心力衰竭患者甲状腺功能减退与睡眠呼吸障碍的相关性分析

目的探讨心力衰竭患者中甲状腺功能减退者睡眠呼吸障碍的临床特征及两者的相关性。方法连续纳入2019年8~12月就诊于北京阜外医院行甲状腺功能检测及睡眠呼吸监测的182例心力衰竭患者。根据甲状腺功能检测结果分为甲状腺功能减退组45例和非甲状腺功能减退组137例。比较两组患者的睡眠呼吸监测的相关指标,多元logistic回归分析甲状腺功能减退与睡眠呼吸障碍的相关性。结果甲状腺功能减退组女性患者比例、体重指数较非甲状腺功能减退组高(P<0.05)。两组多导睡眠监测的结果,甲状腺功能减退组睡眠平均血氧饱和度较非甲状腺功能减退组低(P=0.027)。甲状腺功能减退组睡眠低通气发生次数较非甲状腺功能减退组显著增多(P=0.01)。但甲状腺功能减退与睡眠呼吸暂停无相关性(P=0.533)。结论在心力衰竭患者中,甲状腺功能减退的患者睡眠平均血氧饱和度更低,并且夜间低通气次数更多。     

极低/超低出生体重儿甲状腺功能减退的临床分析

目的 分析极低/超低出生体重（VLBW/ELBW）患儿甲状腺功能减退的危险因素和治疗情况。方法 选择2018年9月至2019年12月诊断为甲状腺功能减退的VLBW/ELBW患儿为病例组（n=29），按照1：3比例匹配甲状腺功能正常的VLBW/ELBW患儿作为对照组（n=87），比较两组患儿的临床特征，分析甲状腺功能与出生胎龄、出生体重的相关性及甲状腺功能减退的危险因素。结果 符合纳入标准的VLBW/ELBW患儿共162例，其中病例组29例，甲状腺功能减退发生率为17.9%。出生体重越低，甲状腺功能减退发生率越高（P < 0.05）；三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）与出生胎龄呈正相关（P < 0.05），T3、游离甲状腺素（FT4）与出生体重呈正相关（P < 0.05）。小于胎龄儿、多胎、孕母≥35岁、使用多巴胺是发生甲状腺功能减退的独立危险因素（P < 0.05）。病例组中16例患儿给予左旋甲状腺素（每日5~10 μg/kg）治疗，甲状腺功能在治疗2周后恢复正常。结论 VLBW/ELBW患儿甲状腺功能减退的发生率较高，小于胎龄儿、多胎、孕母高龄、应用多巴胺是其发生甲状腺功能减退的危险因素，应用左旋甲状腺素治疗的患儿需定期随访，以保证用药剂量适宜。     

Hepatic vascular tumors

The most common hepatic vascular tumor in the pediatric population is the infantile hepatic hemangioma. Although these lesions have a spectrum of presentations, there are three main subtypes that have been described—focal, multifocal, and diffuse. An algorithm on the workup, treatment, and follow-up of these lesions can be based on this categorization. Recent shifts in the management of hemangiomas with beta-blockers (propranolol) have also influenced the treatment of hepatic hemangiomas. This article reviews the current understanding of hepatic hemangiomas and protocols in the management of these patients.     

亚急性甲状腺炎复发及永久性甲状腺功能减退预测因素的研究进展

亚急性甲状腺炎（subacute thyroiditis,SAT）是一种甲状腺炎性疾病,与病毒感染有关。其不良临床转归,即永久性甲状腺功能减退及复发的发病率似有增高趋势。复发引起的反复发热、颈部疼痛等炎性症状使病人生活质量下降,而且永久性甲状腺功能减退的病人即使终身替代治疗,也难以避免对健康的影响。预防SAT的复发,减少永久性甲状腺功能减退,一直是学者们关注的热点。近几年,探讨SAT不良临床转归的研究涉及甲状腺体积、甲状腺功能相关指标、人类白细胞抗原及治疗因素等方面,且出现了许多具有临床意义的新数据。尤其是2019年至今全球大流行的新型冠状病毒是否与SAT有关,愈发引起人们的重视。因此,该研究将从以上几方面对永久性甲状腺功能减退和复发的可能预测因素作一综述,旨在为临床工作及科研提供参考。     

Plasma levels of adiponectin and soluble thrombomodulin in hypothyroid patients with normal thyroid function following levothyroxine replacement therapy

