缺血预处理对心脏瓣膜置换手术围术期甲状腺激素代谢的影响及临床意义

目的 :了解缺血预处理对心脏瓣膜置换手术围术期甲状腺激素 (TH)代谢的影响及临床意义。方法 :选取 16例风湿性心脏病 (风心病 )瓣膜置换手术患者 ,随机均分为实验组 (IP组 )及对照组 (C组 ) ,IP组采取缺血预处理方案 ,对照组不采取预处理 ,其余同IP组。分别于术前、转流中 (最低温 )、再灌注后 5min ,停机、术后 2 ,2 4 ,4 8h采取血样 ,测定血清总三磺甲状腺原氨酸 (TT3 )、总四碘甲状腺原氨酸 (TT4)、游离三磺甲状腺原氨酸 (FT3 )、游离四碘甲状腺原氨酸 (FT4)、促甲状腺激素 (TSH)浓度 ,组内各时点与术前 ,两组之间各时点进行配对比较。结果 :TT3 和FT3 水平在转流最低温时降至最低点 ,术后 4 8h仍低于术前 ,但IP组术后 2 4～ 4 8h二者水平明显高于对照组 (均P <0 .0 5 ) ,两组T4,FT4水平术后 2 4h已恢复术至前水平 ,各时点间无明显差异 ;TSH水平术后 4 8h两组均低于术前 ;IP组无严重并发症发生 ,对照组有 2例发生低心排。结论 :风心病瓣膜置换手术围术期呈现低T3 综合征 ;缺血预处理可以减轻瓣膜置换手术围术期低T3 综合征的严重程度 ,有利于心功能的恢复     

Prevalence of autoimmune diseases in islet transplant candidates with severe hypoglycaemia and glycaemic lability: previously undiagnosed coeliac and autoimmune thyroid disease is identified by screening.

AIMS: Autoimmune diseases such as Addison's or coeliac disease can contribute to hypoglycaemia or malabsorption and are more common in Type 1 diabetes (T1DM). This brief report describes the prevalence of known and newly detected autoimmune disease in clinical islet transplant candidates with longstanding T1DM and severe hypoglycaemia and/or glycaemic lability who are routinely screened for coexisting autoimmune disease. METHODS: One hundred and twenty-four C-peptide negative T1DM subjects [77 (62%) female, mean age 44 +/- 9 years, diabetes duration 28 +/- 11 years, body mass index 24.9 +/- 3.5 kg/m(2)] with indications for clinical islet transplantation at the University of Alberta were screened for autoimmune disease by history and measurement of anti-transglutaminase antibodies (positive > 10 U/ml), 09.00 h cortisol (followed by adrenocorticotrophic hormone-stimulation if < 495 nmol/l) and thyroid-stimulating hormone to determine the prevalence of coeliac disease, Addison's disease and autoimmune thyroid disease, respectively. RESULTS: Forty per cent of subjects had one or more coexisting autoimmune disease. The prevalence of autoimmune disease was 35%, coeliac disease 8% and Addison's disease 1.6%. In 11 individuals (9%), one or more autoimmune disease were newly detected (seven coeliac disease and five thyroid disease). Seven of 10 cases of coeliac disease were newly detected. A gluten-free diet in individuals with newly diagnosed coeliac disease reduced gastrointestinal symptoms, but indications for clinical islet cell transplantation persisted. CONCLUSIONS: Coexisting autoimmune disease is common in candidates for clinical islet cell transplantation. Screening in this group identified a substantial number of previously unrecognized cases. Clinicians should consider the presence of autoimmune disease even in the absence of classical symptoms.     

甲状腺结节的超声诊断

目的：探讨不同病理性质甲状腺结节的超声诊断依据。方法：对107例甲状腺结节患者超声检查。结果：107例患者中，甲状腺结节良性者63例（共74个结节），恶性者44例（共48个结节）。结论：二维超声图像结合彩色多普勒，可提高不同性质的甲状腺的鉴别诊断。     

p21-ras、p53和VEGF在甲状腺乳头状癌中的表达及意义

目的　研究原癌基因Ras、抑癌基因p5 3及血管内皮生长因子 (VEGF)在甲状腺乳头状癌中的表达及相关性。方法　应用免疫组织化学S P法对 4 0例甲状腺乳头状癌中p2 1 ras、p5 3及VEGF的表达进行研究。结果　甲状腺乳头状癌中存在p2 1 ras、p5 3及VEGF的过度表达 ;VEGF的表达与p2 1 ras、p5 3的表达显著相关 (P <0 .0 5 ) ;VEGF的表达与甲状腺乳头状癌淋巴结转移显著相关 (P <0 .0 5 )。结论　p2 1 ras、p5 3、VEGF在甲状腺乳头状癌的发生发展过程中起重要作用 ;VEGF的表达与p2 1 ras、p5 3表达显著相关 ,可能受其调控。     

