成人亚临床甲状腺功能减退症替代治疗疗效观察

目的探讨左旋甲状腺素替代治疗成人亚临床甲状腺功能减退症（亚临床甲减）的临床疗效。方法成人亚临床甲减46例，在诊断初和经左旋甲状腺素治疗4周、12周时分别测定空腹血清总甲状腺素（TT4）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）。结果亚临床甲减可致血脂增高，替代治疗12周后，甲状腺功能逐渐恢复正常，TC、LDL-C明显下降，HDL无明显变化。结论亚临床甲减患者接受左旋甲状腺素替代治疗可使甲状腺功能逐渐恢复正常，并可带来临床症状及血脂改善等益处。故对高危人群的筛查及针对性地行左旋甲状腺素替代治疗是必要的。     

重组人促甲状腺激素和促再分化药物在分化型甲状腺癌中的应用

131Ⅰ去除术后残留甲状腺组织和131I治疗转移灶是分化型甲状腺癌(DTC)联合治疗方案中的重要组成部分。治疗前,最关键的准备是使促甲状腺激素(TSH)升高到适合的水平。重组人促甲状腺激素(rhTSH)可以有效地使血清TSH水平升高,rhTSH与内源TSH有相同的结构和生物活性,应用rhTSH副作用轻微,并可避免因停用甲状腺激素治疗而使患者出现的甲减症状。部分DTC患者的癌灶会发生失分化,造成病情恶化、预后变差,并对131Ⅰ治疗不再敏感。以异维甲酸为代表的促进再分化药物的研究已进入Ⅱ期临床阶段,取得了一定的突破,成为失分化DTC患者131Ⅰ治疗前准备的重要手段。     

甲状腺功能减退症合并血脂异常的研究进展

甲状腺功能减退症（简称甲减）常合并血清胆固醇和甘油三脂水平升高等血脂异常,是动脉粥样硬化性心血管疾病最主要的危险因素之一,严重影响患者的生活和生存质量。笔者就近年来有关甲状腺激素对血脂代谢的调节、临床及亚临床甲减对血脂的影响、甲减合并血脂异常的治疗等的研究进展进行综述,以期为甲减合并血脂异常的防治提供参考。     

甲状腺功能检测异常954例结果分析

目的了解我院周边人群甲状腺功能异常的情况。方法采用酶联免疫法对2009年1月-2013年12月来我院检查甲状腺功能的患者血清游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)及促甲状腺激素(TSH)进行检测,对954例检测异常的结果进行分析。结果在检测出的954例异常病例中,女性病例数显著多于男性,各异常类型的比例大小依次为甲亢>亚临床甲亢>亚临床甲减>甲减。原发性甲亢、甲减、继发性甲亢、甲减的例数分别为208、25、36、4,还有167例甲亢和56例甲减的类型无法做出判断。结论我院周边人群甲状腺功能异常类型以甲亢为主,男性患病率低于女性;甲功三项检测有其局限性,临床医生应结合其他检查作出诊断。     

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。     

解读美国甲状腺协会和临床内分泌医师协会2011年甲亢诊治指南

最近,美国甲状腺协会和临床内分泌医师协会联合发表了甲亢诊治指南,总共提出了100项指南性的参考建议.该指南系统介绍了甲亢的诊断和治疗,重点强调了131I治疗、抗甲状腺药物治疗和手术治疗的适应证、禁忌证、治疗准备、治疗方法和随诊策略,并详细介绍了儿童甲亢、妊娠期甲亢、甲亢突眼和一些少见甲亢的诊治原则.     

老年恶性肿瘤患者甲状腺功能状态及化学药物疗法对其的影响

目的探讨老年恶性肿瘤患者的甲状腺功能状态及化学药物疗法（简称化疗）对其甲状腺功能的影响。方法选取2010-01至2014-02确诊的老年恶性肿瘤患者398例,并选择400例体检老年人群作为健康对照组,进行甲状腺激素（thyroid hormone,TH）和促甲状腺激素（thyroid stimulating hormone,TSH）水平测定。将激素水平正常,KPS（Karnofsky）评分〉60的老年恶性肿瘤患者分为：肿瘤治疗组132例,肿瘤对照组129例。两组年龄、KPS评分无统计学差异。肿瘤治疗组患者进行相应化疗,观察治疗前及治疗后6个月的TH和TSH水平,肿瘤对照组仅给予对症治疗,同期比较两组TH和TSH水平,分析化疗对老年恶性肿瘤患者甲状腺功能的影响。结果 398例老年恶性肿瘤患者的TH、TSH与健康对照组相比差异无统计学意义（P〉0.05）。肿瘤治疗组患者的TH、TSH与肿瘤对照组相比,TSH的差异存统计学意义（P〈0.05）。肿瘤治疗组中甲状腺功能减退（甲减）的比例为7.58%,亚临床型甲减的比例为23.48%。肿瘤对照组中甲减的比例为5.65%,亚临床甲减的比例为5.65%。两组比较,亚临床型甲减的发生率存在统计学差异（P〈0.05）。结论老年恶性肿瘤患者的甲状腺功能异常发生率与健康群体比较无统计学差异,化疗对老年恶性肿瘤患者的甲状腺功能有一定的影响。     

