2009 - Effects of High F- and I on DF & Goiter

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2009 - Effects of High F- and I on DF & Goiter

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115. 巴月, 任丽君, 银功举, 程学敏, 余波, 李世宏, 吉晓梅, 张丽丽, and 崔留欣. "饮水氟碘浓度对儿童氟斑牙及甲状腺功能影响." 中国公共卫生 25, no. 8 (2009): 942-943
http://www.zgggws.com/CN/abstract/abstract12030.shtml
http://222.198.130.40:81/Qikan/Article/ ... d=31169075

Ba Yue, Ren Li-jun, Yin Gong-ju - "Effect of different fluoride and iodine concentration in drinking water on children’s dental fluorosis and thyroid function" Chinese Journal of Public Health 25(8): 942-943 (2009)

73 = HF/HI - 3.1 mg/L (F-) and 291.3 μg∕L (I)
71 = HF/NI = - 1.8 mg/L (F-) and 91.8 μg/L (I)
36 = NF/HI = <1 mg/L (F-) and 351.1 ug/L (I)
60 = NF/NI - Control - <1 mg/L (F-) and 76.3 μg/L (I)

73= High Fluoride/High Iodine - FT3 4.51...FT4 13.....TSH 1.81...FT3/FT4 Ratio: 3.4
71= High Fluoride/Normal Iodine - FT3 5.73...FT4 7.40...TSH 1.03...FT3/FT4 Ratio: 7.74
36= High Iodine/ F < 1 ppm - FT3 3.34...FT4 6.66...TSH 2.16...FT3/FT4 Ratio: 5.0
60= Normal Iodine/ F < 1 ppm - FT3 4.60...FT4 8.07...TSH 1.10...FT3/FT4 Ratio: 5.7

In high fluoride/normal iodine areas (1.8 ppm), FT4 is reduced while FT3 is increased - compared to control. (-->D1 deiodination )
In high fluoride/high iodine areas, FT4 is greatly increased, while FT3 remains same - compared to control. (-->D1/D3 deiodination --> increase in rT3)
In high iodine areas - TSH increased, in high fluoride/high iodine area - slightly reduced compared to high iodine area, but higher than control

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目的 研究饮水中不同氟碘浓度对儿童氟斑牙及甲状腺功能的影响。方法 选择河南省开封、通许2个县的4个村庄分别为饮水高氟区、高氟高碘区、高碘区及对照区;以本地出生的8~12岁儿童为调查对象。检查各调查点儿童氟斑牙及甲状腺肿患病率,并采用放射免疫分析法测定血清中游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)。结果 儿童甲状腺肿大率分别为:高氟碘组19.2%,高碘组19.4%、高氟组12.7%、对照组8.3%,差异无统计学意义(P>0.05);儿童氟斑牙患病率分别为:高氟高碘组49.3%、高氟组46.5%,明显高于高碘组和对照组(P<0.05);2个氟病区氟斑牙患病率差异无统计学意义(P>0.05);4个调查点血清中FT3水平比较差异无统计学意义(P>0.05);高氟高碘组儿童血清FT4水平高于其余3组,差异有统计学意义(P<0.05);高氟高碘及高碘组儿童血清TSH水平高于高氟组和对照组,差异有统计学意义(P<0.05)。结论 高碘及高氟高碘均可加重甲状腺肿的发病率;氟、碘对FT3的分泌影响不大;高碘促进TSH的分泌;高碘条件下,氟可促进FT4分泌

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目的 研究饮水中不同氟碘浓度对儿童氟斑牙及甲状腺功能的影响。方法 选择河南省开封、通许2个县的4个村庄分别为饮水高氟区、高氟高碘区、高碘区及对照区;以本地出生的8~12岁儿童为调查对象。检查各调查点儿童氟斑牙及甲状腺肿患病率,并采用放射免疫分析法测定血清中游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)。结果 儿童甲状腺肿大率分别为:高氟碘组19.2%,高碘组19.4%、高氟组12.7%、对照组8.3%,差异无统计学意义(P>0.05);儿童氟斑牙患病率分别为:高氟高碘组 49.3%、高氟组46.5%,明显高于高碘组和对照组(P<0.05);2个氟病区氟斑牙患病率差异无统计学意义(P>0.05);4个调查点血清中 FT3水平比较差异无统计学意义(P>0.05);高氟高碘组儿童血清FT4水平高于其余3组,差异有统计学意义(P<0.05);高氟高碘及高碘组儿童血清TSH水平高于高氟组和对照组,差异有统计学意义(P<0.05)。结论 高碘及高氟高碘均可加重甲状腺肿的发病率;氟、碘对FT3的分泌影响不大;高碘促进TSH的分泌;高碘条件下,氟可促进FT4分泌。

