肺心病心力衰竭患者血清甲状腺激素测定及其临床意义

目的 探讨肺源性心脏病(简称肺心病)心力衰竭患者血清甲状腺激素水平的变化及其临床意义.方法 用放射免疫法测定82例肺心病心力衰竭患者和75名正常人血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离T3(FT3)、游离T4(FT4)、促甲状腺激素(TSH).结果 轻度肺心病心力衰竭患者T3 (1.01±0.21) nmol/L、T4 (89.92±22.01) nmol/L、FT3(2.80±0.30) pmol/L、FT4(11.39±2.99)pmol/L、TSH(1.44±0.38)mU/L与对照组T3(1.05±0.20)nmol/L、T4(90.01±21.38)nmol/L、FT3(2.81±0.28)pmol/L、FT4(11.42±2.71)pmol/L、TSH(1.40±0.40)mU/L比较差异均无统计学意义(t=0.84、0.017、0.14、0.045、0.42,均P>0.05).重度肺心病心力衰竭患者T3(0.61±0.19)nmol/L与对照组比较明显降低(t=8.83,P＜0.05),T4(88.97±21.20)nmol/L、FT3(2.76±0.32)pmol/L、FT4(11.27±2.76)pmol/L、TSH(1.39±0.39)mU/L与轻度肺心病患者比较差异均无统计学意义(t=0.14、0.46、0.13、0.42,均P＜0.05),治疗后心力衰竭减轻时T3(1.02±0.28)nmol/L明显升高(t=5.34,P<0.05).结论 血清T3水平的改变对判断肺心病心力衰竭患者的预后、严重程度和疗效有一定的指导意义.     

左甲状腺素钠片治疗妊娠期甲状腺功能减退症对甲状腺功能及妊娠结局的影响

目的观察左甲状腺素钠片(优甲乐)治疗妊娠期甲状腺功能减退症对甲状腺功能及妊娠结局的影响。方法选择2014年2月—2015年3月在武汉市武昌医院妇产科确诊为妊娠期甲状腺功能减退症的患者共100例。采用随机数字表法分为2组,观察组50例,以优甲乐治疗,对照组则予以常规处理。比较2组患者妊娠结局以及TSH、FT_3、FT_4、TPOAb的水平变化。结果与治疗前比较,治疗后2组TSH、FT_3、FT_4、TPOAb均有明显的改善[观察组:(3.1±0.9)μU/ml vs.(7.2±1.4)μU/ml,(13.5±1.7)pmol/L vs.(10.0±1.9)pmol/L,(3.2±0.5)pmol/L vs.(2.3±0.9)pmol/L,(52.8±12.5)U/ml vs.(182.0±71.2)U/ml;对照组:(5.1±0.8)μU/ml vs.(7.4±1.5)μU/ml,(11.3±1.6)pmol/L vs.(9.9±1.9)pmol/L,(3.0±0.4)pmol/L vs.(2.2±0.9)pmol/L,(96.5±10.4)U/ml vs.(182.3±73.5)U/ml],差异均有统计学意义(P<0.05),且观察组妊娠并发症总发生率为28.0%,低于对照组的78.0%,观察组围产儿不良结局的总发生率为8.0%,低于对照组的28.0%,2组比较差异均有统计学意义(P<0.05)。结论妊娠期甲状腺功能减退症妇女应用优甲乐治疗,能够有效改善TSH、FT_3、FT_4水平,降低不良妊娠结局的发生,治疗效果显著。     

丙硫氧嘧啶治疗妊娠伴甲状腺功能亢进症对其甲状腺功能及新生儿的影响

目的观察丙硫氧嘧啶治疗妊娠伴甲状腺功能亢进症对其甲状腺功能以及新生儿的影响。方法选择2010年6月—2015年8月济宁医学院附属医院产科接受治疗的伴有甲状腺功能亢进的妊娠期女性患者108例,根据患者的意愿将其分为观察组和对照组各54例。对照组患者不应用抗甲状腺类药物进行治疗,观察组患者应用丙硫氧嘧啶予以治疗。观察比较2组患者的甲状腺激素水平、新生儿以及并发症情况等。结果治疗后,观察组患者的TT_3、TT_4、FT_3、FT_4水平均低于对照组[(1.9±0.2)nmol/L、(148.6±22.7)nmol/L、(6.5±0.8)pmol/L、(21.4±2.6)pmol/L vs.(3.5±14)nmol/L、(296.3±31.9)nmol/L、(23.7±1.3)pmol/L、(55.8±3.0)pmol/L,P<0.05],TSH水平高于对照组[(2.25±0.29)mU/L vs.(0.11±0.02)mU/L,P<0.05];新生儿体质量以及Apgar评分高于对照组[(3 026.8±215.7)g、(9.4±0.5)分vs.(2 188.9±186.3)g、(7.6±0.4)分,P<0.05];并发症少于对照组(P<0.05)。结论丙硫氧嘧啶应用于妊娠期甲状腺功能亢进可显著改善患者的甲状腺功能,提高新生儿体质量,并且具有较少的并发症。     

