碘的神话:碘与甲状腺结节关系的系统回顾和荟萃分析。

IF 5.4 2区 医学 Q1 Medicine
Willy Gräfe, Sandy Scheibe, Josy Schwarz, Lukas Liebig, Karen Voigt, Jeannine Schübel
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引用次数: 0

摘要

背景:碘是合成甲状腺激素必需的微量元素,其在甲状腺健康中的作用已被广泛研究。虽然碘缺乏被认为是甲状腺肿的一个危险因素,但它与甲状腺结节的关系仍然存在争议。本系统综述和荟萃分析的目的是评估碘摄入量与甲状腺结节发展之间的关系。方法:在Medline(通过PubMed)、Cochrane图书馆和指南注册库(AWMF, GIN)中进行系统文献检索,检索2012年至2023年发表的研究。纳入标准侧重于检查碘摄入量与甲状腺结节之间关系的研究。进行了系统回顾,同时使用关键评估技能计划(CASP)的检查清单评估研究质量。对报告基于世卫组织定义的碘类别的优势比的研究进行了荟萃分析。结果:共纳入31项研究。大多数研究(n = 23)是横断面的,限制了因果结论。评估碘摄入量最常用的方法是尿碘浓度(UIC),尽管测量方法各不相同。N = 10项研究比较了有甲状腺结节组和无甲状腺结节组的中位UIC,其中N = 8项研究报告了显著差异。然而,这两组人的碘水平往往保持在世卫组织规定的适足碘范围内。N = 8项研究检查了碘摄入与甲状腺结节风险的比值比,其中N = 5项研究发现碘缺乏(200 μg/L)和碘过量(bb0 ~ 300 μg/L)不一致。N = 3项研究表明碘与甲状腺结节患病率呈u型关系,但荟萃分析结果并未证实这一假设。碘缺乏的合并优势比为1.24 (95% CI [1.16-1.33], I2 = 0.00),而碘摄入过足和过量无显著相关性。结论:本系统综述和荟萃分析表明,碘缺乏会适度增加甲状腺结节发生的风险,而过量和过量的碘摄入并没有显示出一致的影响。然而,研究结果的异质性和横断面设计的优势限制了明确的结论。需要进一步的前瞻性研究来阐明碘摄入与甲状腺结节之间的因果关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The myth of iodine: A systematic review and meta-analysis on the relationship between iodine and thyroid nodule.

Background: Iodine is an essential trace element for thyroid hormone synthesis, and its role in thyroid health has been widely studied. While iodine deficiency is recognized as a risk factor for goiter, its association with thyroid nodules remains controversial. The aim of this systematic review and meta-analysis was to evaluate the relationship between iodine intake and the development of thyroid nodules.

Methods: A systematic literature search was conducted in Medline (via PubMed), the Cochrane Library, and guideline registries (AWMF, GIN) for studies published between 2012 and 2023. Inclusion criteria focused on studies examining the association between iodine intake and thyroid nodule. Systematic review has been conducted whereas study quality was assessed using the checklists of Critical Appraisal Skills Programme (CASP). A meta-analysis was performed for studies reporting odds ratios based on WHO-defined iodine categories.

Results: A total of 31 studies were included. Most studies (n = 23) were cross-sectional, limiting causal conclusions. The most used method for assessing iodine intake was urinary iodine concentration (UIC), though measurement approaches varied. N = 10 studies compared median UIC between groups with and without thyroid nodules, with n = 8 reporting significant differences. However, the iodine levels in both groups often remained within the WHO-defined adequate iodine range. N = 8 studies examined odds ratios for iodine intake and thyroid nodule risk, with n = 5 identifying iodine deficiency (< 100 μg/L) as a significant risk factor. However, results for more than adequate (> 200 μg/L) and excessive iodine intake (> 300 μg/L) were inconsistent. N = 3 studies suggested a U-shaped relationship between iodine and thyroid nodule prevalence, but meta-analysis findings did not confirm this hypothesis. The pooled odds ratio for iodine deficiency was 1.24 (95% CI [1.16-1.33], I2 = 0.00), while more than adequate and excessive iodine intake showed no significant association.

Conclusion: This systematic review and meta-analysis indicate that iodine deficiency increases moderately the risk of developing thyroid nodules, while more than adequate and excessive iodine intake does not show a consistent effect. However, the heterogeneity of study results and the predominance of cross-sectional designs limit definitive conclusions. Further prospective studies are needed to clarify the causal relationship between iodine intake and thyroid nodules.

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来源期刊
Journal of Endocrinological Investigation
Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
8.10
自引率
7.40%
发文量
242
期刊介绍: The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.
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