INS患儿血甲状腺激素水平与糖皮质激素受体的关系

特发性肾病综合征（ＩＮＳ）时甲状腺激素（ＴＨ）水平的变化已引起关注。国内外文献报道，部分ＩＮＳ患儿血中的ＴＨ水平是低下的，原因是ＴＨ及与ＴＨ结合的甲状腺激素结合球蛋白，白蛋白，甲状腺激素结合前白蛋白从尿中丢失。动物实验证明，甲状腺功能减退时，组织糖皮质激素受体（ＧＣＲ）水平是降低的，而予ＴＨ替代处理可提高组织ＧＣＲ水平，有报道ＧＣＲ水平高低与糖皮质激素（ＧＣ）疗效密切相关，ＧＣＲ水平高者，ＧＣ的疗     

INS患儿血甲状腺激素水平与糖皮质激素受体的关系

特发性肾病综合征（ＩＮＳ）时甲状腺激素（ＴＨ）水平的变化已引起关注。国内外文献报道，部分ＩＮＳ患儿血中的ＴＨ水平是低下的，原因是ＴＨ及与ＴＨ结合的甲状腺激素结合球蛋白、白蛋白、甲状腺激素结合前白蛋白从尿中丢失。动物实验证明，甲状腺功能减退时，组织糖皮质激素受体（ＧＣＲ）水平是降低的，而予ＴＨ替代处理可提高组织ＧＣＲ水平。有报道ＧＣＲ水平高低与糖皮质激素（ＧＣ）疗效密切相关，ＧＣＲ水平高者，ＧＣ的疗效好，反之不敏感，疗效差。如能证实ＩＮＳ患儿（尤其是婴幼儿）对ＧＣ治疗无反应与甲状腺功能减退所致ＧＣＲ下降有关，则补充ＴＨ将有助于改善患儿对ＧＣ的反应，对及时缓解病情有利。     

临界性先天性甲状腺功能减退症3年随访结果

研究目的是确定临界性先天性甲状腺功能减退症（ＢＣＨ）婴儿在甲状腺素（Ｔ４）替代治疗３年后持续性甲状腺功能减退（简称甲减）的发病率。 对象和方法　对１９８８～１９９７年美国纽约州某研究所附属医院的ＢＣＨ患儿的临床资料进行回顾性分析。ＢＣＨ诊断标准为：（１）新生儿筛查Ｔ４低于第十百分位,促甲状腺激素（ＴＳＨ）＜４０ｍＵ／Ｌ;（２）血清基础ＴＳＨ高于相应年龄正常值,但低于２０ｍＵ／Ｌ或促甲状腺激素释放激素（ＴＲＨ）刺激试验中ＴＳＨ峰值＞３５ｍＵ／Ｌ。除外母亲有甲状腺疾病的中枢性甲减患儿和早产儿,有１４…     

胰岛素依赖型糖尿病患儿甲状腺功能的观察

本文通过观察１５例胰岛依赖型糖尿病（ＩＤＤＭ）患儿的甲状腺功能的变化，并与１０例正常同龄儿对作照，结果表明，糖尿病组血清Ｔ３，Ｔ３／ｒＴ３比值均显著低于正常对照组（Ｐ＜０．０１），ｒＴ３显著高于对照组（Ｐ＜０．０１），Ｔ４、ＴＳＨ两组无明显差异。但Ｔ４随空腹血糖（ＦＢＧ）的增高有下降趋势，并发现随着糖尿病临床症状及其并发症的控制，其甲状腺激素可以恢复正常，作者认为，单纯以ＦＢＧ不能完全反映其代谢状     

