慢性碘过量对Wistar大鼠甲状腺功能及垂体促甲状腺素β表达的影响

目的探讨不同碘摄入量对垂体促甲状腺素(TSH)含量及垂体促甲状腺素β(TSHβ)表达量的影响,阐明慢性碘过量对垂体TSH细胞合成与分泌功能的影响。方法选用碘营养正常的普通Wistar大鼠60只,随机分入正常对照组、3倍碘过量组、6倍碘过量组、10倍碘过量组和50倍碘过量组。于补碘8周后处死大鼠,制备垂体组织匀浆和脑及垂体组织冰冻切片。应用化学发光免疫测定法检测血清TSH水平,应用放射免疫法检测垂体组织TSH含量,应用免疫组织化学染色法及免疫荧光染色法检测垂体TSHβ蛋白的表达,应用Image Pro-plus软件进行图像分析处理。结果与正常对照组比较,3倍碘过量组和6倍碘过量组雌鼠血清TSH水平无明显变化(P>0.05),10倍碘过量组和50倍碘过量组雌鼠血清TSH水平显著升高(P<0.05);雄鼠血清TSH水平在过量摄入碘后无明显变化。与正常对照组比较,10倍碘过量组和50倍碘过量组雌鼠垂体组织内TSH的含量明显升高(P<0.05);碘摄入量的增高并没有引起雄鼠垂体内TSH含量明显升高。与正常对照组比较,10倍碘过量组和50倍碘过量组雌鼠垂体TSHβ表达量明显增高(P<0.05),雄鼠只有50倍碘过量组TSHβ表达量明显升高(P<0.05)。结论随碘摄入量的升高,雌鼠血清TSH水平显著升高,不同碘摄入量组雌鼠垂体组织TSH含量变化与血清TSH水平变化相一致。雌鼠垂体TSHβ蛋白表达量亦随碘摄入量的升高而增加。提示慢性碘过量可能是影响垂体合成和分泌TSH的因素之一,且对雌鼠的影响更显著。     

帕金森静止性震颤脑局部一致性的功能磁共振研究

目的探讨静息状态下,帕金森静止性震颤患者的脑局部一致性。资料与方法在静息状态下,对9例左侧静止性震颤的帕金森病患者进行功能磁共振成像(functional magnetic resonance imaging,fMRI),分析其脑部局部一致性,并与健康对照组比较。结果与健康对照组相比,单侧静止性震颤的帕金森病患者表现为对侧的楔前叶、额下回、额中回、顶上小叶及同侧前扣带回等区域的局部一致性增强;小脑蚓部的局部一致性减弱。结论静息状态下,帕金森病静止性震颤患者的脑部局部一致性异常,为该病的研究提供了新依据。     

碘充足地区血清TSH正常值范围及其影响因素的流行病学研究

目的 分析血清TSH测定的影响因素,参考美国国家临床生化协会(NACB)指南,建立中国辽宁碘充足地区血清TSH的正常参考范围.方法 2007年,来自辽宁省3个碘充足地区的5 348人参加了甲状腺疾病的社区调查,进行了TSH、甲状腺自身抗体[甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)]的测定,并作了甲状腺超声检查和问卷调查.结果 正常人群的TSH分布向右偏斜,接近于对数正态分布.年龄在12～19岁血清TSH水平明显高于其他年龄段(P＜0.01),而其他年龄段之间无统计学差异.血清TSH水平女性[(1.68±1.90)mIU/L]明显高于男性[(1.45±1.92)mIU/L,P＜0.01].因此,年龄大于20岁的健康男性TSH的分布范围是0.43～4.74 mIU/L,健康女性TSH的分布范围是0.48～5.39 mIU/L.甲状腺疾病家族史、甲状腺超声异常、甲状腺抗体阳性均影响TSH的测定水平,非甲状腺疾病对TSH参考范围没有显著影响.结论建立了碘充足地区血清TSH参考范围.