Hypothyroidism is associated with increased morbidity from cardiovascular disease, and adiponectin (ApN) is a newly-identified adipocytokine, which is expressed in human adipose cells and may have a protective effect against the development of coronary artery disease. The aim of the study was to evaluate the involvement of ApN secretion in hypothyroid patients with normal thyroid function following levothyroxine (L-T(4)) replacement therapy, and to associate plasma ApN levels with intima-media thickness (IMT) in the common carotid artery (CCA), an indicator of early atherosclerosis, and cardiovascular parameters including soluble thrombomodulin (sTM), a plasma endothelial injury marker. The CCA IMT and plasma levels of ApN and sTM were measured in 52 hypothyroid patients and in age-, sex- and body mass index (BMI)-matched normal control subjects. Thirty-six of the hypothyroid patients were further monitored for changes in these markers during 1 year in a euthyroid state induced by L-T(4) replacement therapy. Although the basal CCA IMT was significantly higher in hypothyroid patients [0.633 +/- 0.018 mm (mean +/- S.E.)] than in control subjects (0.552 +/- 0.022 mm, P < 0.005), both groups had similar baseline ApN and sTM levels [10.23 +/- 0.76 vs. 10.10 +/- 0.93 microg/ml: NS; and 2.58 +/- 0.14 vs. 2.68 +/- 0.20 ng/ml: NS, respectively]. Simple regression analysis revealed that plasma ApN was significantly correlated in a positive manner with age (r = 0.339, P = 0.015), HDL-cholesterol (r = 0.295, P = 0.048), and sTM (r = 0.490, P = 0.0005), but not with CCA IMT (r = 0.059, P = 0.742). In multivariate analysis, the plasma ApN level was significantly associated with that of sTM (r = 0.546, P = 0.0001) and with serum high-density lipoprotein (HDL)-cholesterol levels (r = 0.291, P = 0.029) in hypothyroid patients. During 1 year of L-T(4) replacement therapy, hypothyroid patients showed a significant decrease in CCA IMT, to 0.553 +/- 0.016 mm (P < 0.0001), a level comparable to normal controls, but no significant change in ApN (from 10.79 +/- 1.07 to 10.6 9+/- 1.14 microg/ml, NS) or sTM (from 2.59 +/- 0.15 to 2.74 +/- 0.18 ng/ml, NS). Hence, we provide evidence that ApN and sTM might not contribute to enhanced atherosclerosis, as reflected by increased CCA IMT in hypothyroid patients. However, this is the first report to demonstrate a positive and significant association of sTM with ApN. These data support the hypothesis that sTM is one of the determinant of ApN and thus suggest the presence of an sTM-associated regulatory mechanism for ApN secretion in hypothyroid patients.     

桥本甲状腺炎治疗及预后分析

目的:探讨桥本甲状腺炎的临床诊断、治疗方法及其预后.方法:106例桥本甲状腺炎患者中,内科治疗40例,经甲状腺自身抗体检测或细针穿刺细胞学检查确诊,口服甲状腺素片治疗.手术治疗66例.随访时间0.5～6年,中位时间3年.结果:内科治疗组新增甲状腺功能下降18例,外科治疗组新增甲状腺功能下降15例.结论:对于桥本甲状腺炎患者,严格遵守手术指征,对有气管压迫症状和无法排除合并恶性结节的患者选择适当手术方式,术后规律服药及监测甲状腺功能变化,可取得良好疗效.     

Impact of hypothyroidism on the development of non-alcoholic fatty liver disease: A 4-year retrospective cohort study

Background/Aims

Hypothyroidism is reported to contribute to the development of nonalcoholic fatty liver disease (NAFLD). We compared the risk of the development of NAFLD among three groups with different thyroid hormonal statuses (control, subclinical hypothyroidism, and overt hypothyroidism) in a 4-year retrospective cohort of Korean subjects.

Methods

Apparently healthy Korean subjects without NAFLD and aged 20-65 years were recruited (n=18,544) at health checkups performed in 2008. Annual health checkups were applied to the cohort for 4 consecutive years until December 2012. Based on their initial serum-free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels, they were classified into control, subclinical hypothyroidism (TSH >4.2 mIU/L, normal fT4), and overt hypothyroidism (TSH >4.2 mIU/L, fT4 <0.97 ng/dL) groups. NAFLD was diagnosed on the basis of ultrasonography findings.

Results

NAFLD developed in 2,348 of the 18,544 subjects, representing an overall incidence of 12.7%: 12.8%, 11.0%, 12.7% in the control, subclinical hypothyroidism, and overt hypothyroidism groups, respectively. The incidence of NAFLD did not differ significantly with the baseline thyroid hormonal status, even after multivariate adjustment (subclinical hypothyroidism group: hazard ratio [HR]=0.965, 95% confidence interval [CI]=0.814-1.143, P=0.67; overt hypothyroidism group: HR=1.255, 95% CI=0.830-1.899, P=0.28).

Conclusions

Our results suggest that the subclinical and overt types of hypothyroidism are not related to an increased incidence of NAFLD.     

442例Graves病131I治疗后晚发甲减相关因素分析

目的 回顾分析Graves' disease(GD)131I治疗后永久性甲状腺功能减退(晚发甲减)的相关因素.方法 依据摄131I率公式并结合临床经验确定131 I剂量,一次给药,门诊治疗GD患者442例,其中男性128例(29.0％),女性314例(71.0％).一次治疗未愈或复发者,相隔3个月以上同法重复治疗,直至治愈.结束治疗后随访疗效1年以上,并根据是否发生晚发甲减分成甲减组和非甲减组,然后分析两组患者相关因素的差异及临床意义.结果 ①晚发甲减231例(52.3％),包括男性56例(43.8％)和女性175例(55.7％)(x2=4.7639,P＜0.05).②两组事先抗甲状腺药物(antithyroid drugs,ATD)治疗时间分别为43.6±42.0月和64.6±50.1月(t=3.0290,P＜0.01);治疗前ATD停药时间分别为27.2±25.3周和18.7±16.4周(t=2.7709,P＜0.01).③两组的年龄、病程、摄131I率、治疗前激素和自身抗体水平、甲状腺质量和质地、治疗次数、首次和累计治疗剂量等,均无统计学差异(t=0.2592 ～1.2363,P＞0.05).结论 晚发甲减与性别和ATD有一定关系,与年龄、病程、摄131I率、激素和自身抗体水平、甲状腺大小和质地、1311I剂量等未见明显相关,提示患者内在规律的自然转归是晚发甲减主要原因,因此临床应用131I剂量不必过于保守.