促甲状腺素抑制治疗甲状腺癌患者的膳食调查分析

目的 对促甲状腺素(TSH) 抑制治疗期间的分化型甲状腺癌(DTC)患者进行膳食调查，为对患者进行个性化膳食指导及营养干预研究提供参考依据。方法 从湖南省肿瘤医院甲状腺内科的门诊患者中收集行TSH抑制治疗的DTC患者，根据抑制治疗副作用危险分层标准，收集低、中、高危患者各200例，共600例患者作为研究对象。对所有入选病例进行膳食调查:一年食物摄入频率和3天24小时回顾法膳食调查。结果 TSH抑制治疗的DTC患者整体人群膳食摄入不足且膳食结构不合理；整体人群畜肉类摄入过多，鱼类及水产品、蛋、奶、豆、蔬菜、水果则摄入过少；整体人群脂类、碳水化合物、维生素E摄入量基本达到要求；蛋白质、膳食纤维、钙、铁、锌、硒、维生素A、维生素B1、维生素B2、维生素C、烟酸摄入明显不足；碘摄入基本符合要求；低、中、高危组膳食摄入不足率分别是21.0%、8.0%、11.5%；中危组畜肉类摄入最多，碘摄入有0.5%的患者超标；高危组牛奶摄入最少。结论 TSH抑制治疗的DTC患者膳食结构不合理及多种营养素摄入不足，在临床工作中应加强对整体人群的营养教育及针对性的干预，以降低TSH抑制治疗对心血管系统及影响骨代谢的风险。     

超声刀在甲状腺肿瘤手术中的应用效果及安全性评价

目的探讨超声刀在甲状腺肿瘤手术中的应用效果及安全性评价。 方法选择2015年6月至2018年6月手术治疗的甲状腺瘤手术患者100例为研究对象，按随机数字表法分为超声刀组和电刀组，每组患者各50例。电刀组给予常规的高频电刀切除，超声刀组患者给予超声刀手术切除。以SPSS 22.0进行数据处理与分析，组间术中术后各项指标、TSH、PTH、PCT水平等计量资料以( ±s)表示，独立t检验；并发症发生率采用χ²检验，当P<0.05时差异有统计学意义。 结果①超声刀组患者的手术时间、术中失血量、术后引流量、术后住院时间均低于电刀组(P<0.05)。②术前两组患者的血清促甲状腺激素(TSH)、血清甲状旁腺激素(PTH)、血清降钙素原(PCT)水平比较差异无统计学意义(P>0.05)，治疗后超声刀组患者的TSH、PTH水平均高于电刀组，而PCT水平则低于电刀组(P<0.05)。③超声刀组患者术后并发症发生率为6.0%(3/50)，低于电刀组患者22.0%(11/50)，差异有统计学意义(P<0.05)。 结论与常规电切术相比，超声刀手术切除甲状腺肿瘤的效果更为显著，能够降低患者术中出血量、缩短手术时间，术后恢复快，且手术并发症少，安全性高，可在临床上进一步推广应用。     

Reference intervals for free thyroxine, total triiodothyronine, thyrotropin and thyroglobulin for Quebec newborns, children and teenagers

OBJECTIVE: Paediatric reference values, although essential for interpreting patients' results, are scarce. Moreover, they are often population- and instrument-dependent. We have measured free thyroxine (Free T(4)), total triiodothyronine (Total T(3)), thyroglobulin (Tg) and thyrotropin (TSH) in samples obtained from groups of newborns, children and adolescents. SUBJECTS AND METHODS: Blood samples collected from healthy children and teenagers (100 girls and 100 boys) of age groups ranging between 9-10, 11-14 and 15-17 years and selected randomly from a cohort representative of the Quebec population, were used. Samples from infants of age ranging between 1 day and 2 years (n = 99) were obtained from a hospital-based population with benign conditions unlikely to affect thyroid function. Variables were measured on the Access 2 immunosystem. RESULTS: Free T(4), Tg and TSH levels declined significantly with age. However, Total T(3) level presented a nonlinear variation with age, being lower in the first month of life.     