Abstract：

Objective To verify the criteria proposed by National Academy of Clinical Biochemistry(NACB)guidelines in investigating the factors that affect serum TSH determination, and to determine the reference range of serum TSH in iodine-sufficient areas of China. Methods In 2007, 5 348 inhabitants were enrolled from 3 iodine-sufficient areas of Liaoning Province, and were asked to fulfill the questionnaire. Serum TSH, thyroid peroxidase antibody(TPOAb), and thyroglobulin antibody(TgAb)were determined, and thyroid ultrasonography was carried out. Results The distribution of TSH levels was skewed in healthy people and closely fit the curve of Gaussian distribution after logarithmic transformation. The levels of TSH in subjects of 12-19 years of age were significantly higher than those of other age groups(P＜0.01), and no significant difference was found among the latter groups. TSH level in females [(1.68±1.90)mIU/L] was higher than in males[(1.45±1.92)mIU/L, P＜0.01]. The reference range of TSH was 0.43-4.74 mIU/L in males, and 0.48-5.39 mIU/L in females. Family history of thyroid disease, abnormal thyroid ultrasonography, and positive thyroid antibodies were the factors that influenced TSH level. Conclusion The reference range of serum TSH in iodine-sufficient areas of China is established.     

静息态低频振幅对针刺足三里穴中枢作用机制初探

目的观察分析针刺足三里穴引起静息态下脑区低频振幅(ALFF)的改变,以探讨其中枢作用机制。方法 15名健康青年志愿者,分别针刺双侧足三里经穴和非经穴,留针20min后拔针,并采集静息态功能磁共振数据,利用REST软件计算脑区的ALFF,然后用SPM5进行组内单样本t检验,分别得到针刺足三里经穴、非经穴脑区ALFF的变化图,最后比较经穴组与非经穴组ALFF变化脑区的差异。结果针刺足三里穴可引起较广泛大脑皮层(包括额、颞、顶、枕叶)及脑干、小脑等脑区ALFF增高,针刺足三里穴,ALFF增高的脑区范围及ALFF增高的幅度均较非经穴组明显。经穴组与非经穴组比较,右侧小脑后叶、梭状回、中央后回、中央前回、缘上回、顶下小叶、额中回的ALFF均增高,差异有统计学意义(P0.05),左侧颞下极、颞上回、颞中回、钩回及双侧扣带回前部、右侧杏仁体、右侧眶下回ALFF减低,差异有统计学意义(P0.05)。结论针刺足三里穴可引起多个功能脑区ALFF增高,其机制可能是通过相应的作用中枢及复杂的脑功能网络调节,对靶器官产生作用效应。     

常见妇科急腹症的CT诊断

目的 分析常见妇科急腹症的CT表现,以提高对妇科急腹症的CT诊断水平.方法 回顾性分析14例经手术病理证实的妇科急腹症的临床资料和CT征象.结果 14例妇科急腹症分别为卵巢畸胎瘤并蒂扭转8例、巧克力囊肿破裂4例、卵巢黄体囊肿破裂2例.8例扭转病例中7例扭转肿瘤为囊性或囊实性,6例输卵管增粗,4例可见偏心性囊壁增厚,2例行增强扫描者囊壁未见强化.4例巧克力囊肿破裂病例中3例可见盆腔多发囊性低密度影,与肠管分界不清.2例黄体囊肿破裂病例均表现为附件区囊实性肿块并盆腔积血.结论 在妇科急腹症中进行CT检查对临床诊断可以起到重要作用.     

尿微量白蛋白排泄率与血清促甲状腺激素相关性研究

目的探讨尿微量白蛋白排泄率(ACR)与血清促甲状腺激素(TSH)的关系。方法 2007年10月对沈阳市大东区居民进行分层抽样调查共收集1523人,详细填写流行病学调查表,测量血压、身高、体重及腰围(WHR),采集血样测定TSH、甲状腺氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、空腹血糖(FPG)、糖负荷后30 min血糖(OGGT 30minPG)、2 h血糖(OGTT 2hPG)、空腹胰岛素浓度(FINS)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),采集空腹尿液检测尿微量白蛋白(MAU)及尿肌酐,计算尿微量白蛋白与尿肌酐比值。结果 MAU的发生率为11.8%,MAU的发生率随年龄的增长而增加(P<0.01)。MAU组较非MAU组的腰围、体重指数、收缩压、舒张压、心率、空腹血糖、糖负荷后30min血糖、糖负荷后2h血糖、TG、胰岛素抵抗指数均有明显升高(P<0.05);WHR、FINS、TC、HDL-C、LDL-C差异无统计学意义(P>0.05);TSH、亚临床甲减及亚临床甲亢的患病率差异亦无统计学意义(P>0.05);Logistic分析提示,高血压、高血糖是ACR的独立危险因素(OR值分别为1.868和1.469,P均<0.05)。结论 ACR与血清TSH未见相关性,高血糖、高血压是发生ACR的独立危险因素。     

