Article(id=1325530101630391097, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025269, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1740931200000, receivedDateStr=2025-03-03, revisedDate=1748361600000, revisedDateStr=2025-05-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960603386, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960603386, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960603386, creator=13701087609, updateTime=1793960603386, updator=13701087609, issue=Issue{id=1325530078536553117, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='9', pageStart='1217', pageEnd='1368', issueExtLink='null', onlineDate='null', pubDate='1758729600000', pubDateStr='2025-09-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960597879, creator='13701087609', updateTime=1793960597879, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1252, endPage=1256, ext={EN=ArticleExt(id=1325530101856883514, articleId=1325530101630391097, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Monitoring results on iodine nutrition status of children in water-borne iodine-excess areas of Hebei Province from 2018 to 2023, columnId=1259565862625862592, journalTitle=Chinese Journal of School Health, columnName=Student Nutrition, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the iodine nutrition status of children in water-borne iodine-excess areas in Hebei Province, so as to provide references for scientific prevention and control of water-borne iodine-excess hazards.

Methods

From March to September each year during 2018 to 2023, a cross-sectional survey was conducted in 39 water-borne iodine-excess counties (measured in 2017) from 5 cities (Cangzhou, Hengshui, Xingtai, Handan and Langfang) in Hebei Province. The survey included the detection of iodine content in residents' drinking water, the measurement of thyroid volume in children aged 6-12, the detection of salt iodine and urinary iodine. The iodine nutrition status and water iodine distribution of 6-12 year-old children were evaluated from different perspectives such as years, gender, and age. Kruskal-Wallis H test, Mann-Whitney U test and Chi-square test were used for group comparison.

Results

A total of 38 755 children were surveyed from 2018 to 2023, and 1 270 drinking water samples were tested across the province. The mass volume concentration of iodine in water showed a decreasing trend over the years (Z=-30.87, P < 0.01). Among 38 470 salt samples monitored from children 's home, 24 790 were not non-iodized salt, with a non-iodized salt rate of 64.44%. A total of 31 989 urine samples were collected from children aged 8-10 years, with the median urine iodine was 245.94 μg/L. Comparing the results of urinary iodine in children from different years, the median urinary iodine from 2018 to 2023 were 328.0, 339.3, 267.8, 279.1, 291.3, 186.5 μg/L, respectively, with statistically significant differences (H=4 138.40, P < 0.01). Further pairwise comparisons showed that the median urinary iodine of children in 2023 was lower than in all other years (Z=-51.59 to -11.41, all P < 0.01). Among children aged 6-12 years, 1 150 cases of goiter were detected and the rate of goiter was 3.0%; and the goiter rates in boys and girls were 2.8% and 3.1%, with no significant difference between the sexes (χ2=2.76, P>0.05). There were significant differences in the rate of goiter among different years and ages (χ2=324.02, 191.61, both P < 0.05).

Conclusions

With the progress of water reform in water-borne iodine-excess areas of Hebei Province, children's iodine nutrition has reduced from excessive state to suitable state. It is necessary to continue to expand the coverage of water-based iodine reduction projects, and strengthen the monitoring of iodine nutrition status of key populations in water-borne iodine-excess areas.

, authors=Zhijuan YIN, Lihui JIA, Shenqian TIAN, Xuejie GAO, Ning XU, Dong XU, Jing MA*, authorsList=Zhijuan YIN, Lihui JIA, Shenqian TIAN, Xuejie GAO, Ning XU, Dong XU, Jing MA, authorCompany=null, correspAuthors=Jing MA, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325530102708327227, articleId=1325530101630391097, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=河北省水源性高碘地区2018—2023年儿童碘营养监测结果, columnId=1259565866560119750, journalTitle=中国学校卫生, columnName=学生营养, runingTitle=null, highlight=null, articleAbstract=
目的

了解河北省水源性高碘地区儿童碘营养状况,为科学防治水源性高碘危害提供参考依据。

方法

2018—2023年每年3—9月,对河北省所辖5个市(沧州、衡水、邢台、邯郸、廊坊)39个水源性高碘县(2017年测定)开展横断面调查,调查内容包括居民生活饮用水水碘含量、儿童(6~12岁)甲状腺容积、盐碘和尿碘检测。从不同年份、性别及年龄等角度评价6~12岁儿童碘营养状况及水碘分布情况,组间比较采用Kruskal-Wallis H检验、Mann-Whitney U检验和χ2检验。