人血清TRAb酶联免疫吸附试验检测在甲状腺疾病患者中的临床应用

目的 探讨促甲状腺激素受体抗体（TRAb）水平对健康人和不同甲状腺疾病患者的临床意义.方法 分别以重组人促甲状腺激素受体（TSHR）膜外区氨基（N）端蛋白和羧基（C）端蛋白作为抗原建立N法和C法,分别检测89名健康者（正常对照组）和254例各种甲状腺疾病患者的血清TRAb水平,组间血清TRAb水平比较采用方差分析,组间阳性率比较采用x2检验.结果 应用N法检测发现：89名健康者405 nm处的光吸收值（（x）±s）为0.511±0.135,阳性切限值（（x）±2s）为0.789,阳性率为4.5％（4/89）;初发Graves病（毒性弥漫性甲状腺肿）患者及Hashimoto甲状腺炎伴甲状腺功能减退症（简称甲减）患者405 nm处的光吸收值（（x）±s）分别为：0.95±0.30、0.61±0.22,高于健康者（F=2.4851和2.0763,P均＜0.05）;N法对初发Graves病患者、治疗中的Graves 病患者、Graves病治疗恢复期患者、Hashimoto甲状腺炎伴甲减患者检测的阳性率分别为73.2％、55.9％、32.1％、45.0％,与正常对照组阳性率之间的差异均有统计学意义（x2=68.55、56.45、20.71和25.51,P均＜0.05）;初发Graves病患者阳性检出率高于Hashimoto甲状腺炎伴甲减患者（x2=4.63,P＜0.05）,初发Graves病患者与Graves病治疗恢复期患者阳性率之间的差异有统计学意义（x2=15.94,P＜0.05）.应用C法检测发现：89名健康者405 nm处的光吸收值（（x）±s）为0.507±0.142,阳性切限值（（x）＋2s）为0.791,阳性率为3.4％（3/89）;Hashimoto甲状腺炎伴甲减患者及初发Graves病患者405 nm处的光吸收值（（x）±s）为1.18±0.25、0.78±0.25,明显高于健康者（F=3.8164和2.4539,P＜0.05）;C法对Hashimoto甲状腺炎伴甲减患者、初发Graves病患者、治疗中的Graves病患者、Graves病治疗恢复期患者检测的阳性率分别为：75.0％、46.3％、23.6％、16.1％,与正常对照组阳性率之间的差异均有统计学意义（x2=66.34、36.87、15.79和7.30,P均＜0.05）;Hashimoto甲状腺炎伴甲减患者阳性检出率明显高于其他患者（x2=4.48、19.70和23.68,P均＜0.05）.结论 应用N法和C法检测Graves病和Hashimoto患者血清TRAb水平均有重要意义,可用于临床Graves病和Hashimoto甲状腺炎伴甲减患者的诊断、治疗及疗效的评估.     

左旋甲状腺素治疗不同促甲状腺激素浓度老年亚临床甲状腺功能减退患者临床观察

目的分析促甲状腺激素(TSH)浓度因素对应用左旋甲状腺素治疗老年亚临床甲状腺功能减退患者的疗效影响。方法选取海军总医院内分泌科自2015年10月至2016年10月收治的老年亚临床甲状腺功能减退患者118例,根据TSH水平分为低TSH对照组(n=42)、低TSH治疗组(n=44)和高TSH治疗组(n=32)。低TSH对照组给予六味地黄丸治疗,低TSH治疗组及高TSH治疗组给予左旋甲状腺素。对比分析3组患者治疗前及治疗后甲状腺激素水平、血脂参数及左心室功能指标。结果与低TSH对照组比较,低TSH治疗组及高TSH治疗组治疗后血清游离三碘甲状腺原氨酸及血清游离甲状腺素升高,且TSH降低水平存在明显差异(P<0.05);治疗后,低TSH治疗组总胆固醇、甘油三酯、低密度脂蛋白胆固醇较低TSH对照组降低,而其高密度脂蛋白胆固醇较低TSH对照组升高,两组间比较,差异均有统计学意义(P<0.05);高TSH治疗组左心室舒张末期内径、左心室收缩末内径降低水平均高于其余2组,而其左室射血分数均低于其余2组,差异均有统计学意义(P<0.05)。结论对于TSH>10 m U/L老年患者,应用左旋甲状腺素治疗可得到较好疗效;而TSH在4.8~10 m U/L老年患者,应根据临床症状及抗甲状腺抗体等相关实验室检查结果,综合考量。     