甲状腺片治疗对亚临床甲状腺功能减退患者血脂的影响

目的:观察亚临床甲状腺功能减退患者采用甲状腺片治疗后血脂的改变.方法:选取符合亚临床甲状腺功能减退诊断标准的35例患者,每位患者的TSH被测2次,间隔1个月以上,TSH升高,游离甲状腺FT4、FT3正常.空腹抽血检测FSH、FT4、FT3和血总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL).口服甲状腺片20～60 mg/d,2～3个月后复查上述指标.结果:TSH由(9.9±3.5)mlU/L降至(1.6±1.2)mIU/L,FT3由(6.82±1.6)pmol/L升至(8.41±2.40)pmol/L,FT4由(7.89±3.11)pmol/L升至(11.87±3.83)pmol/L.替代治疗后血TC、TG、LDL均较治疗前明显下降.结论:对亚临床甲状腺功能减退患者行替代治疗,能显著降低血脂水平,从而减少心脏缺血的危险性.     

非小细胞肺癌患者化疗前后血清甲状腺激素水平变化及临床意义

目的 探讨非小细胞肺癌(NSCLC)患者血清甲状腺激素水平在化疗前后的变化及其临床意义.方法 采用放射免疫分析法测定78例NSCLC患者化疗前后血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TF4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)水平,并与35例正常人血清甲状腺激素水平比较.结果 NSCLC患者血清TT3[(1.27±0.36) nmol/L比(2.62 ±0.46) nmol/L]、FT3[(2.65±0.76) pmol/L比(3.79 ±0.63) pmol/L]水平低于正常对照组(P＜0.05),TT4、FT4及TSH水平与正常对照组接近(P＞0.05).血清TT3和FT3水平与临床分期有关(P＜0.05),与分化程度和病理类型无关(P均＞0.05);化疗后有效者(完全缓解和部分缓解)血清TT3、FT3水平明显高于化疗前(P＜0.05).结论 血清甲状腺激素水平检测对肺癌的病情判断及疗效监测有一定的临床意义.     

妊娠期孕妇亚临床甲减对妊娠结局的影响分析

目的：分析妊娠期孕妇亚临床甲减对妊娠结局的影响,为临床提供指导。方法随机抽取入住该院的60例妊娠期亚临床甲减孕妇(2011年12月—2015年12月)作为该次实验的研究对象,对60例妊娠期亚临床甲减孕妇实施计算机随机分组(对照组和观察组)。对照组30例妊娠期亚临床甲减孕妇不实施药物治疗,观察组30例妊娠期亚临床甲减孕妇实施药物治疗,分析比较两组妊娠期亚临床甲减孕妇治疗前后血清游离甲状腺素(FT4)、血清游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)情况、妊娠结局及新生儿不良结局发生情况。结果对照组妊娠期亚临床甲减孕妇的并发症发生率(53.33%)显著高于观察组(13.33%),且观察组妊娠期亚临床甲减孕妇治疗后FT4、FT3、TSH水平分别为(13.67±1.61)pmol/L、(6.87±0.81)pmol/L、(3.51±1.09)mU/L,新生儿不良结局发生率为10.00%,对照组妊娠期亚临床甲减孕妇治疗后FT4、FT3、TSH水平分别为(11.13±1.45)pmol/L、(5.06±0.51)pmol/L、(8.24±1.57)mU/L,新生儿不良结局发生率为40.00%,比较可知,观察组和对照组妊娠期亚临床甲减孕妇治疗后FT4、FT3、TSH情况以及新生儿不良结局发生率对比差异有统计学意义,P﹤0.05。结论妊娠期亚临床甲减易增加孕妇发生并发症的机率以及新生儿不良结局发生率,为保证母婴安全,临床应对孕妇实施有效治疗。     

