Abstract: Objective　To investigate the detection rate of nodular goiter and the influencing factors for nodular goiter in Xiangshan county.Methods　Used the multi-stage cluster random sampling in 2013,5 towns were sampled from 17 towns in Xiangshan county;2 villages were sampled from those 5 towns respectively,hence 10 villages were sampled in total.The population was divided by topographical features into 4 groups:town group,mountain group,plain group and island group.Residents older than 18 years old and resided in Xiangshan county longer than 6 months were enrolled in this study.The people included were examined if they suffered from thyroid nodules by color Doppler ultrasonography.The patients diagnosed with nodular goiter were arranged into case group;the same amount of people without nodular goiter diagnosed by B-ultrasonography in the same townships and villages were arranged into control group;the two groups matched in gender,age（±3） and region,and the match ratio was 1∶1.The research objects included were surveyed with questionnaire about influencing factors such as occupational exposure history,personality and psychology,lifestyle,diet and medical history.The data was analyzed by univariate and multivariate Logistic regression method.Results　1 220 cases were screened and 510 patients were diagnosed with nodular goiter,with detection rate of 41.80%.There wassignificant difference in the detection rate of nodular goiter for people lived in different areas（χ2=5.43，P<0.05）.The detection rate of nodular goiter in town group was higher than that in mountain group（χ2=39.54，P<0.007）.The detection rate of nodular goiter in female was higher than that in male〔47.91%（298/622）vs.35.45%（212/598），χ2=18.94，P<0.01〕.The results of multivariate Logistic regression model analysis indicated that the independent influencing factors of nodular goiter included being female〔OR=2.33，95%CI（1.59,4.12）〕,working in knitting textile〔OR=2.31，95%CI（1.89,4.52）〕,die casting〔OR=2.58，95%CI（1.52,4.85）〕,long-term depression〔OR=2.11，95%CI（1.28,3.22）〕,consumption of marine products〔OR=2.35，95%CI（1.04,4.44）〕,X ray examination〔OR=3.54，95%CI（2.17,5.88）〕,CT examination〔OR=2.14，95%CI（1.85,3.98）〕（P<0.05）.Conclusion　The detection rate of nodular goiter in Xiangshan county is 41.80%.Necessary occupational protection for special type of work,keeping a happy mood,rational diet,avoiding unnecessary X ray and CT examinations,and taking precautionary measures in advance for people in cities & towns and females are important manners to prevent nodular goiter.

Key words: Goiter,nodular, Ultrasonography,Doppler,color, Root cause analysis, Case-control studies

摘要： 目的　调查浙江省象山县结节性甲状腺肿的检出率及其影响因素。方法　2013年度采用多阶段整群随机抽样方法，从象山县17个乡镇中，抽取5个乡镇，每个乡镇抽取2个自然村，共10个自然村。再按自然村的地貌，将人群划归为城镇、山区、平原和海岛人群。将每个自然村中>18周岁的象山县户籍常住人口纳为调查对象。使用彩色多普勒超声诊断仪检测调查人群甲状腺。将确诊的甲状腺结节患者纳入病例组；以性别、年龄（±3）岁、地区等因素进行1∶1匹配，选取相同数量同乡镇、同村甲状腺B超检查阴性者作为对照组。进行问卷调查，调查内容包括：职业接触史、性格及心理因素、生活方式、食物特点、医疗史。采用单因素及多因素Logistic回归分析方法分析结节性甲状腺肿的影响因素。结果　共筛查样本人群1 220例，甲状腺彩色多普勒超声检查检出结节性甲状腺肿患者510例，结节性甲状腺肿检出率为41.80%。不同地区人群结节性甲状腺肿检出率比较，差异有统计学意义（χ2=5.43，P<0.05），其中城镇高于山区（χ2=39.54，P<0.007）。女性结节性甲状腺肿检出率高于男性〔47.91%（298/622）与35.45%（212/598），χ2=18.94，P<0.01〕。多因素Logistic回归模型分析结果显示，女性〔OR=2.33，95%CI（1.59,4.12）〕，从事针织纺织〔OR=2.31，95%CI（1.89,4.52）〕、模具铸造工种〔OR=2.58，95%CI（1.52,4.85）〕，长期精神压抑〔OR=2.11，95%CI（1.28,3.22）〕，经常食用海产品〔OR=2.35，95%CI（1.04,4.44）〕，有X线检查〔OR=3.54，95%CI（2.17,5.88）〕、CT检查史〔OR=2.14，95%CI（1.85,3.98）〕为结节性甲状腺肿的独立影响因素（P<0.05）。结论　浙江省象山县结节性甲状腺肿检出率为41.80%，特殊工种应注意职业防护，保持精神愉快，合理膳食，避免不必要的X线以及CT照射，尤其是城镇、女性人群提前采取预防措施等是结节性甲状腺肿预防的重要手段。

关键词: 甲状腺肿,结节性, 超声检查,多普勒,彩色, 影响因素分析, 病例对照研究