结果

2018—2023年共调查38 755名儿童、1 270份生活饮用水水样,水碘质量体积浓度有随年份下降趋势(Z=-30.87,P < 0.01)。共监测儿童家中食盐38 470份,其中未加碘食用盐24 790份,未加碘食盐率为64.44%。采集8~10岁儿童尿样31 989份,尿碘中位数为245.94 μg/L;对不同年份儿童尿碘结果进行比较,2018—2023年儿童尿碘中位数分别为328.0,339.3,267.8,279.1,291.3,186.5 μg/L,差异有统计学意义(H=4 138.40,P < 0.01);经进一步两两比较显示,2023年儿童尿碘中位数低于其他所有年份(Z=-51.59~-11.41,P值均 < 0.01)。6~12岁儿童检出甲状腺肿大1 150例,甲状腺肿大率为3.0%;其中男、女童甲状腺肿大率分别为2.8%,3.1%,差异无统计学意义(χ2=2.76,P>0.05);不同年份、年龄间儿童甲状腺肿大率差异均有统计学意义(χ2值分别为324.02,191.61,P值均 < 0.05)。

结论

随着改水进程推进,河北省水源性高碘地区儿童碘营养从过量状态降低到适宜状态。应继续扩大改水降碘工程覆盖面,加强对水源性高碘地区重点人群的碘营养状况监测。

, authors=尹志娟, 贾丽辉, 田慎谦, 高雪洁, 徐宁, 徐栋, 马景*, authorsList=尹志娟, 贾丽辉, 田慎谦, 高雪洁, 徐宁, 徐栋, 马景, authorCompany=null, correspAuthors=马景, authorNote=

尹志娟(1987-),女,山西省人,硕士,副主任医师,主要从事地方病防治工作

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马景,E-mail:
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尹志娟(1987-),女,山西省人,硕士,副主任医师,主要从事地方病防治工作

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尹志娟(1987-),女,山西省人,硕士,副主任医师,主要从事地方病防治工作

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Monitoring results of water iodine in water-borne iodine-excess counties of Hebei Province from 2018 to 2023

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年份份数中位数/(μg·L-1)范围/(μg·L-1)频数分布
< 40 μg/L40~100 μg/L>100~300 μg/L>300 μg/L
2018167163.955.53~930.823(1.80)21(12.57)112(67.07)31(18.56)
2019180155.258.05~1 018.609(5.00)21(11.67)115(63.89)35(19.44)
2020174114.050.05~482.4839(22.41)37(21.26)82(47.13)16(9.20)
202124820.350.68~262.80152(61.29)69(27.82)27(10.89)0
202219711.000.05~400.00121(61.42)65(33.00)8(4.06)3(1.52)
202330411.300.00~250.10233(76.64)62(20.39)9(2.96)0
合计1 27065.380.05~1 018.60557(43.86)275(21.65)353(27.80)85(6.69)
), ArticleFig(id=1325530106747442027, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530101630391097, language=CN, label=表1, caption=

河北省水源性高碘县2018—2023年水碘监测结果

, figureFileSmall=null, figureFileBig=null, tableContent=
年份份数中位数/(μg·L-1)范围/(μg·L-1)频数分布
< 40 μg/L40~100 μg/L>100~300 μg/L>300 μg/L
2018167163.955.53~930.823(1.80)21(12.57)112(67.07)31(18.56)
2019180155.258.05~1 018.609(5.00)21(11.67)115(63.89)35(19.44)
2020174114.050.05~482.4839(22.41)37(21.26)82(47.13)16(9.20)
202124820.350.68~262.80152(61.29)69(27.82)27(10.89)0
202219711.000.05~400.00121(61.42)65(33.00)8(4.06)3(1.52)
202330411.300.00~250.10233(76.64)62(20.39)9(2.96)0
合计1 27065.380.05~1 018.60557(43.86)275(21.65)353(27.80)85(6.69)
), ArticleFig(id=1325530106814550892, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530101630391097, language=EN, label=Tab.2, caption=

Comparison of goiter and nodules detection rates in children of different groups in Hebei Province from 2018 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数甲状腺肿大结节
检出人数χ2值检出人数χ2值
性别男19 942564(2.8)2.76160(0.8)0.17
女18 813586(3.1)144(0.8)
年份20186 103305(5.0)324.02**34(0.6)29.02**
20196 833352(5.2)43(0.6)
20206 802176(2.6)52(0.8)
20214 22598(2.3)60(1.4)
20227 07499(1.4)50(0.7)
20237 718120(1.6)65(0.8)
年龄/岁< 82 223131(5.9)191.61**6(0.3)28.33**
89 573378(3.9)68(0.7)
912 254398(3.2)92(0.8)
1010 167181(1.8)76(0.7)
>104 53862(1.4)62(1.4)
), ArticleFig(id=1325530106894242669, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530101630391097, language=CN, label=表2, caption=