甲状腺素结合球蛋白缺乏致婴儿持续性甲低

婴儿甲状腺素结合球蛋白（ＴＢＧ）缺乏的发生率为１／５０００～１／１２０００,可造成甲状腺素（Ｔ４）、三碘甲腺原氨酸（Ｔ３）总量降低,游离甲状腺激素正常,无需另外补充。如新生儿Ｔ４低、促甲状腺素（ＴＳＨ）和游离Ｔ４（ｆＴ４）正常即可确诊。ＴＳＨ测定可发现早期甲低但不能发现ＴＢＧ缺乏。现报告１例ＴＢＧ缺乏致持续性甲低的婴儿。 病例男婴,足月,正常产,生后第２天甲状腺筛查试验异常（Ｔ４４３μｇ／Ｌ）,ＴＳＨ １４．１ＩＵ／Ｌ（先天性甲低早期＞２９Ｉ／Ｌ）。生后第９天 Ｔ４ １８μｇ／Ｌ,ＴＳＨ１２．３ＩＵ…     

早产儿血清甲状腺激素的测定及临床意义

本文通过观察１８例患非甲状腺疾病（简称ＮＴＩ）的早产儿的甲状腺功能（ＦＴ３、ＦＴ４、ＴＳＨ）的变化，并与２０例正常早产儿作了对照，结果表明患ＮＴＩ的早产儿ＦＴ、ＦＴ４显著低于对照组（Ｐ＜０．０５），而ＴＳＨ两组无明显差异。并发现所有患儿均呈低甲状腺素血症，而无ＴＳＨ升高。提示投予适量的甲状腺激素有助于ＮＴＩ的早产儿的治疗和恢复。     

铁缺乏症患儿血清甲状腺素,生长激素胰岛素水平的动态观察

本文测定了５７名铁缺乏症患儿铁剂治疗前后血清Ｔ３、Ｔ４、ＴＳＨ、ＧＨ和ＩＮＳ含量，并与健康对照组进行比较。结果表明，铁缺乏患儿血清Ｔ３、Ｔ４、ＧＨ含量明显低于对照组者，血清ＴＳＨ、ＩＮＳ水平则显著升高。铁剂治疗后随着铁营养状况的改善，上述各指标均恢复正常。表明铁缺乏可影响体内某些激素的代谢，其原因可能与参与激素代谢的含铁酶活性在铁缺乏时减低有关。     

新生儿依赖维生素K凝血因子活性的动态观察

新生儿依赖维生素Ｋ凝血因子活性的动态观察楼金吐，俞锡林，孔宏伟浙江医科大学附属儿童医院ＴＨＥＣＨＡＮＧＩＮＧＰＡＴＴＥＲＮＯＦＶＩＴＡＭＩＮＫ－ＤＥＰＥＮＤＥＮＴＦＡＣＴＯＲＳＩＮＮＥＯＮＡＴＥＳ￥ＬｏｕＪｉｎｔｕ，ｅｔａｌ．（Ｉｎｓｔｉｔｕｔｅｏｆ...     

风湿热,风湿性心脏病与血脂关系的探讨

报告风湿热（ＲＦ）和风湿性心脏病（ＲＨＤ）患儿５３例，正常对照８１例，均检测其血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）。结果：ＲＦ／ＲＨＤ组的ＴＣ、ＴＧ、ＨＤＬ－Ｃ明显低于对照组，其相对危险度为对照组的３．１５～５．７８倍；ＴＣ、ＴＧ、ＨＤＬ－Ｃ血清值与相对危险度呈反比。提示血中保持一定的ＴＣ、ＴＧ和ＨＤＬ－Ｃ浓度水平，对于预防ＲＦ／ＲＨＤ的发病是有益的。     

