191. 于林玉, 刘洪亮, 王睿, 曾强, 侯常春, 赵亮, 张磊, 崔玉山, 冯宝佳. 天津市高氟高碘联合对儿童甲状腺功能影响[J]. 中国公共卫生, 2014, 30(2): 212-215.
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Yu Lin-yu, Liu Hong-liang, Wang Rui, et al. - "Joint effects of excessive fluoride and iodine on thyroid function among children in Tianjin" Chinese Journal Of Public Health 30(2): 212-215 (2014)
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、293.5 μg/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 investigate the joint effects of excessive fluoride and iodine on thyroid function among children in Tianjin.Methods According to the concentration of fluoride and iodine in drinking water,four small towns in two counties of Tianjin were classified into three groups of high fluoride and iodine,high fluride,and control.Children aged 8-10 years in the four towns were chosen.The morning urine was collected and venous blood was taken from the children before breakfast.The concentrations of urinary fluoride,urinary iodine,triiodothyronine(T3),thynoxine(T4),thyroid stimulating hormone(TSH),free T3(FT3),and free T4(FT4) in the serum were detected.Maleicdialdehyde(MDA),superoxide dismutase(SOD),and reactive oxygen species(ROS) were also measured.Results The concentration of iodine in the urine of the children from high fluoride and iodine,high fluoride,and control group were 721.7,788.3,and 293.5 μg/L and those of fluoride were 2.48,2.70,and 1.59 mg/L.Significant increases in urinary fluoride and iodine were observed in the children of high fluoride and iodine,and high fluoride groups compared to the control group (F=24.1,P=0.000;F=11.0,P=0.000).The concentrations of T4 in the serum of the children from high fluoride and iodine,high fluoride,and control group were 95.0,86.2,and 89.2 ng/L.Thyroid hormone T4 in the children of high fluoride and iodine group was higher than that of high fluoride group (F=4.0,P=0.021),but there were no significant differences in other thyroid hormone (T3,FT3,FT4 and TSH) among the three groups.The concentration of ROS in the serum of children from high fluoride and iodine,high fluoride, and control group were 89.95± 63.85,76.65±125.45,and 72.83± 13.70 U/ mL,and those of the activity of SOD were 2.14±5.20,2.22±2.50,and 0.79±0.90.ROS in the children of high fluoride and iodine group was higher than that in high fluoride group (χ2=14.9,P=0.001),but the activity of SOD demonstrated an inverse trend(χ2=20.9,P=0.000).The difference in MDA was not statistically significant among the groups (χ2=0.9,P=0.626).The content of urinary iodine had a positive correlation with ROS(r=0.226,P=0.026),and an inverse correlation of urinary iodine with SOD was identified(r=-0.264,P=0.009).Conclusion The exposure of high fluoride combination with iodine has a definite impact on children's thyroid function,but has no significant impact on other thyroid hormone except T4.Oxidative stress indexes such as ROS and SOD are closely related to urinary iodine and fluoride.