短期高强度军事作业对个体疲劳感及内分泌功能的影响

目的 研究短期高强度军事作业诱发疲劳的特点和神经-内分泌改变规律.方法 2010年解放军总医院在某部为期7d高强度军事演习作业前后,分析240名官兵疲劳发生状况及垂体-肾上腺（包括血浆促肾上腺皮质激素、皮质激素、24 h尿游离皮质醇）、垂体-性腺（黄体生成素、睾酮、雌二醇）、垂体-甲状腺（血清TSH、TT4、TT3、FT4和FT3）轴激素水平改变.结果 高强度军事作业后,官兵作业疲劳症状自评量表中不快感分量表得分增加（7.53±2.64 ys 8.02±3.06,P＜0.05）;皮质醇由（336.97±105.23） nmol/L降至（283.94±84.61） nmol/L（P＜0.001）,24h尿游离皮质醇由（426.39±162.35） nmol/24 h降至（371.76±155.51） nmol/24 h（P＜0.001）、TT3由（2.13±0.30） nmol/L升至（2.72±2.26） nmol/L（P＜0.05）,FT4由（13.45±1.45） pmol/L升至（15.92±1.95） pmol/L（P＜0.001）,FT3由（5.23±0.42） pmol/L升至（5.61±0.58） pmol/L（P＜0.001）,睾酮水平由（23.51±6.49） nmol/L降至（18.89±5.89） nmol/L（P＜0.001）.结论 短期高强度军事作业可增加官兵的疲劳状况,影响神经-内分泌系统.     

丙硫氧嘧啶与甲巯咪唑治疗甲状腺功能亢进的临床疗效及安全性对比分析

目的分析和探讨丙硫氧嘧啶与甲巯咪唑治疗甲状腺功能亢进的临床疗效及安全性。方法用"随机分组法",将90例甲状腺功能亢进患者平均分成两组,分别为对照组和观察组,每组45例患者,对照组患者采用丙硫氧嘧啶治疗,观察组患者采用甲巯咪唑治疗,疗程结束之后,观察两组患者治疗前后的游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺过氧化物酶抗体(TPOAb)以及促甲状腺素受体抗体(TRAb)的水平以及治疗期间的不良反应发生情况。结果观察组与对照组治疗前FT3、FT4、TSH、TPOAb差异不大(P 0.05);观察组患者治疗后FT3为(3.19±0.71)pmol/L,FT4为(9.06±2.41)pmol/L,TSH为(1.48±0.69)μIU/mL,TPOAb为(21.56±4.22)IU/mL,TRAb为(3.16±0.75)U/L,而对照组患者治疗后FT3为(5.66±1.21)pmol/L,FT4为(13.92±3.66)pmol/L,TSH为(2.82±0.91)μIU/mL,TPOAb为(25.13±6.78)IU/mL,TRAb为(4.92±0.99)U/L,观察组与明显优于对照组(P0.05);观察组不良反应发生的概率为11.11%,而对照组不良反应发生的概率为33.33%,观察组明显优于对照组(P0.05)。结论在甲状腺功能亢进的治疗上,丙硫氧嘧啶与甲巯咪唑都具有比较好的效果,但是相比较而言,甲巯咪唑的临床效果更加显著一些,并且患者的不良反应发生率低,相对比较安全,适合在临床进行推广和使用。     

动态监测ICU非甲状腺疾病危重症患者甲状腺激素水平与患者预后的研究

目的 探讨动态监测ICU非甲状腺疾病危重症患者甲状腺激素水平与患者预后结局的关系.方法 方便选取2015年1月—2016年1月该院ICU内收治的非甲状腺疾病重症患者93例作为研究对象.根据APACHE评分分为危重症组(35例)、严重危重症组(39例)、极危重症组(19例),另选取同期普通病房住院的非甲状腺疾病非危重症患者50例作为对照组,动态监测各组患者甲状腺激素水平及不同预后结局危重症患者甲状腺激素水平.结果 入院24h、3d、7d时4组患者TT3、TT4、TSH、FT3、FT4水平比较差异有统计学意义(P<0.05),并且极危重症组各项指标最低;存活的危重症患者与死亡患者TT3(0.81±0.24)nmol/L vs[(0.55±0.22)nmol/L],TT4[(90.39±20.14)nmol/L vs(63.24±16.71)nmol/L],TSH[(1.39±1.15)mU/L vs(1.13±1.72)mU/L],FT3[(2.34±0.74)pmol/L vs(1.47±0.52)pmol/L,FT4(15.39±5.44)pmol/L vs(12.19±3.85)pmol/L]水平比较差异有统计学意义(P<0.05).结论 非甲状腺疾病危重症患者甲状腺激素水平与患者临床预后结局密切相关,临床应重视ICU内危重症患者甲状腺激素水平的变化,有助于及时纠正与治疗,改善患者临床预后结局.     