转化生长因子β_3对早产大鼠肺表面活性物质蛋白质基因表达的影响及机理

为研究转化生长因子β３（ＴＧＦ－β３）对发育期肺表面活性物质蛋白质（ＳＰｓ）基因表达的影响。利用孕１９天早产大鼠肺组织块及肺Ⅱ型细胞培养，检测ＳＰｓ（ＳＰ－Ａ、ＳＰ－Ｂ和ＳＰ－Ｃ）基因表达。结果：单纯使用ＴＧＦ－β３对ＳＰ－Ａ、ＳＰ－Ｂ、ＳＰ－Ｃ基因表达无明显影响，但ＴＧＦ－β３可明显抑制１００ｎｍｏｌ／ｍｌ地塞米松增加ＳＰ－Ｂ、ＳＰ－Ｃ基因表达的效应，随ＴＧＦ－β３浓度增加抑制显著。ＴＧＦ－β３并非直接作用于肺Ⅱ型上皮细胞，而是以成纤维细胞为介导产生抑制效应。ＴＧＦ－β３对地塞米松增加ＳＰ－Ａ基因表达无影响。提示：ＴＧＦ－β３对肺发育期ＳＰｓ基因表达有抑制作用，糖皮质激素预防新生儿呼吸窘迫综合征效果不理想可能与ＴＧＦ－β３作用有关。     

Thyroid function in fetus and mother during the second half of normal pregnancy

Thyroid hormones, thyroxine-binding globulin (TBG) and thryrotropin (TSH) concentrations were measured in 46 paired fetal and maternal blood samples collected between 17 and 36 weeks of gestation. The samples were selected retrospectively from fetuses that had undergone cordocentesis for prenatal diagnosis, had been found to be unaffected and confirmed healthy at birth. In maternal serum, total thyroxine (TT4) and triiodothyronine (TT3) concentrations were high, but free thyroxine (FT4) and free triiodothyronine (FT3) were within normal adult ranges; reverse T3 (RT3) increased and TSH levels decreased towards term. Fetal TT4, FT4, TT3, FT3, TBG and TSH levels significantly increased whereas RT3 sharply decreased with gestational age. The ratio of fetal TSH/FT4 significantly decreased, suggesting that the set point for negative feedback of pituitary TSH secretion is changing while the sensitivity of the thyroid gland to TSH increases throughout gestation. There was no significant correlation between the maternal and fetal TBG, TSH, TT4 and FT4, whereas maternal TT3 was positively correlated with fetal TT4, FT4, TT3 and FT3. Normal reference values for maternal and fetal iodothyronines, TBG and TSH throughout the second half of gestation provide insight into fetal thyroid development and may be useful for prenatal diagnosis.     

Relationship between serum leptin and thyroid hormones in children

BACKGROUND: Because leptin decreases food intake and increases energy expenditure, the possible influence of thyroid status on the leptin system has been investigated mainly in adults and animals. However, the data available at present are very confusing. The aim of the present study was to assess the possible interaction of thyroid hormones with the leptin system. METHODS: Serum free thyroxine (FT4), a biologically active thyroid hormone, and thyroid stimulating hormone (TSH), a sensitive and reliable index of thyroid status, were examined in 51 children (19 males, 32 females) with mass screening-detected congenital hypothyroidism on continuous L-thyroxine (L-T4) substitution therapy. The subjects were divided into younger (n = 35, aged 1 month-5 years) and older (n = 16, 6 years-11 years) children groups. Serum levels of leptin and thyroid hormones were measured in the subjects. Body mass index (BMI) was estimated by the formula bodyweight (kg)/height x height (m2), which is known as the Kaup index in younger children and BMI in older children and adults. RESULTS: In the younger children group, serum leptin levels showed no correlation with serum TSH, FT4 or T4. In the older children group, serum leptin concentrations significantly correlated with T4 (r = 0.510, P < 0.05) and BMI (n = 16, r = 0.647, P < 0.01), but not with TSH or FT4. CONCLUSION: The role of thyroid hormones in modulating leptin synthesis and secretion seems to have little, if any, clinical or biological relevance.     

