孔德明;张家秀;
(8-year follow up investigations)Guiyang Medical College etc.

• 1: 贵阳医学院地方性甲状腺肿和克汀病防治研究组
• 2:天津医学院临床内分泌研究所
• 3:贵州省黔东南州、麻江县、凯里县卫生防疫站

摘要(Abstract)：

从1979年起,在贵州省麻江县河坝公社用1/5万加碘盐对地方性甲状腺肿和克汀病进行了八年防治。结果:防治一年时,成人尿碘几何平均值从14.5μg/gcr 上升到117.5μg/gcr;甲状腺24h 吸~(131)I 率从74.3%降至40.6%。防治二年时,甲状腺肿患病率从31.5%降至5.2%。防治三年时,居民甲状腺激素水平和功能恢复正常,克汀病患病率从3.1%降为0。防治五年时,引产胎儿甲状腺形态和功能正常,大脑发育与非病区同龄胎儿相比已无差异。防治八年时,甲状腺患病率降至1.9%,达到根除本病的水平。
Prior to the using of iodized salt in 1979,investigations had been carried out on the etiology,epidemiology,iodine metabolism,pituitary-thyroid axis f unc tion and clinical features of cretinism,and morphologic and functional changes of the thyroid and cerebral cortex of artificial aborted fetuses in Heba commune, Majiang county,Guizhou province.The results were as follows:The goiter rate was 31.5% and the cretinism was 3.1%.The mean value of urinary iodine of adu- its was 14.5μg/g creatinine;64% of the inhabitants surveyed showed the value tess than 25μg/g creatinine.The 24-hr thyroid I uptake rate was 0.74 (74.3%).The T4 value was 83.2±41.6nmol/L(6.4±3.2μg/dl),T31.92±2.3 nmol(127.9±39.3ng/dl)and TSH19.6±18.9mu/L.Analysis of the thyroid fun- ction types showed that decompensated type and compensated type were 9.5% and 49.0% respectively.The incidence of infant hormonal hypothyroidism and cretinism were 53.8% and 20% respectively.The detection rate of hypot- hyroidism of maternal blood,umbilical cord blood and fetal ventricular blood in the endemic region was around 50%,In the endemic region the goiter rate among 30 fetuses was 43.3% and 6—8th month fetuses showed the brain reta rded in development. The effects of prophylaxis with iodized salt(1:50,000)after one year the inhabitant urinary iodine raised to 117.5μg/gcr,and only 2.2% of those were less than 25μg/gcr.The goiter prevalence was 5.2%,two years after prophyla_ xis and further reduced to 1.9% in 1987.It was showed that the complete eradication of iodine deficiency was therefore feasible within eight yaars.Af- ter using iodized salt for three years,the inhabitant thyroid fuction became normal and not a single case of hypothyroidism or cretinism was detected among 51 and 111 infants respectively.After five years of supplement with iodized salt 14 6—8th month fetal brains and the thyroid glands were studied There was no significant difference between the iodine treated endemic fetuses and the nonendemic ones and the hormonal hypothyroidism in both mothers and fetuses in the endemic area returned to normal after correction of iodine lack in the mothers.

关键词(KeyWords)： 地方性甲状腺肿;;克汀病;;碘化钠;;甲状腺激素;;甲状腺机能减退;;贵州
Endemic goiter;;Cretinism;;Iodized Salt;;Thyroid hormones;;Hypothyroidism;;Guizhou

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 孔德明;张家秀;
(8-year follow up investigations)Guiyang Medical College etc.

Email:

参考文献(References)：

• 1． Hou Mingtai(侯明泰),et a.Eie(?)d emic goiter and cretinism in Guizhou.CMJ 1982;95(1) :4-7．
• 2． Shi Zhongfu(时钟孚),et al.Endemic goiter and cretinism in Guizhou clinical analysis of 247 cretins.CMJ 1984;97(9) :689-697．
• 3． Zhu Xianyi(朱宪彝),et al.Studies on endemic goiter anden demic cretinism in Guizhou,observations on iodine metabolism and pituitary thyroid axis functional status.CMJ 1981;94(9) :555-564．
• 4． Liu Jialiu(刘家骝),et al.Morphologic studies of therapeutically aborted fetus thyroid in an endemic goiter region of Guizhou province.CMJ 1982;95(5) :347-354．
• 5． Liu Jialiu(刘家骝),et al.Morphologic study on cerebral cortex development in therapeutically aborted fetuses in an endemic goiter region in Guizhou.CMJ.1984;97(1) :67-72．
• 6． 时钟孚,等.地方性甲状腺肿食盐加碘五年对胎儿垂体-甲状腺功能的影响.中华内科杂志 1985;24(9) :520-522．
• 7． 中共中央地方病办公室.《地方性甲状 腺肿防治工作标准》(试行).中华预防医学杂志 1978;12(1) :62．
• 8． 地方性甲状腺肿和地方性克汀病学术会议。地方性甲状腺肿防治工作标准和地方性克汀病诊断标准.地甲肿和克汀病学术讨论汇编 1980:384～387。
• 9． 贵阳医学院地方性甲状腺肿和地方性克汀病防治研究组,等.贵州省东南部地区30例地方性克汀病甲状腺扫描及 r 照相的检查报告.中华医学杂志 1980;60(12) :733～735．
• 10． 贵阳医学院地方性甲状腺肿和地方性克汀病防治研究组,等.婴儿期地方性克汀病和甲状腺功能低下早期诊断的初步探讨.中华医学杂志 1980;60(12) :724～726．
• 11． 朱宪彝,等.贵州省地甲肿流行区孕妇脐带血及胎儿血清 T_3、 T_4和 TSH 含量观察。中国地方病学杂志 1985;2(1) :16．
• 12． 唐培兰,等.贵州省东南部地方性克汀病人碘盐防治五年后甲状腺显像结果.中华核医学杂志 1987;7(2) :81．
• 13． 刘家骝,等.地方性甲状腺肿和克汀病病区加碘食盐防治五年后胎儿甲状腺、脑及骨的研究.中华病理学杂志 1986;15(4) :217～273。
• 14． Hetzel BS.Iodine deficiency and their eradication.Lancet 1983;11(8359) :1126．
• 15． Standury JB,et al.Endemic goiter and cretinism.New York:John Wiley and Sons,1980:477．
• 16． 卢倜章,等.承德地区地方性克汀病的临床规察.天津医药杂志 1965;7(1) :1～8．
• 17． 贵阳医学院地方性甲状腺肿和地方性克汀病防治研究组,等.应用食盐加碘三 年防治婴儿甲状腺功能低下的效果观察,中华医学杂志 1984;64(6) :345．
• 18． Thilly CH,et al.Fetal hypothyroidism of endemic cretinism.in:Dana Jt.Medeiros Note GS,eds.Endemic goiter and cretinism: Continuing threats to world health Washington:PAHO,1974:125．
• 19． 马泰,等.地方性甲状腺肿与地方性克汀病.北京:人民卫生出版社,1981:105．

文章评论(Comment)：