河北省2018—2023年不同组别儿童甲状腺肿大及结节检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数甲状腺肿大结节
检出人数χ2值检出人数χ2值
性别男19 942564(2.8)2.76160(0.8)0.17
女18 813586(3.1)144(0.8)
年份20186 103305(5.0)324.02**34(0.6)29.02**
20196 833352(5.2)43(0.6)
20206 802176(2.6)52(0.8)
20214 22598(2.3)60(1.4)
20227 07499(1.4)50(0.7)
20237 718120(1.6)65(0.8)
年龄/岁< 82 223131(5.9)191.61**6(0.3)28.33**
89 573378(3.9)68(0.7)
912 254398(3.2)92(0.8)
1010 167181(1.8)76(0.7)
>104 53862(1.4)62(1.4)
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河北省水源性高碘地区2018—2023年儿童碘营养监测结果
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尹志娟 , 贾丽辉 , 田慎谦 , 高雪洁 , 徐宁 , 徐栋 , 马景 *
中国学校卫生 | 学生营养 2025,46(9): 1252-1256
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中国学校卫生 |学生营养 2025 , 46 (9) : 1252 -1256
河北省水源性高碘地区2018—2023年儿童碘营养监测结果
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尹志娟, 贾丽辉, 田慎谦, 高雪洁, 徐宁, 徐栋, 马景*
作者信息
  • 河北省疾病预防控制中心地方病防治所,石家庄 050021
通讯作者:
马景,E-mail:
作者简介:

尹志娟(1987-),女,山西省人,硕士,副主任医师,主要从事地方病防治工作

Monitoring results on iodine nutrition status of children in water-borne iodine-excess areas of Hebei Province from 2018 to 2023
Zhijuan YIN, Lihui JIA, Shenqian TIAN, Xuejie GAO, Ning XU, Dong XU, Jing MA*
Affiliations
  • Institution for Endemic Disease Prevention and Control, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang 050021, Hebei Province, China
出版时间: 2025-09-25 doi: 10.16835/j.cnki.1000-9817.2025269
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目的

了解河北省水源性高碘地区儿童碘营养状况,为科学防治水源性高碘危害提供参考依据。

方法

2018—2023年每年3—9月,对河北省所辖5个市(沧州、衡水、邢台、邯郸、廊坊)39个水源性高碘县(2017年测定)开展横断面调查,调查内容包括居民生活饮用水水碘含量、儿童(6~12岁)甲状腺容积、盐碘和尿碘检测。从不同年份、性别及年龄等角度评价6~12岁儿童碘营养状况及水碘分布情况,组间比较采用Kruskal-Wallis H检验、Mann-Whitney U检验和χ2检验。

结果

2018—2023年共调查38 755名儿童、1 270份生活饮用水水样,水碘质量体积浓度有随年份下降趋势(Z=-30.87,P < 0.01)。共监测儿童家中食盐38 470份,其中未加碘食用盐24 790份,未加碘食盐率为64.44%。采集8~10岁儿童尿样31 989份,尿碘中位数为245.94 μg/L;对不同年份儿童尿碘结果进行比较,2018—2023年儿童尿碘中位数分别为328.0,339.3,267.8,279.1,291.3,186.5 μg/L,差异有统计学意义(H=4 138.40,P < 0.01);经进一步两两比较显示,2023年儿童尿碘中位数低于其他所有年份(Z=-51.59~-11.41,P值均 < 0.01)。6~12岁儿童检出甲状腺肿大1 150例,甲状腺肿大率为3.0%;其中男、女童甲状腺肿大率分别为2.8%,3.1%,差异无统计学意义(χ2=2.76,P>0.05);不同年份、年龄间儿童甲状腺肿大率差异均有统计学意义(χ2值分别为324.02,191.61,P值均 < 0.05)。

结论

随着改水进程推进,河北省水源性高碘地区儿童碘营养从过量状态降低到适宜状态。应继续扩大改水降碘工程覆盖面,加强对水源性高碘地区重点人群的碘营养状况监测。

碘  /  营养状况  /  人群监测  /  儿童
Objective

To investigate the iodine nutrition status of children in water-borne iodine-excess areas in Hebei Province, so as to provide references for scientific prevention and control of water-borne iodine-excess hazards.