181例老年非甲状腺疾病患者血清FT3 FT4和TSH测定结果分析

目的测定老年患者血清游离FT3、FT4、TSH含量,探讨老年患者甲状腺功能状况。方法用电化学发光法测定181例因非甲状腺疾病就诊的老年患者血清FT3、FT4和TSH,并进行统计分析。结果 FT3、FT4和TSH测定结果分别为(3.6968±0.7772)pmol/L、(15.8207±2.9632)pmol/L和(3.8660±3.8049)μIU/ml,FT3和FT4降低发生率分别为19.9%和7.7%,TSH增高发生率为34.3%;男性FT3显著高于女性(P0.05),两性FT4和TSH差异均无统计学意义;FT3、FT4和TSH异常发生率在两性之间差异无统计学意义;FT3随年龄增加而下降(P0.01),FT4和TSH在不同年龄组之间差异均无统计学意义(P0.05);FT3降低发生率随年龄增加而上升(P0.05),TSH和FT4异常发生率在不同年龄组之间差异无统计学意义(P0.05)。结论老年患者随着年龄增高,甲状腺功能异常发生率较高,主要为FT3降低,TSH增高。     

Comparison of the Reference Intervals Used for the Evaluation of Maternal Thyroid Function During Pregnancy Using Sequential and Nonsequential Methods

Background:

Maternal thyroid dysfunction is common during pregnancy, and physiological changes during pregnancy can lead to the overdiagnosis of hyperthyroidism and misdiagnosis of hypothyroidism with nongestation-specific reference intervals. Our aim was to compare sequential with nonsequential methods for the evaluation of thyroid function in pregnant women.

Methods:

We tested pregnant women who underwent their trimester prenatal screening at our hospital from February 2011 to September 2012 for serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) using the Abbott and Roche kits. There were 447 and 200 patients enrolled in the nonsequential and sequential groups, respectively. The central 95% range between the 2.5^th and the 97.5^th percentiles was used as the reference interval for the thyroid function parameter.

Results:

The nonsequential group exhibited a significantly larger degree of dispersion in the TSH reference interval during the 2^nd and 3^rd trimesters as measured using both the Abbott and Roche kits (all P < 0.05). The TSH reference intervals were significantly larger in the nonsequential group than in the sequential group during the 3^rd trimester as measured with both the Abbott (4.95 vs. 3.77 mU/L, P < 0.001) and Roche kits (6.62 vs. 5.01 mU/L, P = 0.004). The nonsequential group had a significantly larger FT4 reference interval as measured with the Abbott kit during all trimesters (12.64 vs. 5.82 pmol/L; 7.96 vs. 4.77 pmol/L; 8.10 vs. 4.77 pmol/L, respectively, all P < 0.05), whereas a significantly larger FT4 reference interval was only observed during the 2^nd trimester with the Roche kit (7.76 vs. 5.52 pmol/L, P = 0.002).

Conclusions:

It was more reasonable to establish reference intervals for the evaluation of maternal thyroid function using the sequential method during each trimester of pregnancy. Moreover, the exclusion of pregnancy-related complications should be considered in the inclusion criteria for thyroid function tests.     

