甲状腺疾病发病趋势碘缺乏学会

1、会计学1甲状腺疾病发病趋势碘缺乏学会甲状腺疾病发病趋势碘缺乏学会第1页/共64页甲状腺、甲状腺激素合成、作用和调节甲状腺、甲状腺激素合成、作用和调节第2页/共64页 碘主要通过肾清除，碘主要通过肾清除， 尿碘反映碘的摄入量尿碘反映碘的摄入量第3页/共64页临床型、亚临床型临床型、亚临床型第4页/共64页第5页/共64页临床型、亚临床型临床型、亚临床型第6页/共64页第7页/共64页第8页/共64页第9页/共64页Endocrine,2012,May,12,online第10页/共64页W:1972-1993: Whickham surviviorsT:1994-2001: TEARS stud

2、ysL1: 1999, LjubljanaL2:2009, LjubljanaEJ:1987-1998, East JutlandDT:1997-2000,DaThyrEndocrine,2012,May,12,online第11页/共64页Wickham study: 1972-1993TEARS: 1993-1996DanTHr study: 1997-2000Endocrine,2012,May,12,online第12页/共64页Endocrine,2012,May,12,online第13页/共64页L1: 1999, LjubljanaL2:2009, LjubljanaM1:19

3、70-1974M2: 1988-1990M3: 2003-2005EJ:1987-1998, DT:1997-2000,A1:1987-1989A2:1993As:1995* M3 vs M2Endocrine,2012,May,12,online第14页/共64页Jamtland, Sweden ,1975-1984;Canterbury, New Zealand,1983-1985;East Jutland, Denmark, 1987-1988The DanThyr Study,1997-2000The Swedish Thyroid study 2003-2005Endocrine,2

4、012,May,12,online第15页/共64页THYROID,2006 (16),第16页/共64页第17页/共64页 CA Cancer J Clin 1980 . CA Cancer J Clin20101980-2010年期间美国甲状腺癌新发人数和死亡人数的变化趋势050001000015000200002500030000350004000045000500001980198519901995200020052010人数人数年份年份 CA Cancer J Clin 1980 . CA Cancer J Clin2010050001000015000200002500030000

5、3500040000450001980198519901995200020052010甲状腺癌新发总人数第18页/共64页Health Rep. 2012 Mar;23(1):7-16.Increases were relatively large for liver and thyroid cancer第19页/共64页Health Rep. 2012 Mar;23(1):7-16.第20页/共64页第21页/共64页第22页/共64页JAMA, May 10, 2006Vol 295, No. 18JAMA, May 10, 2006Vol 295, No. 18第23页/共64页Canc

6、er 15, 2009，3801第24页/共64页1.912.935.767.187.296.4100010203040506070809010070百分比（百分比（%）年龄（岁）年龄（岁）图图: 83-10年北京协和医院确诊的年北京协和医院确诊的2064例例PTC患者的年龄分布患者的年龄分布分布频率分布频率累积频率累积频率第25页/共64页第26页/共64页甲状腺疾病患病率（%）妊娠前半期甲状腺疾病患病率Shan ZY,Chen YY,Teng WP,et al. A study for maternal thyroid hormone deficiency during the first

7、 half of pregnancy in China.Eur J Clin Invest,2009,39:37-42.第27页/共64页Shan ZY, et al. Eur J Clin Invest. 2009;39:37-42.妊娠期TPOAb阳性组的亚临床甲减发病率高妊娠前半期，亚临床甲减中28.86%为TPOAb阳性与对照组相比，均为P0.05*亚临床甲减发病率（%）妊娠周数第28页/共64页第29页/共64页第30页/共64页第31页/共64页Lancet. 1998 Sep 5;352(9130):763-6.第32页/共64页第33页/共64页Prevalence of th

8、yroid ATAs in the contaminated and noncontaminated Belarusian villages. Agate L et al. JCEM 2008;93:2729-27362008 by Endocrine Society第34页/共64页Prevalence of thyroid ATAs in the contaminated and noncontaminated Ukrainian villages. Agate L et al. JCEM 2008;93:2729-27362008 by Endocrine Society第35页/共64

9、页Prevalence of thyroid ATAs in the contaminated and noncontaminated Russian villages. Agate L et al. JCEM 2008;93:2729-27362008 by Endocrine Society第36页/共64页Autoimmune Thyroiditis and Exposure to Iodine 131 inthe Ukrainian Cohort Study of Thyroid Cancer andOther Thyroid Diseases after the Chornobyl

10、Accident:Results from the First Screening Cycle (19982000)暴露组：白俄罗斯、核泄漏时年龄：6M-4岁（1986,4，26）评估时间：核泄漏后12-14年（1998-2000）对照组：意大利和丹麦匹配碘缺乏状态：轻中度第37页/共64页Association between prevalent autoimmune thyroid outcomes and 131I thyroid dose estimates: Ukrainian cohort study ofthyroid cancer and other thyroid disea

11、ses after the Chornobyl accident, 19982000第38页/共64页Association between prevalence of elevated ATPO and 131I thyroid dose estimates according to level of ATPO elevation:Ukrainian cohort study of thyroid cancer and other thyroid diseases following the Chornobyl accident, 19982000第39页/共64页Occupational

12、Exposure to Ionizing Radiation IsAssociated with Autoimmune Thyroid DiseaseThe Journal of Clinical Endocrinology & Metabolism 90(8):45874592第40页/共64页第41页/共64页第42页/共64页Epidemiology. 2009 Mar;20(2):181-7.RESULTS: The number of thyroid cancer cases among women (n = 241) was nearly 5-fold the number

13、 of cases among men (n = 55). Estimated thyroid dose was positively associated with thyroid cancer incidence among women A-bomb survivors (excess relative rate/Gy = 0.70; 90% confidence interval = 0.20-1.46). In contrast, a negative association was observed between thyroid dose and thyroid cancer am

14、ong men (excess relative rate/Gy = -0.25; 0 to 90% confidence interval = 0.35). The association among women was positive for all time-since-exposure periods examined but tended to diminish in magnitude with time-since-exposure.CONCLUSIONS: Exposure to ionizing radiation in adulthood was positively a

15、ssociated with thyroid cancer among women A-bomb survivors, although the risk seems to be lower than for those exposed to radiation in childhood.第43页/共64页第44页/共64页第45页/共64页第46页/共64页第47页/共64页第48页/共64页第49页/共64页第50页/共64页第51页/共64页第52页/共64页第53页/共64页Partial List of Environmental Agents That Interfere with Thyroid Function第54页/共64页Thyroid，2010,12第55页/共64页第56页/共64页T第57页/共64页L1: 1999, LjubljanaL2:2009, LjubljanaM1:1970-1974M2: 1988-1990M3: 2003-2005EJ:1987-1998, DT:1997-2000,A1:1987-1989A2:1993As:1995* M3 vs M2Endocrine,2012,May,12,online第58页/共64页Health Rep. 2012 Mar;23(1):7-16.Increases were rela