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目的研究天津市高氟高碘联合对儿童甲状腺功能的影响及作用机制。方法选择天津市静海县和武清区4个乡镇分为高氟组、高氟高碘组及对照组,以本地出生的8~10岁儿童为调查对象,采集晨尿并抽取晨起空腹静脉血,检测尿氟、尿碘;测定血中三碘甲腺原氨酸(T3)、四碘甲腺原氨酸(T4)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)及氧化应激指标丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性和活性氧(ROS)水平。结果高氟高碘组、高氟组和对照组的尿碘中位数分别为721.7、788.3、293.5μg/L,尿氟中位数分别为2.48、2.70、1.59 mg/L,高氟高碘组、高氟组尿碘和尿氟水平均高于对照组(P=0.000);高氟高碘组、高氟组和对照组血清T4均数分别为95.0、86.2和89.2 ng/L,血清甲状腺激素水平除高氟高碘组的血清T4高于高氟组(q=4.0,P<0.05)外,其余4项指标(T3、FT3、FT4、TSH)3组间差异均无统计学意义;高氟高碘组、高氟组和对照组ROS分别为(89.95±63.85)、(76.65±125.45)、(72.83±13.70)U/mL,SOD活性分别为(2.14±5.20)、(2.22±2.50)、(0.79±0.90)酶活力单位,ROS和SOD高氟高碘组均高于高氟组和对照组(P<0.001),3组儿童血清MDA含量差异无统计学意义;尿碘与ROS呈正相关(r=0.226,P=0.026),与SOD呈负相关(r=-0.264,P=0.009)。结论高氟与高碘联合慢性暴露对儿童甲状腺功能产生了一定影响,甲状腺激素水平除T4外无明显差异,氧化应激指标ROS、SOD与尿氟、尿碘关系密切。
Objective To study the effect of high fluoride and iodine combined with iodine on thyroid function in children and its mechanism. Methods Four towns and villages in Jinghai County and Wuqing District of Tianjin were divided into high fluoride group, high fluoride and iodine group and control group. Local children aged 8 to 10 years old were selected as research objects. Morning urine samples were taken and fresh fasting veins Blood was collected to detect urinary fluoride and urinary iodine. Blood levels of triiodothyronine (T3), tetraiodothyronine (T4), thyrotropin (TSH), free triiodothyronine (FT3 ), Free thyroid hormone (FT4) and oxidative stress indicators such as malondialdehyde (MDA) content, superoxide dismutase (SOD) activity and reactive oxygen species (ROS) Results The urinary iodine median of high fluoride group, high fluoride group and control group were 721.7,788.3 and 293.5μg / L respectively, and the urinary fluoride median was 2.48, 2.70 and 1.59 mg / L, respectively. The levels of urinary iodine and urinary fluoride in the high fluoride group were higher than those in the control group (P = 0.000). The mean serum T4 levels of high fluoride group, high fluoride group and control group were 95.0, 86.2 and 89.2 ng / L, respectively Thyroid hormone levels in the high fluoride group were higher than the high fluoride T4 group (P <0.05), and the other four indicators (T3, FT3, FT4, TSH) were no significant difference between the three groups ; ROS in high fluoride group and high fluoride group and control group were (89.95 ± 63.85), (76.65 ± 125.45) and (72.83 ± 13.70) U / mL, SOD activity was (2.14 ± 5.20) and 2.50), (0.79 ± 0.90), ROS and SOD in high fluoride group and high iodine group were significantly higher than those in high fluoride group and control group (P <0.001). There was no significant difference in serum MDA levels between the three groups ROS (r = 0.226, P = 0.026), and had a negative correlation with SOD (r = -0.264, P = 0.009). Conclusion Chronic exposure to high fluoride combined with high iodine has a certain effect on thyroid function in children. There is no significant difference in thyroid hormone levels except T4. The indicators of oxidative stress, ROS and SOD, are closely related to urinary fluoride and urinary iodine.