影响血清甲状腺球蛋白水平因素的流行病学研究

目的 研究不同因素对≥14周岁人群血清甲状腺球蛋白(TG)水平的影响。方法 选择碘缺乏、碘充足和碘过量的3个农村社区,测定3地区甲状腺球蛋白抗体(TGAb)阴性的3335例居民的血清TG、促甲状腺激素(TSH)水平和甲状腺体积(B超法)。结果 在尿碘中位数(MUI)80—650μg/L人群中,血清TG浓度呈现一个V型变化,即碘缺乏和碘过量状态都可以导致血清TG的升高;血清TSH浓度与血清TC浓度也呈现V型的关系,即血清TSH低于0．3mU／L时,血清TG显著升高;血清TSH高于4．8mU／L时,血清TG也显著升高;甲状腺的体积与血清TG的水平呈现明显正相关的关系;女性的血清TG浓度显著高于男性;年龄对血清TG的影响仅发生在碘缺乏地区,50岁以上人群的血清TG水平显著增高。结论 性别、碘摄入量、血清TSH浓度和甲状腺体积因素影响血清TG浓度。     

Thyroid hormone and seasonal regulation of reproduction

Organisms living outside the tropics use changes in photoperiod to adapt to seasonal changes in the environment. Several models have contributed to an understanding of this mechanism at the molecular and endocrine levels. Subtropical birds are excellent models for the study of these mechanisms because of their rapid and dramatic response to changes in photoperiod. Studies of birds have demonstrated that light is perceived by a deep brain photoreceptor and long day-induced thyrotropin (TSH) from the pars tuberalis (PT) of the pituitary gland causes local thyroid hormone activation within the mediobasal hypothalamus (MBH). The locally generated bioactive thyroid hormone, T₃, regulates seasonal gonadotropin-releasing hormone (GnRH) secretion, and hence gonadotropin secretion. In mammals, the eyes are the only photoreceptor involved in photoperiodic time perception and nocturnal melatonin secretion provides an endocrine signal of photoperiod to the PT to regulate TSH. Here, I review the current understanding of the hypothalamic mechanisms controlling seasonal reproduction in mammals and birds.     

Graves病患者甲状腺激素水平正常后sTSH长期抑制机制的探讨

目的 探讨临床上部分Graves病(GD)患者经抗甲状腺药物(ATD)治疗后甲状腺激素水平达到正常,但促甲状腺素(TSH)仍长期处于被抑制状态的机制.方法 入选初发122例GD甲亢患者,予以初始等效剂量的ATD治疗,每月随访时根据甲状腺功能测定的结果酌情减量,并适时添加左旋甲状腺素(L-T4).当甲状腺激素(FT3、FT4)水平持续正常3个月即达随访标准,复查FT3、FT4、sTSH、TSH受体抗体(TRAb),并根据TRAb是否阳性分组比较.结果 122例GD甲亢患者经(7.1±1.1)个月的ATD治疗后,甲状腺激素水平均已经达到正常3个月.随访时,58例TRAb转为阴性,64例TRAb持续阳性.两组甲状腺激素水平无差异, TRAb阳性组的sTSH水平明显低于阴性组[0.044 mIU/L(0.001～4.163 mIU/L) vs 1.749 mIU/L(0.079～4.646 mIU/L),P＜0.01];血清sTSH水平与TRAb呈明显负相关(r=-0.539,P＜0.01),与FT3、FT4、年龄、病程、治疗时间、L-T4剂量、L-T4添加时间等均无相关性.结论 药物治疗过程中,甲状腺激素水平正常的GD患者,其TSH水平长期受抑制的原因与高水平TRAb相关,可能由于TRAb直接与垂体内TSH受体结合,通过超短环反馈抑制TSH的分泌所致.     