【关键词】 氟;碘;氟斑牙;甲状腺;儿童;饮水

Effect of different fluoride and iodine concentration in drinking water on childrens dental fluorosis and thyroid function BA Yue,REN Lijun,YIN Gongju,et al.Department of Environment Health,School of Public Health,Zhengzhou University(Zhengzhou 450001,China)

  Abstract: Objective To investigate the effect of different concentrations of fluoride and iodine in drinking water on childrens dental fluorosis and thyroid function.Methods According to different concentration of fluoride and iodine in drinking water,four villages in two counties of Henan provine were classified as high fluoride and iodine,high fluoride,high iodine,and control area.Children who were born and grew in the four araeas were chosen for dental fluorosis examination with Deans method.The prevalence rate of the goiter,and the concentrations of FT3,FT4 and TSH in serum were detected with radioimmunoassay method among the children.Results The prevalence of goiter in children from high fluoride and iodine,high fluoride,high iodine and control areas were 19.2%,12.7%,19.4%,and 8.3%,respectively.There was no significant difference in goiter prevalence among the four groups (P>0.05).The prevalences of dental fluorosis were 49.4% and 46.5% in the children lived in high fluoride and iodine area and high fluoride area,rsepectively.No dental fluorlsis case was found in high iodine and control area.There was no significant difference in the concentration of serum FT3 among the children from the four areas (P<0.05).The content ratios of serum FT4 and TSH in children from high fluoride and iodine area were higher than that of in the children from the other three areas (P<0.05).There were no significant diffeience in serum FT4 between the children from high fluoride area,high iodine area and control area (P>0.05).The concentration of serum TSH of children from high fluoride and iodine area and high iodine area was higher than that of children from high fluoride area and control area.Conclusion High fluoride and iodine increase the prevalence of goiter.High iodine increases thd concentration of FT4.Fluoride can increase the concentration of FT4 under high iodine condition.

  Key words:fluoride;iodine;fluorosis;thyroid;children;drinking water

  由于特殊的地理环境,中国很多地区不是单一元素分布不均,而是外环境多种元素水平过高、过低并存。因此,20世纪90年代以来,多元素间联合生物学效应已成为研究热点。有文献报道〔1-2〕,氟、碘2种致病因素同时存在对儿童智力及甲状腺功能有一定影响。同时,动物实验发现,碘可拮抗氟对小鼠门齿和骨骼的毒性作用〔3〕。但是在饮水高氟高碘同时存在条件下,对儿童氟斑牙及甲状腺功能的影响报道较少。本研究于2005-2006年对河南省开封、通许县不同水氟、水碘浓度的4个村庄8~12岁儿童进行了氟斑牙及甲状腺功能检测。现报告如下。

  1 对象与方法

  1.1 对象 以河南省开封、通许县各2个村庄作为调查点。选择平均水碘浓度为291.3 mg/L、平均水氟浓度为3.9 mg/L的开封县某村为高氟高碘区;选择平均水碘浓度为351.1 μg/L、平均水氟浓度<1.0 mg/L的该县另一个村作为单纯高碘区;选择平均水碘浓度为91.8 μg/L、平均水氟浓度为1.8 mg/L的通许县某村为单纯高氟区;选择平均水碘浓度76.3 μg/L、平均水氟浓度<1.0 μg/L的该县另一村作为对照区。各调查点经济水平、人口结构及生活习惯基本一致。同时选择4个调查点本地出生成长的8~12岁儿童进行健康体检。排除肝、肾功能异常及接受氟化物或碘化物治疗,以及患有影响钙磷代谢疾病和近期服用补钙制剂的儿童。其中高氟高碘区儿童73人,男35人,女38人,平均年龄10.03岁;高氟区儿童71人,男39人,女32人,平均年龄9.54岁;高碘区儿童36人,男19人,女17人,平均年龄9.62岁;对照区儿童60人,男33人,女27人,平均年龄9.94岁;各调查点儿童年龄、性别比较,差异无统计学意义(P>0.05)。

