摘要
目的探讨不同发育变化模式对不同性别、不同时期儿童甲状腺容积增大趋势的影响以及女性青春发育启动是否存在协同效应,为降低成年后甲状腺异常的风险提供理论依据。方法采用分阶段整群抽样方法,分别在上海市闵行区、江苏省海门市、浙江省玉环市各选定1所小学,将所有8~10岁儿童共784名纳入"8~10岁学龄儿童队列";同时,分别在上述3地各选定1所初中,将所有11~13岁初一年级女生共491名纳入"11~13岁青春期女童队列"。基线及1年后随访时,采用B超法测定儿童甲状腺容积,测量身高、体重、腰围(WC)等体格发育指标,收集清晨随机尿样并检测其中尿碘含量。计算体质量指数(BMI)、腰围及甲状腺容积(V)等指标的变化。根据BMI和WC的变化高低(差值d),将研究对象归为"BLWL(BMI低、WC低)""BLWH(dBMI低、dWC高)""BHWL(dBMI高、dWC低)"及"BHWH(dBMI高、dWC高)"4类发育变化模式。结果经偏相关分析,基线或随访时甲状腺容积大小和BMI,WC均有较强关联(P值均<0.05);8~10岁男生组中甲状腺容积变化与BMI及WC变化均有关(P值均<0.05),8~10岁女生组中甲状腺容积变化仅与WC变化有关(P=0.03),11~13岁女生组中未发现关联(P>0.05)。经多因素Logistic回归分析,在不同模型中校正基线年龄、地区、尿碘差值等变量后,8~10岁男生中BHWH类儿童甲状腺容积增大的可能性是BLWL的2.70(95%CI=1.29~5.66)倍;11~13岁女生中,BLWH,BHWL及BHWH类研究对象甲状腺容积增大的风险分别是BLWL的2.46(95%CI=1.31~4.61)、2.16(95%CI=1.15~4.03)及1.79(95%CI=1.07~2.99)倍;初潮年龄及发育变化模式对甲状腺容积变化趋势的影响无交互作用(P=0.49)。结论儿童青少年甲状腺容积随体格发育的进展而增大,不同发育变化模式对于甲状腺形态变化有影响。要避免儿童期的肥胖(尤为关注中心性肥胖),及时识别并有效干预甲状腺形态异常,以降低成年期甲状腺疾病发生的风险。
Objective To investigate the effects of different developmental patterns on the increases of thyroid volume in children from different genders and periods, and to explore whether there is a synergistic effect on the initiation of puberty in girls, so as to provide a theoretical basis for reducing the risk of thyroid abnormalities in adulthood. Methods A multi-stage cluster sampling was used to select a primary school in Minhang District of Shanghai, Haimen City of Jiangsu Province and Yuhuan city of Zhejiang Province. A total of 784 children aged 8-10 years old were included in "8-10 years school-aged children cohort". At the same time, a total of 491 girls aged 11-13 years were included in the "11-13 years adolescent girls cohort". The content of survey on follow-up was consistent with the one on baseline. B-ultrasonography was used to measure thyroid volume. The physical development indexes such as height(H), weight(W) and waist circumference(WC) were measured. The morning urine samples were collected and the urinary iodine content was detected. The changes of body mass index(BMI), waist circumference(WC), and thyroid volume(V) were calculated(dBMI, dWC, and dV, respectively). According to the changes of BMI and WC, the subjects were classified into four types of developmental changes, namely "BLWL(low dBMI, low dWC)" "BLWH(low dBMI, high dWC)" "BHWL(high dBMI, low dWC)" and "BHWH(high dBMI, high dWC)". Results In partial correlation analysis, thyroid volume was significantly correlated with BMI and WC at baseline or follow-up(P<0.05). The changes of thyroid volume in 8-10 years old boys were related to the changes of BMI and WC(P<0.05), the changes of thyroid volume in 8-10 year old girls were only associated with the changes of WC(P=0.03), and no association was found in 11-13 year old girls(P>0.05). In multivariate logistic regression analysis, after adjusting for baseline age, region, and differences of urinary iodine, the risk of thyroid volume increasing in BHWH was 2.70 times(95%CI=1.29-5.66) higher than that of BLWL in boys aged 8-10 years;among girls aged 11-13 years, the risk of thyroid volume increasing in BLWH, BHWL and BHWH were 2.46 times(95%CI=1.31-4.61), 2.16 times(95%CI=1.15-4.03) and 1.79 times(95%CI=1.07-2.99), respectively;there was no interaction between menarche age and developmental pattern on thyroid volume change trend(P=0.49). Conclusion The thyroid volume in children and adolescents increases with the development of physical development. Different developmental patterns and estrogens have certain effects on thyroid morphological changes. To avoid obesity in childhood(especially with central obesity), timely identify and effectively intervene thyroid morphological abnormalities in childhood,and to reduce the risk of thyroid diseases in adulthood.
作者
王莹莹
徐芊
徐东丽
董晓莲
苏美芳
钱俊华
江峰
付朝伟
王娜
姜庆五
WANG Yingying;XU Qian;XU Dongli;DONG Xiaolian;SU Meifang;QIAN Junhua;JIANG Feng;FU Chaowe;WANG Na;JIANG Qingwu(Key Laboratory of Public Health Safety of Ministry of Education,Department of Epidemiology,School of Public Health,Fudan University,Shanghai(200032),China)
出处
《中国学校卫生》
CAS
北大核心
2019年第10期1521-1525,共5页
Chinese Journal of School Health
基金
上海市公共卫生三年行动计划慢病重点学科项目(15GW ZK0801)
国家自然科学基金(81602806)
关键词
生长和发育
甲状腺
青春期
学生
Growth and development
Thyroid gland
Puberty
Students
作者简介
王莹莹(1993-),女,江苏南京人,在读硕士,主要研究方向为慢性非传染性疾病;通讯作者:王娜,E-mail:na.wang@fudan.edu.cn。