Methods

From March to September each year during 2018 to 2023, a cross-sectional survey was conducted in 39 water-borne iodine-excess counties (measured in 2017) from 5 cities (Cangzhou, Hengshui, Xingtai, Handan and Langfang) in Hebei Province. The survey included the detection of iodine content in residents' drinking water, the measurement of thyroid volume in children aged 6-12, the detection of salt iodine and urinary iodine. The iodine nutrition status and water iodine distribution of 6-12 year-old children were evaluated from different perspectives such as years, gender, and age. Kruskal-Wallis H test, Mann-Whitney U test and Chi-square test were used for group comparison.

Results

A total of 38 755 children were surveyed from 2018 to 2023, and 1 270 drinking water samples were tested across the province. The mass volume concentration of iodine in water showed a decreasing trend over the years (Z=-30.87, P < 0.01). Among 38 470 salt samples monitored from children 's home, 24 790 were not non-iodized salt, with a non-iodized salt rate of 64.44%. A total of 31 989 urine samples were collected from children aged 8-10 years, with the median urine iodine was 245.94 μg/L. Comparing the results of urinary iodine in children from different years, the median urinary iodine from 2018 to 2023 were 328.0, 339.3, 267.8, 279.1, 291.3, 186.5 μg/L, respectively, with statistically significant differences (H=4 138.40, P < 0.01). Further pairwise comparisons showed that the median urinary iodine of children in 2023 was lower than in all other years (Z=-51.59 to -11.41, all P < 0.01). Among children aged 6-12 years, 1 150 cases of goiter were detected and the rate of goiter was 3.0%; and the goiter rates in boys and girls were 2.8% and 3.1%, with no significant difference between the sexes (χ2=2.76, P>0.05). There were significant differences in the rate of goiter among different years and ages (χ2=324.02, 191.61, both P < 0.05).

Conclusions

With the progress of water reform in water-borne iodine-excess areas of Hebei Province, children's iodine nutrition has reduced from excessive state to suitable state. It is necessary to continue to expand the coverage of water-based iodine reduction projects, and strengthen the monitoring of iodine nutrition status of key populations in water-borne iodine-excess areas.