早期2型糖尿病患者胰岛素抵抗与甲状腺激素水平的关系研究

目的探讨在甲状腺功能正常的2型糖尿病(T2DM)患者中甲状腺激素生理范围内的变化是否能影响胰岛素的敏感性。方法选取23例糖耐量正常的健康者(对照组)、20例糖耐量减低(IGT)的患者(IGT组)和21例T2DM患者(T2DM组)。抽取血样进行促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)和游离四碘甲腺原氨酸(FT4)检测,分别用胰岛素抵抗指数(HOMA-IR)和胰岛素敏感性指数(ISI)来评估胰岛素抵抗和敏感性。结果 IGT组和T2DM组患者FT3水平〔(4.54±0.30)pmol/L和(4.69±0.23)pmol/L〕显著高于对照组〔(3.74±0.49)pmol/L,P<0.01)〕;FT4水平〔(16.13±1.60)pmol/L和(17.62±1.63)pmol/L〕显著高于对照组〔(14.02±1.08)pmol/L,P<0.01)〕;HOMA-IR显著高于对照组(P<0.01),而ISI显著低于对照组(P<0.01)。HOMA-IR与FT3、FT4水平呈线性正相关(r值分别为0.592和0.602,P均<0.001);ISI与FT3和FT4水平呈线性负相关(r值分别为-0.578和-0.605,P均<0.001)。结论生理范围内的甲状腺激素水平增加与胰岛素抵抗呈正相关,甲状腺激素水平增高可能是早期T2DM发展中代谢紊乱的部分发病机制。     

Effect of surgical castration on risk factors for arteriosclerosis of patients with prostate cancer

Objective To analyze the effect of castration on risk factors for arteriosclerosis of patients with prostate cancerMethods Thirty patients with primary regional prostate adenocarcinoma limited to the prostate theca were selected in this study.Serum levels of testosterone (T), free testosterone (FT), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), prostatic specific antigen (PSA), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), apoprotein α(1) (APOα(1)) and apoprotein β (APOβ), insulin, plasma fibrinopeptide A (FPA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined just prior to, 1 week and 1, 4 and 8 months after castration.Results T, FT and PSA decreased significantly 1 week after castration (21.12±15.11 ng/ml vs 383.9±62.6 ng/ml, P&lt;0.001; 4.08±3.29 pmol/L vs 34.11±11.59 pmol/L, P&lt;0.001; 14.34±7.77 ng/ml vs 23.51±6.57 ng/ml, P=0.001, respectively) and continued to decrease until reaching their lowest levels 8 months after castration.DHEA and SHBG did not undergo any changes.TG, fasting insulin and glucose, 2-hour insulin and glucose levels were significantly elevated 1 month after castration (1.84±0.61 mmol/L vs 1.30±0.40 mmol/L, P&lt;0.05; 18.16±5.57 mU/L vs 9.47±3.81 mU/L, P&lt;0.05; 4.77±0.66 mmol/L vs 3.92±0.34 mmol/L, P&lt;0.05; 65.52±14.78 mU/L vs 36.94±17.12 mU/L, P&lt;0.01; 6.98±0.79 mmol/L vs 6.01±0.23 mmol/L, P=0.001, respectively).TC, LDL-C, FPA and PAI-1 levels were elevated 4 months after castration (6.56±0.99 mmol/L vs 5.29±0.75 mmol/L, P&lt;0.01; 4.09±0.86 mmol/L vs 3.04±0.15 mmol/L, P&lt;0.01; 3.39±1.67 nmol/L vs 1.48±0.50 nmol/L, P&lt;0.01; 27.02±5.98 ng/ml vs 21.78±3.16 ng/ml, P&lt;0.05, respectively), continuing to increase after that point.Insulin sensitive index (ISI) decreased significantly 1 month after surgery (-4.42±0.36 vs -3.50±0.39, P&lt;0.001), and continued to decrease from that point forward.HDL-C, APOα(1), APOβ and fibrinogen remained at pre-operative levels.There was a negative linear correlation between FT and TG, TC, LDL-C, PAI-1, FPA, fasting insulin and glucose, 2-hour insulin and glucose (r=-0.311, -0.384, -0.385, -0.339, -0.353, -0.381, -0.303, -0.460 and -0.395, respectively; P&lt;0.05).A similar phenomenon occurred with T (r=-0.308, -0.309, -0.356, -0.320, -0.430, -0.453, -0.435, -0.483 and -0.512, respectively; P&lt;0.05).T and FT were positively associated with ISI (r=0.555 and 0.501; P&lt;0.001).Conclusions At 8 months follow-up of the study subjects, we found that lower androgen levels have adverse effects on lipid metabolism, coagulative function and insulin sensitivity, related to arteriosclerosis in men.     

Efficacy of the long-acting octreotide formulation in patients with thyroid-stimulating hormone-secreting pituitary adenomas after incomplete surgery and octreotide treatment failure

Background  Little information about the current management of patients with thyroid-stimulating hormone (TSH)-secreting pituitary adenomas or about the usefulness of the somatostatin analogue octreotide was contained in the literature. This study aimed to report the efficacy and safety of the long-acting octreotide formulation in patients with TSH-secreting pituitary adenomas after incomplete surgery and octreotide treatment failure. 