分化型甲状腺癌术后131I治疗及诊断性显像前提高TSH水平的方案及其影响

分化型甲状腺癌(DTC)术后131I治疗及诊断性显像前较高水平的促甲状腺激素(TSH)能增强131I疗效和提高显像灵敏度。提高TSH的方案主要包括甲状腺激素撤退（THW）及重组人TSH,但THW引起的急性甲状腺功能减退将导致血脂代谢异常、肾功能受损、心血管疾病和神经精神疾病,对患者的生活质量造成显著影响。笔者就目前应用于临床的两种提高TSH的方案及其对DTC患者临床和生活质量的影响进行综述。     

A radiologist’s guide to the clinical scales used in the 2015 Endovascular Stroke Trials and the Revised American Heart Association/American Stroke Association Guidelines for Endovascular Stroke Treatment

In 2015, five trials demonstrated the efficacy of endovascular treatment for acute stroke, culminating in the revised American Heart Association/American Stroke Association (AHA/ASA) recommendations for stroke management. The different clinical scales used in these trials may be unfamiliar to emergency and on-call radiologists. The modified Rankin Scale was used to describe patient disability for prestroke assessment in three of the trials and for the 90-day follow up in all five trials. The Barthel index was used in one trial to score prestroke ability to perform activities of daily living. The NIH Stroke Scale was used as part of eligibility criteria in four of the stroke trials to assess pre-existing neurological deficits. Also, the modified Rankin Scale and the NIH Stroke Scale are used in the revised AHA/ASA recommendations. By understanding these scales, emergency and on-call radiologists will better appreciate the stroke patient’s condition and will be able to more actively collaborate in the care of acute stroke patients.     

老年女性甲状腺功能减退的骨代谢改变

目的　通过观察青年、老年健康女性及老年女性原发性甲状腺功能减退 (甲减 )患者的骨代谢指标的变化 ,探讨增龄、绝经及甲减对骨代谢的影响。方法　分别测定 3 0例女性青年、40例女性老年健康人及 3 0例老年女性甲减患者的骨密度 (BMD) ,血清雌二醇 (E 2 )、碱性磷酸酶 (ALP)、骨钙素 (BGP)、酸性磷酸酶 (ACP)、降钙素 (CT)、甲状旁腺激素 (PTH)、钙 (Ca)、磷 (P)等进行比较。结果　老年甲减组的股骨颈、股骨三角、股骨粗隆和腰椎较青年及老年健康组BMD均低 ,差异有显著性 ,老年甲减组血清ALP ,BGP ,CT较老年健康组低 (P <0 .0 5 ) ,血清ALP ,BGP与游离甲状腺素 (FT4)呈显著正相关 ,与血清促甲状腺素 (TSH)呈显著负相关。结论　BMD减低的原因不仅与增龄、绝经有关 ,原发性甲减时BMD减低还可能是肠钙吸收减少 ,骨形成缓慢 ,骨吸收增加共同作用的结果。     

Hashimoto's thyroiditis and the role of selenium. Current concepts

Hashimoto's thyroiditis (HT) is part of the spectrum of autoimmune thyroid diseases. Clinical manifestations of HT are variable and commonly include diffuse or nodular goiter with euthyroidism, subclinical hypothyroidism and permanent hypothyroidism. Uncommonly, HT causes acute destruction of thyroid tissue and release of stored thyroid hormones, causing transient thyrotoxicosis (hashitoxicosis). The contribution of methods and techniques of nuclear medicine to diagnosis and differential diagnosis of HT is indisputable. In HT patients with overt hypothyroidism L-thyroxine (L-T(4)) should be given in the usual replacement doses, but in HT patients with a large goiter and normal or elevated serum thyroid-stimulating hormone (TSH), L-T(4) may be given in doses sufficient to suppress serum TSH. Symptomatic patients with hashitoxicosis and low 24-hour thyroid radioactive iodine ((123)I or (123)I) uptake (RIU) may be treated with beta-blockers (as propranolol) and sodium ipodate or iopanoic acid (iodinated contrast agents) that block the peripheral conversion of T(4) to T(3). Recent clinical studies have documented the suppressive effect of selenium treatment on serum anti-thyroid peroxidase concentrations in patients with HT.     