Iodine  /  Nutritional status  /  Population surveillance  /  Child
尹志娟, 贾丽辉, 田慎谦, 高雪洁, 徐宁, 徐栋, 马景. 河北省水源性高碘地区2018—2023年儿童碘营养监测结果. 中国学校卫生, 2025 , 46 (9) : 1252 -1256 . DOI: 10.16835/j.cnki.1000-9817.2025269
Zhijuan YIN, Lihui JIA, Shenqian TIAN, Xuejie GAO, Ning XU, Dong XU, Jing MA. Monitoring results on iodine nutrition status of children in water-borne iodine-excess areas of Hebei Province from 2018 to 2023[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1252 -1256 . DOI: 10.16835/j.cnki.1000-9817.2025269
碘是人体必需微量元素之一,我国从20世纪90年代中期开始推行食盐加碘干预措施,碘营养状况有了明显改善,碘缺乏病逐年减少;到2000年底,我国基本实现了消除碘缺乏病的阶段性目标[1]。但是近年来,高碘问题成为人们日益关注的热点。2018年河北省对高碘地区重新划定,高碘地区主要集中在沧州、衡水、邢台、邯郸、廊坊5市[2]。尿碘含量是反映人体碘营养状况最敏感的指标,而儿童生长发育迅速,需碘量多,是碘相关疾病最敏感的人群之一[3]。为全面了解河北省水源性高碘地区儿童碘营养情况,从不同年份、性别及年龄等角度评价学龄儿童碘营养状况及水碘分布情况,进一步指导高碘地区人群科学补碘,本研究对2018—2023年在新划定的高水碘地区对儿童进行了水源性高碘地区监测工作,现将监测结果报道如下。
于2018—2023年的每年3—9月运用横断面调查,按照“全国水源性高碘地区监测方案(2018版)”[4]和“河北省水源性高碘地区监测方案”[5]的要求,根据2017年河北省居民生活饮用水调查结果,在河北省39个高碘县开展调查工作,采用系统抽样法从每个监测县抽取5个行政村进行调查,如果行政村少于5个,则全部抽取;若行政村为集中供水,调查改水工程运行情况且采集2份末梢水水样测定水碘含量并计算平均值;如果行政村为分散式供水,采用简单随机抽样方法抽取东、南、西、北、中10%的水井,对于少于5个水井的村则全部抽取,测定水碘含量。最终抽取1 270份生活饮用水水样调查。
在每个监测点所在村小学(乡镇中心小学),采用简单随机抽样方法抽取40名、男女各半的8~10岁非寄宿学生,不足40名时,年龄扩大到6~12岁。2018—2023年共调查儿童38 755名;其中男童19 942名,女童18 813名;各年度儿童分别为6 103,6 833,6 802,4 225,7 074,7 718名;各年度男女构成差异无统计学意义(χ2=2.43,P>0.05)。采用半定量试剂滴定检测儿童家中食用盐加碘情况,6年共采集食盐38 470份。本研究通过河北省疾病预防控制中心伦理委员会批准(编号:HeBIRBS-2024-011),调查对象监护人均知情同意。
尿碘水平测定采用《尿中碘的测定第1部分:砷铈催化分光光度法》(WS/T 107.1—2016)[6]。尿碘水平是评价人群碘营养状况和干预措施实施效果的重要指标之一[7-9]。碘营养评价参照2007年世界卫生组织/联合国儿童基金会/国际控制碘缺乏病理事会提出的碘营养状况评价标准[10]以及2018年联合国儿童基金会发布的《食盐加碘项目的监测和人群碘营养的判定指南》[11],儿童尿碘 < 100 μg/L属于碘缺乏,100~299 μg/L为碘适宜,≥300 μg/L为碘过量状态。
水碘采用中国疾病预防控制中心国家碘缺乏病参照实验室推荐的“适合缺碘及高碘地区水碘检测的砷铈催化分光光度方法”在对应的波长下检测[12]。参考《水源性高碘地区和高碘病区的划定》(GB/T 19380—2016)[13]以及《碘缺乏地区和适碘地区的划定》(WS/T 669—2020)[14],水碘中位数 < 40 μg/L为碘缺乏地区,40~100 μg/L为适碘地区,>100 μg/L为高碘地区。
采用B超检测儿童甲状腺容积,其中甲状腺容积采用mL表示大小,甲状腺容积为甲状腺左叶和右叶之和[15];按《地方性甲状腺肿诊断标准》(WS 276—2007)[15]判定甲状腺肿大情况,计算甲状腺肿大率。
由河北省疾病预防控制中心对各市、县级监测人员逐级开展培训与考核,尿样、盐样分开收集和运送。从事甲状腺B超检查的专业人员,培训合格后才能开展甲状腺容积测量工作。尿碘、盐碘检测每年由国家碘缺乏参照实验室认证合格的实验室完成检测工作。
将监测数据录入全国碘缺乏病监测信息管理系统,采用SPSS 20.0软件进行统计分析。尿碘、水碘结果不符合正态分布,用中位数表示;多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验(校正P=0.05/5=0.01);趋势分析采用Mann-Kendall检验。计数资料用频数或构成比表示,采用χ2检验进行组间比较,趋势分析采用趋势性χ2检验。检验水准α=0.05。
2018—2023年全省范围内调查1 270份生活饮用水水样,各年份水碘质量体积浓度差异有统计学意义(H=577.07,P < 0.01)。经非参数检验Mann-Kendall检验,表明随着年份变化,水碘中位数有下降趋势(Z=-30.87,P < 0.01)。见表1。