Methods  Fifteen patients with TSH-secreting pituitary adenomas (8 men and 7 women), who previously underwent incomplete surgical resection and/or adjuvant radiotherapy (n=12) and failure of octreotide treatment (n=15), followed between 2007 and 2010 in Beijing Tiantan Hospital were included in this study. All patients received 1- to 2-months of the long-acting octreotide formulation treatment after the above combination of treatment. Paired samples t-test was used to analysis the variables.

Results  After two-month duration of the long-acting octreotide formulation treatment, the mean serum free or unbound thyroxine (FT4) ((16.02±1.72) pmol/L) and free triiodothyronine (FT3) ((2.87±0.43) pmol/L) levels of 15 patients significantly decreased compared with those after octreotide-treatment (FT4, (35.36±7.42) pmol/L, P <0.001; FT3, (17.85±7.22) pmol/L, P <0.001). Mean TSH levels stayed in the normal range after the long-acting octreotide formulation treatment ((0.72±0.21) mU/L) and were significantly lower than the pretreatment value ((5.27±1.04) mU/L, P <0.001), post-surgery value ((3.37±0.31) mU/L, P <0.001) and post-octreotide-treatment value ((4.52±0.41) mU/L, P <0.001). In these patients with TSH-secreting pituitary adenomas there was no evidence of tachyphylaxis.

Conclusion  The long-acting octreotide formulation may be a useful and safe therapeutic tool to facilitate the medical treatment of TSH-secreting pituitary adenomas in patients who underwent incomplete surgery or need long-term somatostatin analog therapy.

     

非毒性甲状腺肿人群血清甲状腺球蛋白和促甲状腺素水平相关性研究

目的　探讨非毒性甲状腺肿人群血清甲状腺球蛋白 (Tg)和促甲状腺素 (TSH)的相关性。方法　对缺碘和适碘地区 2 32 0名成年人进行甲状腺B超检查和甲状腺功能、甲状腺自身抗体(TAA)、尿碘测定。结果　两地区弥漫性和结节性甲状腺肿人群血清TSH水平低于同地区正常人群(P <0 0 1 ) ;缺碘地区正常人群血清TSH明显低于适碘地区正常人群 (P <0 0 0 1 )。血清Tg水平弥漫性甲状腺肿人群轻度 (P <0 0 5) ,结节性甲状腺肿人群显著高于正常人群 (P <0 0 1 ) ,后者随甲状腺体积增大而明显增加 ,前者无此现象。结论　轻度缺碘地区甲状腺肿的发生与TSH的刺激作用无直接关系。非毒性甲状腺肿存在甲状腺自主性功能。甲状腺体积增大和自主性功能不是结节性甲状腺肿血清Tg增加的主要原因 ,而大胶质滤泡退化和滤泡构造崩溃 ,使Tg漏入血循环 ,可能是其重要的病理机制     

2型糖尿病合并不同水平高血压患者甲状腺激素水平变化及其相关性研究

目的观察2型糖尿病（T2DM）合并不同水平高血压患者甲状腺激素水平的变化,并探讨其相关因素。方法选取T2DM合并高血压患者392 例,根据血压水平分为正常血压组135 例、高血压1 级组107 例、高血压2 级组89 例及高血压3 级组61 例。测定各组甲状腺激素水平,包括游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）及促甲状腺激素（TSH）,并采用Pearson相关分析和多元逐步回归分析指标间的相关性。结果①随高血压水平升高,各组TSH 水平升高[0.42（0.22～0.88）vs 0.80（0.33～1.01）vs 1.45（0.97～2.11）vs 2.75（2.10～4.20）mIU/L]、FT3水平降低[（5.31±0.54）vs（4.79±0.66）vs（4.47±0.52）vs（3.51±0.30）pmol/L]（p <0.05）,而各组间FT4水平比较,差异无统计学意义[（16.26±2.71）vs（16.04±2.75）vs（15.39±3.41）vs（16.30±2.70）pmol/L]（p >0.05）;②Pearson相关分析发现,FT3与高血压分级和年龄呈负相关（ r=-0.408 和-0.194,p =0.000 和0.042）;FT4 与TG 呈负相关,与HDL-C 呈正相关（r =-0.227 和0.189,p =0.028 和0.046）,与高血压分级无相关性（ r=0.017,p=0.463）;TSH与高血压分级、BMI、TG、TC、LDL-C及SUA呈正相关（r =0.357、0.196、0.277、0.123、0.214 和0.342,p =0.005、0.041、0.025、0.046、0.020 和0.001）,与HbA1c 呈负相关（r =-0.222,p =0.034）;③多元逐步回归分析发现,高血压分级和年龄为FT3 的影响因素（均p=0.00）;高血压分级和SUA 为TSH的影响因素（均p=0.00）;FT4未发现影响因素。结论随着血压水平的升高,TSH 水平升高、FT3 水平降低及FT4 水平无变化;高血压分级是FT3和TSH 的影响因素。     

