两种免疫试剂检测妊娠期甲状腺功能结果的比较

目的 比较2种临床常用的自动化化学发光免疫检测试剂对不同孕周的正常孕妇甲状腺功能指标的检测结果和参考范围的差异.方法 采集2011年2月17日至6月9日就诊于上海交通大学医学院附属国际和平妇幼保健院的正常孕妇血清样本共693例,按孕周不同分妊娠9～13、16～20、24～28、32～34和37～40周共5组.同期采用2种检测试剂—— 雅培试剂(Abbott Architect I2000)和罗氏试剂(Roche Cobas Elecsys 600)进行血清促甲状腺激素(thyroid stimulating hormone,TSH)、游离甲状腺素(free thyroxine,FT4)和游离三碘甲状腺原氨酸(free triiodothyronine,FT3)的检测.根据美国临床生化研究院建议的甲状腺功能检测指标参考范围的制定方法,将测定结果的第2.5～97.5百分位数作为各项指标的参考范围.采用单因素方差分析、多重比较法和Spearman相关分析进行统计学分析.结果 妊娠期间,2种检测试剂测定的TSH值有线性相关性且变化趋势一致(r=0.833～0.973,P均=0.000),均在妊娠9～13周显著低于同一试剂其他妊娠时点,而在妊娠37～40周显著高于同一试剂其他妊娠时点(F雅培=18.830,F罗 氏=21.012,P均=0.000);同一样本罗氏试剂测得的各妊娠时点的TSH水平及参考范围均显著高于雅培试剂(|t|=3.002、4.948、6.353、4.636、4.391,P均＜0.01).2种检测试剂测定的妊娠9～13周血清FT4水平均显著高于同一试剂其他妊娠时点(F雅培=17.230,F罗氏=14.439,P均=0.000);罗氏试剂测定的妊娠9～13周血清FT4水平显著高于雅培试剂(|t|=4.964,P=0.000),而妊娠24～28周和37～40周FT4水平显著低于雅培试剂(|t|=4.183,P=0.000;|t|=2.417,P=0.016).2种检测试剂测定的妊娠9～13周和16～20周血清FT3水平均显著高于同一试剂其他妊娠时点(F雅培=46.142,F罗氏 =68.149,P均=0.000);罗氏试剂测得的各妊娠时点的FT3水平及参考范围均显著高于雅培试剂(|t|=31.762、26.411、28.877、22.710、22.736,P均=0.000).2种试剂均仅在妊娠9～13周时,血清TSH与FT4、FT3之间呈现显著相关性(雅培试剂:r=-0.319和 -0.361,P均=0.000;罗氏试剂:r=-0.352和-0.329,P均=0.000).结论 血清TSH最能准确反映甲状腺功能,美国甲状腺学会推荐的经验性妊娠期TSH参考范围上限不宜在国内直接采纳,不同检测试剂应建立各自的妊娠期甲状腺功能参考范围.     

汕头地区孕妇甲状腺功能参考值的建立及甲状腺功能异常的筛查

目的建立汕头地区妊娠妇女甲状腺激素功能指标的参考值范围,并依据该参考值了解本地区妊娠妇女甲状腺功能异常的发生情况。 方法对2013年1月至2015年12月期间在汕头大学医学院第二附属医院妇产科门诊就诊的837名妊娠妇女,进行血清甲状腺激素和甲状腺自身抗体检测。其中,2013年1月至2014年6月符合入组标准的367名妊娠妇女的甲状腺功能资料,用于建立本研究妊娠各期血清促甲状腺激素(Thyroid stimulating hormone, TSH)、游离甲状腺素(Free thyroxine, FT₄)的参考值。根据本研究初步建立的参考值,对2014年7月至2015年12月在汕头大学医学院第二附属医院妇产科门诊就诊的470名妊娠妇女进行甲状腺功能异常的筛查。 结果(1)初步建立的汕头地区妊娠妇女孕早、中和晚期血清TSH的正常参考范围分别为：0.07～5.34 mIU/L、0.09～4.96 mIU/L、0.05～6.59 mIU/L,血清FT₄的正常参考范围分别为：8.71～15.53 pmol/L、5.58～11.84 pmol/L、5.57～21.91 pmol/L;(2)本院就诊孕妇甲状腺功能异常的发生率：临床甲亢为1.91%(9/470)、亚临床甲亢为0.64%(3/470)、临床甲减为0、亚临床甲减为1.06%(5/470)。 结论建立汕头地区妊娠妇女甲状腺功能的参考值有利于本地区妊娠妇女甲状腺功能疾病的及时诊断和早期干预,从而减少疾病对孕妇及胎儿造成的影响。     

