新疆维吾尔族甲状腺结节患病率及其影响因素研究

摘要

目的 了解新疆维吾尔族甲状腺结节患病率,并探讨其影响因素.方法 于2015年9-12月,采用分层整群随机抽样方法,选取新疆乌鲁木齐市天山区18 ～ 80岁的居民为调查对象.发放流行病学调查表,调查内容包括一般情况、甲状腺疾病史及家族史,饮食及生活习惯;体格检查检测血压、身高、体质量、腰围,计算体质指数(BMI);采集空腹静脉血及晨尿,检测血糖、血脂、尿酸、糖化血红蛋白、尿碘等;采用甲状腺超声检查确诊甲状腺结节.采用单因素及多因素Logistic回归分析甲状腺结节患病的影响因素.结果 纳入l 500例,共1 268例完成调查,实际调查率为84.53％.调查对象甲状腺结节粗患病率为27.21％ (345/1 268),男性粗患病率为20.49％ (118/576),女性粗患病率为32.80％ (227/692).女性甲状腺结节患病率高于男性(x2=24.080,P＜0.01).18 ～29、30 ～39、40 ～49、50 ～59、60 ～ 80岁甲状腺结节患病率分别为14.55％ (55/378)、16.07％ (45/280)、29.93％ (88/294)、45.15％ (93/206)、58.18％ (64/110),随着年龄的增长,甲状腺结节患病率逐渐升高(x2趋势=126.591,P＜0.01).单因素Logistic回归分析结果显示,女性(OR=1.895)、年龄(OR=1.056)、轻度进食盐习惯(OR=1.697)、吸烟史(OR=1.431)、甲状腺功能减退(OR=1.555)、甲状腺肿(OR=6.351)、糖尿病(OR=2.481)、高血压(OR=2.925)、血脂异常(OR=1.928)、BMI为24.0～27.9 kg/m2(OR=1.542)和≥28.0 kg/m2(OR=2.721)、腰围(OR =2.639)、空腹血糖(FPG)(OR=2.645)、口服葡萄糖耐量试验(OGTT)2 h血糖(OR=2.542)、收缩压(OR=3.180)、舒张压(OR =2.928)、三酰甘油(TG) (OR=1.586)、总胆固醇(TC) (OR=1.714)、低密度脂蛋白(LDL)(OR=1.684)、糖化血红蛋白(OR=1.864)、促甲状腺激素(TSH) ＞4.20 mU/L(OR=1.554)、甲状腺过氧化物酶抗体(TPOAb) (OR=1.479)、甲状腺球蛋白抗体(TGAb) (OR=1.581)是甲状腺结节的影响因素(P＜0.05).多因素Logistic回归分析结果显示,性别(OR=2.044)、年龄(OR=1.046)和收缩压(OR=2.638)是甲状腺结节的独立影响因素(P＜0.05).结论 新疆维吾尔族甲状腺结节患病率较高,危险因素较多,尤其是对于女性、高龄、高血压患者,应做到早预防、早诊断、早治疗.%Objective To explore the prevalence rate of thyroid nodules among Uyghur Nationality in Xinjiang and to analyze the influencing factors of thyroid nodules.Methods A stratified cluster sampling method was used to select Uyghur residents aged from 18 to 80 from Tianshan area in Urumqi of Xinjiang as research objects from September to December 2015.Epidemiological survey form was sent out to investigate the general condition,history of thyroid disease and family history,diet and living habits of the subjects.Physical examination was performed to measure blood pressure,height,body mass,and waist circumference and calculate body mass index (BMI).Fasting venous blood and morning urine were collected,blood glucose,blood lipid,uric acid,glycosylated hemoglobin and urinary iodine were measured.Thyroid ultrasonography was applied to make a definite diagnosis of thyroid nodules.Univariate and multivariate Logistic regression were used to analyze the influencing factors of thyroid nodule.Results Among the included 1 500 subjects,1 268 completed the survey and the actual investigation rate was 84.53％.The rough prevalence rate of developing thyroid nodules was 27.21％ (345/1 268) for research objects,20.49％ (118/576) for men and 32.80％ (227/692) for women.The prevalence rate of women developing thyroid nodules was significantly higher than that of men (x2 =24.080,P ＜ 0.01).The prevalence rate of people aged from 18 to 29,30 to 39,40 to 49,50 to 59 and 60 to 80 developing thyroid nodules was 14.55％ (55/378),16.07％ (45/280),29.93％ (88/294),45.15％ (93/206),and 58.18％ (64/110) respectively,it can be seen that the prevalence rate of thyroid nodules gradually increased with age (x2trend =126.591,P ＜0.01).Univariate Logistic regression analysis showed that female (OR =1.895),age (OR =1.056),habit of mild salt intake (OR =1.697),smoking history (OR =1.431),hypothyroidism (OR =1.555),goiter (OR=6.351),diabetes (OR =2.481),hypertension (OR =2.925),hyperlipidemia (OR =1.928),BMI from 24.0 to 27.9 kg/m2 (OR =1.542) and greater than or equal to 28.0 kg/m2 (OR =2.721),waist circumference (OR =2.639),fasting blood glucose (OR =2.645),OGTT 2 h blood glucose (OR =2.542),systolic blood pressure (OR =3.180),diastolic blood pressure (OR =2.928),TG (OR =1.586),TC (OR =1.714),LDL (OR =1.684),glycosylated hemoglobin (OR =1.864),TSH greater than 4.20 mU/L (OR =1.554),TPOAb (OR =1.479),TGAb (OR =1.581) were the influencing factors of thyroid nodules (P ＜ 0.05).Multivariate Logistic regression analysis showed that gender (OR =2.044),age (OR =1.046) and systolic blood pressure (OR =2.638) were the independent risk factors of thyroid nodules (P ＜0.05).Conclusion As the prevalence rate of thyroid nodules among Uyghur Nationalitv in Xinjiang is relatively high,and there are many risk factors of this disease,especially for female,aged and hypertension,we should achieve early prevention,early diagnosis and early treatment.