Efficacy of the long-acting octreotide formulation (sandostatin-LAR) in patients with TSH-secreting pituitary adenomas after incomplete surgery and octreotide treatment failure

Background: To report the efficacy and safety of Sandostatin-LAR in patients with TSH-secreting pituitary adenomas after incomplete surgery and Octreotide treatment failure. Methods: Fifteen patients with thyroid-stimulating hormone (TSH)-secreting pituitary adenomas (8 male and 7 female), who previously underwent incomplete surgical resection and/or adjuvant radiotherapy (n = 12) and failure of Octreotide treatment (n = 15), followed between 2007 and 2010 in Beijing Tiantan Hospital were included in this study. All patients received 1- to 2-months of Sandostatin-LAR treatment after the above combination of treatment. Paired samples t-Test was used to analysis the variables. Results: After two-month duration of Sandostatin-LAR treatment, the mean serum FT4 (16.02 ± 1.72 pM) and FT3 (2.87 ± 0.43 pM) levels of 15 patients significantly decreased compared with those after Octreotide-treatment (FT4, 35.36 ± 7.42 pM, P < 0.001; FT3, 17.85 ± 7.22 pM, P < 0.001). Mean TSH levels stayed in the normal range after Sandostatin-LAR treatment (0.72 ± 0.21 mU/L) and were significantly lower than the pretreatment value (5.27 ± 1.04 mU/L, P < 0.001), post-surgery value (3.37 ± 0.31 mU/L, P < 0.001) and post-octreotide-treatment value (4.52 ± 0.41 mU/L, P < 0.001). In these patients with TSH-secreting pituitary adenomas there was no evidence of tachyphylaxis. Conclusions: Sandostatin-LAR may be a useful and safe therapeutic tool to facilitate the medical treatment of TSH-secreting pituitary adenomas in patients who underwent incomplete surgery or need long-term somatostatin analog therapy.     

Assessment of thyroid function during pregnancy: first-trimester (weeks 9-13) reference intervals derived from Western Australian women

OBJECTIVE: To establish first-trimester-specific reference intervals for thyroid function tests in pregnant Australian women. DESIGN, SETTING AND PARTICIPANTS: Serum samples were collected from 2159 pregnant women (9-13 weeks' gestation) attending a private pathology practice for first-trimester screening during October and November 2006. Levels of serum thyrotropin (TSH), free thyroxine (fT(4)), free triiodothyronine (fT(3)), thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TgAb) were measured by chemiluminescent immunoassay (Abbott ARCHITECT analyser). MAIN OUTCOME MEASURES: Reference intervals based on 2.5th and 97.5th percentiles for TSH, fT(4) and fT(3), after exclusion of 338 women with positive TPOAb or TgAb tests; comparison with reference intervals for non-pregnant women (TSH, 0.40-4.0 mU/L; fT(4), 9-19 pmol/L; fT(3), 3.0-5.5 pmol/L). RESULTS: Derived reference intervals for thyroid function tests during the first trimester of pregnancy were: TSH, 0.02-2.15 mU/L; fT(4), 10.4-17.8 pmol/L; and fT(3,) 3.3-5.7 pmol/L. If the non-pregnant TSH reference range was applied to the study participants, 344 women (16.0%) whose serum TSH concentration was within the first-trimester-specific reference range would be misclassified as having subclinical hyperthyroidism, and 98 women (4.5%) with a TSH concentration above the first-trimester-specific upper reference limit would not be identified. CONCLUSIONS: The reference interval for TSH during the first trimester of pregnancy differs substantially from that for non-pregnant women, and applying the general laboratory reference range to pregnant women results in misclassification of thyroid status for 20.5% of women. Australian pathology laboratories should adopt pregnancy-specific reference intervals for thyroid function tests.