促甲状腺激素受体对分化型甲状腺癌~(131)I治疗效果预测价值

目的通过分析正常甲状腺及分化型甲状腺癌(DTC)组织中促甲状腺激素受体(TSHR)表达位置及表达强度的差异,探讨TSHR对DTC术后131I治疗效果的预测价值。方法回顾性分析DTC术后进行~(131)I清甲治疗患者49例,采用免疫组化ABC法,检测上述病例甲状腺癌组织及癌旁正常甲状腺组织中TSHR的表达位置及表达强度,根据~(131)I治疗效果分组,分析比较两组TSHR表达情况及相关临床资料。结果 49例患者病理切片中,正常甲状腺组织细胞膜TSHR表达阳性率近乎100%,甲状腺癌组织细胞膜TSHR表达阳性率为57.14%,差异有统计学意义(P<0.05);甲状腺癌组织细胞质内TSHR表达阳性率(87.76%)高于正常甲状腺组织(32.65%),差异有统计学意义(P<0.05)。一次性清甲成功患者DTC组织细胞膜上TSHR表达强度(阳性率70.00%及强阳性率46.67%)高于清甲治疗次数≥2次患者(阳性率36.84%及强阳性率15.79%),差异有统计学意义(P<0.05)。结论 DTC细胞膜TSHR的表达强度较正常甲状腺组织低,而其细胞质内TSHR表达强度升高,分化型甲状腺癌细胞膜TSHR表达强度或许能够预测~(131)I治疗效果。     

促甲状腺素分泌激素对实验性脊髓损伤的治疗

为研究促甲状腺素分泌激素（TRH）对脊髓损伤的早期及晚期治疗效果，将24只猫分为4组，伤后1h治疗组、伤后24h治疗组、伤后48h治疗组及对照组。用改良Allen’s打击法致伤L1部，治疗组用Zmg/kgTRH冲击剂量及1mg／ks／h持续量（4h）治疗，观察动物神经功能情况，定期检测MEP、SEP和形态学的量化分析。结果显示，虽然四组之间形态学无明显差异，但治疗组神经功能及MEP明显优于对照组。     

促甲状腺激素与亚临床性甲状腺功能异常

亚临床性甲状腺功能异常的临床症状轻微、无特异性、不易被察觉,只表现为促甲状腺激素的上升、下降。对促甲状腺激素在亚临床性甲状腺功能异常中早期诊治的价值进行综述。     

新生儿先天性甲状腺功能减退症的筛查及临床分析

目的：开展新生儿先天性甲状腺功能减退症（CH）的筛查及临床治疗,以期降低残疾儿童的发生率,提高我国人口素质,方法：应用国际先进的时间分辨荧光免疫法（Tr-FIA)检测新生儿滤纸干血片上TSH的[浓度筛查CH;且对筛查阳性的患儿进行临床分析。结果：筛查新生儿315 472例,确诊CH者66例,包括47例典型甲减,19例亚临床甲减,筛查阳性率为1／4 780,47例典型病例最终诊断为永久性甲减的41例,暂时性甲减2例,2例未满2岁未再作重新评估,1例因其他原因夭折,1例放弃,19例亚临床型病例最终诊断永久性甲减7例,暂时性甲减4例,商TSH血症5例,有3例未满2岁未再作重新评估,随访患儿目前体格及智力发育皆正常,结论：Tr-FIA法是筛查CH十分理想的非放射性免疫分析技术,筛查阳性的CH患儿,包括甲减和亚临床甲减病例,都应给以及时合理剂量甲状腺素治疗,是否终身治疗则需要根据2岁及5岁的重新评估作出决定。     