甲状腺功能与血清饥饿素和瘦素水平的相关性研究

目的 观察甲状腺功能亢进症(甲亢)、甲状腺功能减退症(甲减)及正常人血清饥饿素和瘦素水平,并探讨它们与甲状腺功能的关系.方法 采用放射免疫分析法分别检测46例未接受治疗甲亢患者(甲亢A组)、15例131I治疗有效的甲亢患者(甲亢B组)、21例甲减患者和18例正常对照者血清饥饿素及瘦素水平,同时采用全自动化学发光免疫分析法检测血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)水平.结果 (1)甲亢A组的血清饥饿素水平明显低于甲亢B组(t=3.21,P<0.01)、甲减组(t=3.02,P<0.01)和正常对照组(t=3.39,P<0.01);甲亢B组、甲减组和正常对照组之间的血清饥饿素水平比较无显著差异.(2)甲亢A组血清瘦素水平与甲亢B组、甲减组和正常对照组比较无显著差异;甲亢B组、甲减组和正常对照组之间的血清瘦素水平比较无显著差异.(3)血清饥饿素水平与血清兀FT3(r=-0.29,P<0.05)和FT4(r=-0.26,P<0.05)呈负相关,与TSH呈正相关(r=0.36,P<0.05);血清瘦素水平与血清FT3、FT4和TSH无显著相关性.结论 血清饥饿素水平在不同甲状腺功能状态下不同,并与甲状腺激素水平有一定的相关性,而血清瘦素无此作用.     

2015美国心脏协会心肺复苏及心血管急救指南核心更改解读

发布的《2015美国心脏协会心肺复苏及心血管急救指南更新》主要更新点涉及多个方面的内容,包括新增院内成人生存链、修改成人基础生命支持流程、优化了胸外按压的速率及深度、简化复苏药物的使用等方面。作者就最主要的更新点进行解读。     

Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association

OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. PROCESS: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.     

Celebrating 40 years of the achievements of the American Association for Women Radiologists

For the past 40 years the American Association for Women in Radiology (AAWR) has continued to support efforts to achieve its founding goals of improving the visibility of women in radiology, advancing the professional and academic standing of women in radiology, and identifying and addressing issues faced by women in radiology. In the past 5 years, the AAWR has made great strides to support women in radiology through amplifying the voices of women heard at the American College of Radiology (ACR) Annual Meeting, initiating the AAWR Research & Education Capital Campaign, establishing the fellows of the AAWR, and advocating for practicing radiologists and trainee parental leave. The many accomplishments of the AAWR over the past 40 years and the committed future work of the AAWR ensure the voices of women in radiology are heard and the needs of women in radiology are recognized.     

美国腹部放射学会及美国胰腺协会关于胰腺导管腺癌放射学共识解读

胰腺导管腺癌是一种高死亡率的侵袭性恶性肿瘤。薄层多层CT是最有效的术前分期手段。标准化的报告模板能提供完整、准确、标准化的病变分期报告，从而有利于最佳治疗方案的选择，方便临床试验的设计实施和结果比较。解读美国腹部放射学会及美国胰腺协会关于胰腺癌放射学报告模板标准化的专家共识。     

Results of the 2001 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES: The American Association of Academic Chief Residents in Radiology (A3CR2) conducts an annual survey of residency training programs. The survey data allow comparative analyses to be performed among training programs regarding resident education, benefits, clinical demands, and other resident-related issues. MATERIALS AND METHODS: Questionnaires were mailed to all accredited programs registered in the A3CR2 database (150 total programs). The yearly questions address demographic information concerning the individual programs including academic affiliation, number of radiologic examinations performed per resident, changes in the number of residents per program, and financial compensation. The rotating questions, which are revisited every 4 years, focused on preparation for the American Board of Radiology examinations, educational issues, and employment outlook. RESULTS: Completed surveys were received from 55 programs (37.3%). Among the responses, three issues prevailed: (a) increased number of examinations performed per resident, with resultant decrease in educational time, (b) decreased quality of education in all sections of radiology and decreased number of educational conferences, and (c) improved employment outlook, but continued trend of fewer residents choosing a career in academics. CONCLUSION: The current boom in the radiology job market and the increased number of radiologic examinations performed annually appear to adversely affect radiologic education through a decreased number of conferences and an increased number of radiologic examinations performed per resident.