuse type and mixed type. The physical development of the school-age children aged from 8 to 12 years is basically normal. There are positive correlations among urinary iodine, urinary fluorine, and urinary arsenic. Large BMI and high urinary fluorine level are suspected risk factors for goiter.

     

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