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(DALY)沈洪兵1 俞顺章21 (DALY,Disabilityadjustedlifeyear) ,,、、。,;,。,,。,,1993(DALY),。DALY、、,。2 DALY(),。DALY、。、、、,。DALY,:①DALY,,,。②、,DALY。③(、)DALY,,。④,、DALY,,。1 ,2100292 1998—09—24 1998—11—243 DALY①()。,,。②、,、。、、、,。③,DALY,。④,,。4 DALYDALY:;;;()。①(standardexpectedyearsoflifelost),: ∑x=1x=0dxex(1)(1),dxx,1,ex。1WHO,082.5,80,。,20,60.44,63.08。,“”(70)。 ②,,,。,。661999261 ModernPreventiveMedicine,1999,Vol.26,No.11 WHO*()()080.0082.504040.6443.53179.3681.844535.7738.72575.3877.955030.9933.991070.4072.995526.3229.371565.4168.026021.8124.832060.4463.086517.5020.442555.4758.177013.5816.203050.5153.277510.1712.283545.5648.38807.458.90 * (): Cxe-Ux(2)(2),x,U=0.04,C,DALY。25。③DALY。,,(、),0、1,0,1。WHO6(0.096,0.22,0.40,0.60,0.810.92)。(),。,,,、、、,。,、。()。④(,timepreference),。1。1001100,,10%,1110,。DALY、,,。,,,。DALY,WHO3%。,,DALYDALY,。,DALY。,,Cxe-Ux,er-(x-a)(r,a)。DALY:∫x=a+Lx=aDCxe-Uxe-r(x-a)dx(3)aa+L,L。DALY:-{DCe-Ua(U+r)2[e-(U+r)(L)(1+(U+r)(L+a)-(1+(U+r)a))]}(4)(4),D(1),r(3%),a,L,U=0.04,C=0.16243。(D=1)DALY。5 2WHO1990、DALY。,、15.1%,73.4%,11.5%;DALY,、25.3%,58.0%,16.7%。,DALY。6 DALY。,DALY,、,,。1993WHODALY,。DALY,,,。671999261 ModernPreventiveMedicine,1999,Vol.26,No.12 1990DALY(:×103)DALYDALYDALY4829.01034614056.0978058885.0201267Ⅰ,688.2(14.2%)*22767(22.0%)654.4(16.1%)28101(28.7%)1342.5(15.1%)50868(25.3%)Ⅱ3550.8(73.5%)60928(58.9%)2968.4(73.2%)55846(57.1)6519.2(73.4%)116774(58.0%):855.9(18.4%)11350(11.0%)522.1(12.9%)7255(7.4%)1408.0(15.9%)18605(9.2%)1322.1(27.4%)14936(14.4%)1244.1(30.7)13434(13.7%)2566.2(28.9%)28369(14.1%)828.8(17.2%)9644(9.3%)756.2(18.6%)8580(8.8%)1584.9(17.8%)18224(9.1%)Ⅲ()590.0(12.2%)19766(19.1%)433.3(10.7%)13858(14.2%)1023.3(11.5%)33624(16.7%)()(58520)(954850)(113370)*DALY7 1 MurrayCJ.Quantifyingtheburdenofdisease:thetechnicalbasisfordisability-adjustedlifeyears.BulletinoftheWorldHealthOr-ganization,1994,72(3):4472 MurrayCJ,LopezAD.Quantifyingdisability:data,methodsandresults.BulletinofWorldHealthOrganization,1994,72(3):4813 MurrayCJ,LopezAD,JamisonDT.Theglobalburdenofdiseasein1990:summaryresults,sensitivityanalysisandfuturedirections.BulletinofWorldHealthOrganization,1994,72(3):495(65) (P0.01)。3 9～10100μg/L100μg/L20152081403918062 i2=17.52,P0.014 (μg/L)20.23～0.770.5071.90～5.903.6061.23～22.713.20150.23～22.77.01 t=3.14,P0.012.4 (5) ,、19,38,17.30μg/kg,(P0.05)。5 (μg/kg)190～4213.47196.3～4820.82380～4817.30 t=2.10,P0.052.5 TSH 82,5mIU/L30,36.60%,10mIU/L11,13.40%。126.60mIU/L。3 3.1 9～1045.63%。,,,,,,。,200μg/L,(700～800)μg/g,。3%,(7.00～220)μg/L,7.01μg/L,7.00μg/L。136.14μg/L,100μg/L22.69%。65μg/kg,(34～95)μg/kg[1]。。17.30μg/kg,48.00μg/kg。“IDD”TSH5mIU/L3%。5mIU/L36.60%。,,。,。3.2 ,。,,;,,100μg/L、;,;。,,,。,。(、)。4 1 ,,.——..:,1993,53-54681999261 ModernPreventiveMedicine,1999,Vol.26,No.1