新生儿筛查滤纸干血样测定的影响因素探讨

目的探讨新生儿筛查滤纸干血样法检测过程中,可能影响促甲状腺素(TSH)及苯丙氨酸(phe)测定结果的因素,以建立有效的改进措施.方法观察采血时间等因素对酶免疫标记法(BA-ELISA)和细菌抑制法结果的影响,观察其变化规律.结果新生儿筛查试验影响因素众多,TSH测定72 h后采血结果稳定,季节间TSH水平有差异,应选择不同的适宜的筛查临界值;滤纸血样自然干燥易于洗脱;于干血样1/4处取样结果近于靶值;BA-ELISA洗脱4～5 h效果较好.phe测定72 h后采血可减少假阳性;制板温度以55～60℃为宜,加血样间距不宜过密.结论采血时间、临界值、血片处理等因素影响筛查结果,选择最佳实验条件,能较好保证新生儿筛查试验质量.     

Changes in TRH and its degrading enzyme pyroglutamyl peptidase II, during the development of amygdaloid kindling

Pyroglutamyl peptidase II (PPII) is a neuronal ectoenzyme responsible for thyrotropin releasing hormone (TRH) degradation at the synaptic cleft. PPII, heterogeneously distributed in different brain regions and adenohypophysis, is regulated under various endocrine conditions where TRH is involved in thyrotropin or prolactin regulation but only at the adenohypophyseal level. TRH can downregulate PPII activity in cultured adenohypophyseal cells. TRH present in extrahypothalamic brain areas has been postulated to serve as a neuromodulator and levels of this peptide increase in amygdala, hippocampus and cortex after electrical stimulation (kindling or electroshock). To study whether brain PPII could be regulated in conditions that stimulate TRHergic neurons, TRH and PPII activity were determined during the development of amygdaloid kindling in the rat. TRH levels increased from stage II to V in amygdala and hippocampus in the ipsi- and contralateral side to stimulation. In n. accumbens a decrease, compared to sham was observed at stage II, but levels raised through stage V. In contrast, PPII activity was increased at stage II, in amygdala of both sides and in hippocampus, frontal cortex, n. accumbens and hypothalamus of the contralateral side; levels decreased at stage V to sham values in most structures (except amygdala and hippocampus where the activity was 30% below controls). These results suggest that PPII activity in the central nervous system can be regulated in conditions known to affect TRHergic neurons.     

Brain Thyrotropin-Releasing Hormone Content Varies Through Amygdaloid Kindling Development According to Afterdischarge Frequency and Propagation

Summary: Purpose: Thyrotropin-releasing hormone (TRH), present in extra hypothalamic brain areas, has been proposed to have neuromodulatory functions and to be susceptible to change by electrical stimulation paradigms. We measured TRH concentrations of several brain areas during kindling development before its establishment and determined whether the changes detected in TRH levels were related to the behavioral stages of kindling, the number of stimulations required to reach these stages and, with the electrophysiological parameters characteristic of this paradigm (amygdaloid afterdischarge (AD) frequency, duration, and propagation). Methods: Male Wistar rats were implanted stereotaxically with indwelling bipolar electrodes in the basolateral nucleus of the amygdala and with two stainless-steel electrodes epidurally in frontal cortex. Amygdaloid kindling was induced by daily electrical stimulation; AD frequency and duration were recorded and analyzed throughout the development of kindling. TRH was extracted from several regions and quantified by radioimmunoassay (RIA). Results: Modifications in TRH concentrations were detected, depending on the region assayed, from stage II of kindling. A positive correlation was noted between the levels of TRH and the frequency and propagation of AD, but not with the number of stimulations. The rate of change in TRH concentration in relation to AD frequency or duration was highest in frontal cortex followed by hippocampus and amygdala. Conclusions: A graded response was noted in the increase in TRH concentration dependent on the increase of AD frequency and propagation. The rate of response correlated with the region's epileptogenic susceptibility.