  1.2 材料与方法

  1.2.1 血清指标检测 采集调查对象空腹静脉血用于各指标检测。血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)采用放射免疫法测定。试剂盒(北京科美东雅生物技术有限公司),FT3批号为060225、FT4批号为060425、TSH批号为060225。GC-400γ放射免疫计数器(科大创新股份有限公司中佳分公司)。

  1.2.2 儿童甲状腺肿检查 按照《GB16004-1995》中甲状腺肿大的诊断分度标准〔4〕。

  1.2.3 儿童氟斑牙检查 按照Dean氏分度法〔5〕。斑釉齿指数计算公式为:斑釉齿指数=

  (可疑人数×1/2+极轻×1+轻度×2+中度×3+重度×4)被检查总例数1.3 统计分析 采用SPSS12.0软件进行分析。计数资料应用χ2检验;各组数据以±s表示,非正态分布计量资料排秩后进行非参数检验;不同地区儿童血清学指标比较选用单因素方差分析(ANOVA)。均以α=0.05为检验水准。

  2 结 果

  2.1 不同地区儿童氟斑牙患病情况 调查结果显示,高氟高碘区儿童氟斑牙患病率为49.3%(36/73),氟斑牙指数为1.056;单纯高氟区氟斑牙患病率为46.5%(33/71),氟斑牙指数为1.240,2区氟斑牙患病率差异无统计学意义(P>0.05);单纯高碘区及对照区未检出氟斑牙患者。

  2.2 不同地区儿童甲状腺肿大情况比较(表1) 由表1可见,4个地区儿童甲状腺肿大率的差异无统计学意义(P>0.05)。表1 不同地区儿童甲状腺肿患病率的比较注: χ 2=10.589,P=0.305。

  2.3 不同地区儿童FT3、FT4、TSH水平比较(表2) 血清FT4、TSH为非正态分布,故对其进行非参数检验。由表2可见,不同地区儿童血清FT3水平差异无统计学意义(P>0.05)。不同地区儿童血清FT4及TSH水平差异有统计学意义(P<0.05);对不同地区进行两两比较发现,高氟高碘组儿童血清FT4高于其他3组(P<0.05);其他各组血清FT4水平差异无统计学意义(P>0.05)。高氟高碘及高碘组TSH水平高于其余2组(P<0.05),高氟高碘和高碘组之间,以及高氟组与对照组之间差异无统计学意义(P>0.05)。表2 不同地区儿童血清中FT3、FT4、TSH 测定结果注:F=10.589,P=0.07。 χ2=12.851,a P=0.002; χ2=30.151,b P=0.000。

  3 讨 论

  本次研究显示,高碘对氟病区儿童氟斑牙的患病率无影响,但值得注意的是,本次调查高氟高碘组水氟浓度明显高于单纯高氟组,而该组氟斑牙指数却小于单纯高氟组,说明碘在一定程度上可减轻氟斑牙的严重程度,与Zhao W等对小鼠的研究结果一致〔3〕。

  调查结果显示,尽管儿童甲状腺肿大率在所选4个调查点差异无统计学意义(P>0.05),但高氟高碘组(19.2%)和高碘组(19.4%)儿童甲状腺肿大率均高于全国平均水平(10%),提示饮水高碘可加重甲状腺肿流行;单纯高氟对甲状腺肿的影响不明显,表明高氟高碘组甲状腺肿大主要是碘的作用,与文献结果一致〔2-3,6〕。