共监测儿童家中食盐38 470份,其中加碘食盐13 680份,未加碘食盐24 790份,未加碘食盐率为64.44%。2018—2023年未加碘食盐率分别是52.37%(3 173/6 059)、59.95%(4 069/6 787)、69.70%(4 606/6 608)、80.47%(3 400/4 225)、61.30%(4 336/7 073)、67.45%(5 206/7 718),差异有统计学意义(χ2=1 059.75,P < 0.01),趋势性χ2检验显示有随年份增加趋势(χ趋势2=265.51,P < 0.01)。
共采集儿童尿样31 989份,尿碘中位数为245.94 μg/L,其中尿碘中位数<100 μg/L的占8.6%(2 744份);100~<200 μg/L的占30.1%(9 627份);200~<300 μg/L的占23.2%(7 412份);≥300 μg/L的占38.1%(12 206份)。2018—2023年儿童尿碘中位数分别为328.0,339.3,267.8,279.1,291.3,186.5 μg/L,差异有统计学意义(H=4 138.40,P < 0.01)。进一步两两比较显示,2023年儿童尿碘中位数低于其他所有年份(Z=-51.59~-11.41,P值均 < 0.01),且儿童尿碘中位数随着年份有降低趋势(Z=-170.30,P < 0.01)。
共检查儿童38 755名,检出甲状腺肿大1 150例,甲状腺肿大率为3.0%;儿童甲状腺结节检出304例,检出率为0.8%。其中8,9,10岁儿童甲状腺肿大率分别为3.9%,3.2%,1.8%,不同年份、年龄间儿童甲状腺肿大率和结节检出率比较差异均有统计学意义(P值均 < 0.01)。男、女童甲状腺肿大率和结节检出率分别为2.8%,3.1%;0.8%,0.8%,差异均无统计学意义(P值均>0.05)。见表2。
河北省属于水资源严重短缺的省份,为解决北方水资源缺乏问题,我国制定了南水北调计划;南水北调工程为水源性高碘地区引入低碘的南水,与当地高碘地下水或地表水混合,可降低水中碘含量,减少因长期饮用高碘水导致的高碘性甲状腺肿等风险。为巩固地方病防治成果,维护人民群众身体健康,国家卫生健康委员会等十部门联合印发《地方病防治专项三年攻坚行动方案(2018—2020年)》[17],明确开展重点防控措施强化行动等任务,指导地方病防治,助力脱贫攻坚,因此水源性高碘地区2021年改水效果显著。人体碘的摄入来源主要包括水、膳食和加碘食盐。根据相关研究[18],除水源性高碘地区外,碘盐对碘的平均贡献率最高,各类食物次之,食物中海带、紫菜和海鱼贡献较大,最后为饮用水。在水源性高碘地区,饮用水是摄入碘的主要来源[19],随着国家南水北调改水项目推动,河北省高碘地区居民饮水来源显著改变。根据本研究监测结果,水源性高碘地区水碘中位数有逐年下降的趋势,水碘值已降至正常范围;但目前我国水源性高碘地区食用未加碘食盐的政策还未改变,需权衡碘缺乏的风险。2018—2023年监测结果显示水源性高碘地区儿童无碘食盐率偏低,均低于国家标准[16](90%),2018—2021年未加碘盐食用率逐年增高,从2022年开始又有下降趋势;可能的原因是我国2017年开始实施的盐业体制改革,开放盐业供销市场,居民可在市场上自由选购食盐导致河北省水源性高碘地区无碘盐食用率偏低,与河南、山西等地情况类似[20-21]。
本研究监测结果显示,儿童尿碘中位数呈逐年降低趋势,碘营养状况从碘过量状态降低到适宜状态。2018—2019年河北省儿童尿碘中位数分别为328.0,339.3 μg/L(均>300 μg/L),属于碘过量状态。原因可能是抽取的监测村改水工程竣工时间较晚,当年监测的8~12岁儿童饮用改水工程水时间较短。2020—2023年连续4年儿童尿碘中位数在186.5~291.3 μg/L,属于碘适宜状态,可能是改水工程彻底更换水源的原因。
本次监测整体儿童甲状腺肿大率 < 5%,已达到国家规定 < 5%的碘缺乏病控制消除标准要求[22]。本次调查结果显示,不同性别儿童甲状腺容积增大差异无统计学意义,与于林玉等[23-24]研究结果一致。多项尿碘与甲状腺疾病相关性的研究结果显示[25-26],当尿碘水平处于合理范围内时甲状腺疾病发生的概率较低,尿碘低于或高于适宜值可能增加甲状腺疾病患病率。也有研究表明,高地下水碘含量地区的儿童面临碘过量的风险,随着年龄的增长,儿童碘过量的风险增加,男生的风险高于女生[27]。提示为了更好保护儿童健康,应适当调整尿碘含量过高儿童的饮食及生活习惯。
控制水源性高碘危害最根本的措施是改水降碘,下一步河北省要以《健康中国行动(2019—2030年)》[28]为指引,搭上南水北调改水工程便车,更换已建改水工程的高碘水源,彻底解决水源性高碘危害;同时在高碘、适碘、碘缺乏地区有针对性地开展水源性高碘和碘缺乏病健康教育促进活动;持续开展水源性高碘监测,使公众充分了解本地区水碘环境及人群碘营养状况,切实控制高碘危害。
  • 河北省医学科学研究指导性课题(20250987)
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025269
  • 接收时间:2025-03-03
  • 首发时间:2026-11-06
  • 出版时间:2025-09-25
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  • 收稿日期:2025-03-03
  • 修回日期:2025-05-28
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河北省医学科学研究指导性课题(20250987)
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    河北省疾病预防控制中心地方病防治所,石家庄 050021

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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