Indirect estimation of pediatric Health Related Limits for serum thyrotropin using the ADVIA Centaur analyzer

OBJECTIVES: To determine pediatric reference values for thyrotropin using Advia Centaur analyzer. DESIGN AND METHODS: The study was conducted in a large regional hospital on TSH results obtained from 5741 females and 4332 males aged 0-17 years. After the exclusion of the results outside 4 standard deviations, we calculated the Health Related Limits (HRLs) following the indirect Kairisto's procedure and using the software GraphROC. RESULTS: The lower HRL of TSH concentration was 0.70 mU/L in the years 0-11 and 0.50 mU/L in the following years. The upper TSH HRL was 6.9 mU/L in males vs. 5.7 mU/L in females in the first year and 6.7 mU/L vs. 5.3 in the period 1-2 years. The upper HRLs in females and males were similar in the following years and the upper HRL in the 13-17 years class was 3.8 mU/L. CONCLUSIONS: The indirect methods appear reliable for calculating the pediatric HRLs for TSH.     

术前TSH水平与甲状腺结节良恶性关系

目的：探讨血清促甲状腺激素（TSH）浓度与甲状腺结节良恶性的关系。 方法：回顾性分析近3年间收治的421例甲状腺结节患者的临床资料,其中结节性甲状腺肿347例,甲状腺癌74例。比较良恶性甲状腺结节患者血清TSH浓度差异,并分析TSH浓度与甲状腺结节的恶性风险以及甲状腺癌不同病理类型与血清TSH浓度的关系。 结果：甲状腺癌患者血清TSH浓度明显高于结节性甲状腺肿患者[（2.57±3.32）mIU/L vs. （1.67±2.90）mIU/L]（P<0.05）;甲状腺结节的恶性风险随血清TSH浓度的升高而逐渐升高,当TSH>5 mIU/L时,恶性率为50.0%;甲状腺癌不同病理类型间血清TSH浓度无统计学差异（P>0.05）。 结论：甲状腺结节恶性风险随血清TSH浓度的升高而增加,术前血清TSH测定可以作为甲状腺结节良恶性判断的一个辅助性指标。     

肿瘤坏死因子对鼠甲状腺细胞钙离子的作用

目的　观察 Ｔ Ｎ Ｆα对甲状腺细胞肌醇脂质／ 钙离子（ Ｉｎｓ／ Ｃａ２ ＋ ） 系统的作用。方法　利用激光扫描共聚焦显微镜（ Ｌ Ｓ Ｃ Ｍ） 观察 Ｔ Ｎ Ｆα对鼠甲状腺 Ｆ Ｒ Ｔ Ｌ５ 细胞内 Ｃａ２ ＋ 的影响。实验前细胞以不含 Ｔ Ｓ Ｈ 的５ Ｈ（５ 种激素） 培养液培养３ 天，将待测细胞以 Ｆｌｕｏ３ 负载，分别加入不同浓度的 Ｔ Ｎ Ｆα，以 Ｌ Ｓ Ｃ Ｍ 扫描（４８８ｎｍ ） 测定细胞内 Ｃａ２ ＋ ，观察 Ｔ Ｎ Ｆα的作用。结果　１ ． Ｔ Ｎ Ｆα可降低 Ｆ Ｒ Ｔ Ｌ５ 细胞内基础的 Ｃａ２ ＋ 水平，其效应随 Ｔ Ｎ Ｆα浓度的增加而增强。２ ． Ｔ Ｎ Ｆα可抑制 Ｔ Ｓ Ｈ 刺激甲状腺 Ｆ Ｒ Ｔ Ｌ５ 细胞 Ｃａ２ ＋ 升高的效应。结论　 Ｔ Ｎ Ｆα可以通过抑制甲状腺细胞 Ｉｎｓ／ Ｃａ２ ＋ 系统发挥其抑制效应。