  本次实验结果显示,血清FT3水平在不同地区儿童中差异无统计学意义,表明在本次调查水碘、水氟浓度下,血清中FT3水平未受到明显影响,与郭怀兰等研究结果一致〔7〕。研究认为氟可降低FT4分泌,增加TSH分泌〔3,8〕,但这些研究大多是在碘缺乏或正常时的检测结果,而在高氟高碘同时存在时,氟对这2种激素分泌的影响结果则不尽相同。本次研究结果显示,高氟高碘组儿童血清中FT4水平高于其余3组,说明氟可促进FT4分泌,与HaraK等研究结果基本一致〔9〕。此外,本次研究还发现,高氟高碘组与单纯高碘组血清中TSH水平没有差别,但2组儿童血清TSH水平均高于单纯高氟和氟碘正常组,表明TSH的升高主要是由于高碘所致。与文献报道的氟可增加TSH分泌结果不尽一致〔8〕。

  综上所述,在饮水高氟高碘同时存在时,儿童甲状腺肿大有增高趋势,儿童血清FT4分泌增加。

【参考文献】
 〔1〕 许晓路,章子贵,申秀英.氟与碘对脑功能影响的研究进展[J].中国公共卫生,2003,19(1):99-100.

  〔2〕 邹焰,王建华,陈伟,等.氟、钙与碘对甲状腺重量和功能的交互作用观察[J].中国地方病防治杂志,2008,23(4):257-260.

  〔3〕 Zhao W,Zhu H,Yu Z,et al.Longterm effects of various iodine and fluorine doses on the thyroid and fluorosis in mice[J].Endocrine regulations,1998,32(2):63-70.

  〔4〕 钱明,陈祖培,聂秀玲,等.碘过量对8~10岁学生智力发育的影响[J].中国公共卫生,2005,21(9):1064-1065.

  〔5〕 Dean HT.Classification of mottled enamel diagnosis[J].Am Dent Assoc,1934,21:1421-1426.

  〔6〕 桑仲娜,张万起,董作亮,等.不同碘摄入水平与人群甲状腺疾病关系[J].中国公共卫生,2008,24(8):952-954.

  〔7〕 郭怀兰,侯晓晖,杨雪锋,等.高碘对仔鼠脑甲状腺激素的影响及硒的干预作用[J].卫生研究,2006,35(2):194-196.

  〔8〕 国秀娟,单忠娟,滕卫平.氟过量与碘氟过量对甲状腺功能和形态影响的实验研究[J].中华内科杂志,2006,45(10):846-847.

  〔9〕 Hara K.Studies on fluorosis,especially effects of fluoride on thyroid metablism[J].Shikouk Eisei Gakkai Zasshi,1980,30(1):42-57.
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Objective To study the effects of different fluoride and iodine concentrations in drinking water on dental fluorosis and thyroid function in children. Methods Four villages in Kaifeng and Tongxu counties in Henan Province were selected as drinking water high fluoride area, high fluoride and high iodine area, high iodine area and Control area; local-born children aged 8-12 were selected as the survey objects. The prevalence rates of dental fluorosis and goiter in children at each survey site were examined, and serum free triiodothyronine (FT3) was determined by radioimmunoassay. , free thyroxine (FT4) and thyroid-stimulating hormone (TSH). Results The goiter rates of children were: 19.2% in the high fluoride iodine group, 19.4% in the high iodine group, 12.7% in the high fluoride group, and 8.3% in the control group, with no difference. Statistical significance (P>0.05); the prevalence of dental fluorosis in children were: high fluoride and high iodine group 49.3%, high fluoride group 46.5%, significantly higher than high iodine group and control group (P<0.05); 2 There was no significant difference in the prevalence of dental fluorosis in the fluorosis area (P>0.05); there was no significant difference in serum FT3 levels among the four survey sites (P>0.05); the serum FT4 levels in children in the high fluoride and high iodine group were higher In the other three groups, the difference was statistically significant (P<0.05). The serum TSH levels in the high-fluoride and high-iodine groups were higher than those in the high-fluoride group and the control group, and the difference was statistically significant (P<0.05). Conclusion Both iodine and high fluoride and high iodine can aggravate the incidence of goiter; fluorine and iodine have little effect on the secretion of FT3; high iodine promotes the secretion of TSH; under high iodine conditions, fluorine can promote the secretion of FT4 .
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