101例甲状腺结节的临床及病理分析

目的:探讨甲状腺结节患者临床特点及超声引导下细针穿刺活检病理结果分析,评估无创及微创检查对甲状腺结节良恶性鉴别的临床意义。方法:分析2009年1月至2013年7月在成都军区总医院内分泌科住院的101例甲状腺结节患者的临床资料。结果:甲状腺结节高发年龄为41~50岁,男女发病比例为1∶5.3,甲状腺功能异常者占总数的54.45%,甲状腺超声检查发现单发结节占46.53%,多发结节占53.47%;63例行超声引导下细针穿刺活检,其中良性病变占总数的87.30%;不确定及可疑恶性病变占总数的9.52%。结论:甲状腺结节在几乎所有年龄段均有发病,甲状腺结节患者甲状腺功能异常约占一半,甲状腺超声在诊断中常被列为首选检查,超声引导下细针穿刺活检更是对良恶性鉴别有重要价值,有助于甲状腺结节术前评估。     

血清TSH水平与血脂异常的相关性研究

目的 探讨亚临床甲状腺功能减退(甲减)以及甲状腺功能正常的人群中TSH水平与血脂谱之间的关系.方法 2007年在沈阳市大东区进行糖尿病及甲状腺疾病的整群抽样调查,其中包括亚临床甲减110例和1 240名甲状腺功能正常者进入研究,研究对象既往无甲状腺病史,未服用影响甲状腺功能和调节血脂的药物.检查项目包括甲状腺功能、血脂、空腹血糖、胰岛素等.结果 (1)亚临床甲减患者高密度脂蛋白胆固醇(HDL-C)水平低于甲状腺功能正常组.(2)按照<中国成人血脂异常诊治指南>将人群分组,在超重的人群中(体重指数≥24.0 kg/m2),高低密度脂蛋白胆固醇(LDL-C)组的TSH水平明显升高[(3.07±0.27对2.41±0.11)mU/L,P=0.027],这种差异在超重女性组中更加明显.甲状腺功能正常且超重的人群中,TSH与总胆固醇呈正相关,且这种相关性不受稳态模型评估的胰岛素抵抗指数(HOMA-IR)的影响.(3)在女性中,TSH与甘油三酯呈正相关,与HDL-C呈负相关.在超重的女性组中,TSH与总胆固醇、LDL-C呈正相关,且经过年龄、性别、体重指数等因素的校正后相关性仍然存在.结论在甲状腺功能正常及亚临床甲状腺功能减退症人群中,TSH升高为血脂异常的危险因素,且独立于胰岛素抵抗.

Abstract：

Objective To investigate the relationship between serum thyrotrophin(TSH)and dyslipidemia in subclinical hypothyroid and euthyroid subjects. Methods An epidemiological study on diabetes and thyroid diseases was performed in Dadong community, Shenyang city, in 2007. 110 subjects with subclinical hypothyroidism(SCH)and 1 240 euthyroid subjects were enrolled in the study. Neither history of thyroid diseases nor administration of thyroid-related and lipid-regulating medicines were reported in these subjects. The levels of serum thyroid hormones, lipids, fasting plasma glucose(FPG), and insulin were determined. Results (1)Patients with SCH had significantly lower HDL-C levels than those who were euthyroid.(2)According to the guideline of treatment of adult dyslipidemia in China, the lipid profiles were each categorized. Mean TSH levels were higher in subjects in the dyslipidemia subclass than subjects in the normal subclass. The differences were significant in high LDL-C subclass in overweight individuals. In euthyroid overweight women, mean TSH levels were significantly higher in high LDL-C subclass. In the euthyroid population, TSH was positively associated with total cholesterol in overweight population. The association was not modified by the homestasis model assessment for insulin resistance(HOMA-IR)values.(3)TSH was associated positively with serum triglycerides and negatively with serum HDL-C in women. TSH was positively associated with total cholesterol in overweight population and positively associated with total cholesterol and LDL-C in overweight women after adjustment for age, sex, and body mass index. Conclusion Raised serum TSH seems to be a risk factor of dyslipidemia in subclinical hypothyroid and euthyroid subjects, which is independent of insulin sensitivity.