补益中药对老龄雄性大鼠下丘脑神经递质——甲状腺轴机能作用的研究

本文通过对3月龄、18月龄、24月龄雄性大鼠下丘脑去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)、5-羟吲哚乙酸(5-HIAA),和下丘脑垂体促甲状腺释放激素(TRH)、垂体、血甲状腺释放激素(TSH)、血甲状腺激素(T_3、T_4)的测定,研究了大鼠下丘脑神经递质与甲状腺轴机能的增龄性变化,并在此基础上探讨了补益中药对老龄大鼠下丘脑—垂体—甲状腺机能的作用。结果提示:老龄大鼠下丘脑机能的减退是甲状腺轴机能减退的重要原因;补益中药可能改善了老龄大鼠下丘脑的调控机能,进而延缓了甲状腺轴机能的老年性变化。     

Clinical and immunological studies on patients with Graves' disease preoperatively treated with corticosteroids and iodides

The purpose of this study was to evaluate the acute effects of corticosteroid and iodide preoperative therapy in patients with Graves' disease in terms of thyroid function and immunological parameters. The above combination was prescribed for 4 patients who had experienced severe side effects from antithyroid drugs (ATD) in order to reduce the possibility of post-thyroidectomy thyroid storm. Corticosteroids were employed daily for four days, and iodides were given daily for two weeks prior to thyroidectomy. The free T₃ values decreased rapidly to euthyroid levels following the administration of both drugs, although the free T₄ values were still much higher than normal in 3 of the 4 patients at the time of surgery. By comparison, 3 of 8 patients treated with ATD also had thyroid hormone levels above normal. Studies of lymphocyte subsets revealed that the percentage of helper T cells was significantly less in the corticosteroidiodide treatment group than in the control and ATD groups. It is thus possible that postoperative thyroid storm might be prevented through corticosteroid-iodide therapy by virtue of the reduction of free T₃ values to within the normal range by the time of surgery. The acute suppression of helper T cells was another result of this form of therapy observed.     

Primary leiomyosarcoma of the thyroid gland

Primary leiomyosarcoma of the thyroid gland is extremely rare, and to the best of our knowledge only five well-documented cases have been reported in the world literature. We herein report a 58-year-old female patient with primary leiomyosarcoma of the thyroid who was successfully treated by total thyroidectomy with a modified neck dissection. Immunohistochemically, the tumor cells showed positive reactivity to α-smooth muscle actin and vimentin. Radical surgery was thus considered to be essential in the treatment of this rare but rather aggressive malignancy.     

抗人甲状腺过氧化物酶抗体与其他自身抗体的关系

甲状腺过氧化物酶（ＴＰＯ）是甲状腺微粒体的抗原成分。在纯化抗原建立测定抗ＴＰＯ抗体ＥＬＩＳＡ法的基础上，并对抗ＴＰＯ与其他自身抗体的伴随关系作了研究。发现除自身免疫性甲状腺病有较高阳性率外，ＳＬＥ等患者抗ＴＰＯ检出率也很高（１０％￣５２．１％），且抗ＴＰＯ阳性者，抗核抗体等其他自身抗体的阳性率也高达３０．８％￣９５．２％。抗ＴＰＯ抗体与其他自身抗体的相关系数ｒ＝０．７４６７（Ｐ〈０．０１）。     

大鼠实验性肝硬化时甲状腺激素水平及甲状腺形态学变化的研究

将Wistar大鼠分为三组：肝硬化组，给予四氯化碳等复合因素，给药组，除给CCl4等复合因素外，用赤栀黄合剂灌胃41天；正常组给以一般饮食及饮水。结果，与正常组及给药组相比，硬化组血T3、T4测定值低，甲状腺滤泡中胶质明显减少，滤泡细胞与胶质间空泡增多，滤泡上皮细胞内PAS阳性小滴数日增多。表明在实验性肝硬化期间甲状腺参与了抗疾病的代谢活动，其机理可能是肝硬化时肝细胞合成、转运T3，T4的蛋白质减少。运输中的T3，T4减少，活性甲状腺素不足，从而导致甲状腺代偿性功能活跃。赤栀黄合剂具有保肝，恢复甲状腺素水平的作用。     

高碘摄入对SD大鼠钠/碘同向转运体蛋白表达影响的免疫组化研究

目的:动态观察长期高碘摄入对SD大鼠甲状腺细胞钠/碘同向转运体(NIS)蛋白表达的影响.方法:SD大鼠分别饲以去离子水及不同碘浓度的碘化钾水,给碘后1 d及1,2,4,8周处死.测定尿碘、组织碘含量,免疫组织化学方法观察甲状腺细胞NIS蛋白表达水平.结果:高碘摄入可引起甲状腺滤泡细胞膜表面NIS蛋白表达的下降.短期较低浓度的高碘摄入对NiS蛋白的表达无明显影响,而较高浓度的碘摄入则引起NIS蛋白表达的明显减少;长期高碘摄入对NIS蛋白表达的抑制作用,可在机体自我调节机制作用下得以部分恢复,但NIS蛋白表达仍处较低水平.结论:高碘摄入可导致甲状腺细胞表面NIS蛋白表达下降,随摄碘浓度的增加抑制作用增强;不同浓度的碘摄入对NIS蛋白表达的抑制作用表达时间不同.