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目的探讨心脏疾患及合并充血性心力衰竭(CHF)患儿心衰时,血清甲状腺激素(TH)水平的变化规律及临床意义。方法对2003-09—2006-09山西省阳泉市第一人民医院收治的116例心脏疾病患儿分为2组,心脏病合并CHF组82例,心脏病未合并CHF组34例,以28例健康体检儿童为对照组,均做如下检测及分析:(1)检测CHF患儿血清TH水平,包括三碘甲状腺原氨酸(T3)、游离T3(FT3)、甲状腺素(T4)、游离T4(FT4)、反T3(rT3)及促甲状腺激素(TSH),三组间进行比较。(2)以血清TH水平与心功能进行相关分析。(3)动态观察CHF患儿的血清TH水平,探索其变化规律。结果(1)CHF组与N-CHF组及正常对照组比,血清T3、FT3及FT4均显著降低(P<0.01),rT3显著升高(P<0.01)。(2)随心功能的下降,T3、FT3、T4、FT4渐降低,rT3渐升高。TSH与心功能变化无相关性。(3)CHF组经治疗后血清TH多恢复(P<0.01),顽固性心衰组则无恢复(P>0.05)。结论(1)小儿CHF伴有血清TH的改变,以T3、FT3及FT4的降低,rT3的升高为主,其改变程度与心功能状态具有相关性。(2)随着心功能的改善,TH的改变多渐恢复,顽固性心衰患儿则无恢复,提示TH水平持续不恢复者预后较差。     

Effects of anticonvulsant drugs on thyroid hormones in epileptic children.

Serum total and free thyroid hormones, reverse T3 (rT3), thyroxin binding globulin (TBG) and thyroid stimulating hormone (TSH) concentrations were measured in 35 epileptic patients receiving anticonvulsants (phenobarbitone, phenytoin). There was a significant reduction found in total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), free triiodothyronine (FT3) and rT3 in the group treated with, phenytoin. The thyroid hormone levels were within normal limits in the group receiving phenobarbitone.     

Changes in serum concentrations of thyroid hormones and thyroid hormone-binding proteins during early infancy. Studies in healthy fullterm, small-for-gestational age and preterm infants aged 7 to 240 days.

Serum concentrations of thyrotropin (TSH), thyroxine (T4), triiodothyronine (T3), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were determined in 492 blood samples from 127 fullterm (FT), 91 small-for-gestational age (SGA) and 88 preterm (PT) healthy infants aged 7 to 240 days. Serum T4 decreased about 20% during the first month of life. In infants aged 7--49 days, serum T4 concentrations were significantly lower in SGA than in FT infants, and even lower values were found in PT infants. Serum T3 increased 50--70% reaching maximal values by 50--79 days of life. Serum T3 levels were higher in FT than in SGA infants throughout the observation period. In PT infants serum T3 increased from low values to levels which exceeded those of SGA and FT infants by 120--240 days of life. Serum TSH level did not change with age and was less than or equal to 5 mU/l in all infants. Serum TBG values were high compared to normal adult values and did not change significantly with age. Comparable serum TBG values were found in FT, SGA and PT infants. Serum TBPA increased with age. Serum TBPA increased gradually in FT infants. In SGA infants serum TBPA increased from low values to levels which by 120--240 days of life exceeded those of PT and FT infants. In PT infants a decrease in serum TBPA appeared before the rise commenced. Serum Alb increased gradually in FT, SGA and PT infants during the observation period. Serum Alb in PT infants aged 30--119 days was lower than those in FT infants with similar ages. These physiological changes in serum concentrations of thyroid hormones and hormone-binding proteins during early infancy should be considered when interpreting thyroid function tests in infants with various maturity.     

Influence of anticonvulsant drugs on thyroid hormones in epileptic children

Thyroid function tests were studied in epileptic children undergoing long-term anticonvulsive therapy with phenytoin, primidone or mephenytoin. Serum T4 was decreased in all three treated groups, serum T3 was diminished only in those treated with phenytoin or primidone. FT4 was also significantly decreased while serum TSH and TBG were not affected in the treated patients. The effect of anticonvulsant drugs on thyroid hormone catabolism and peripheral conversion of T4 seems to be important in these alterations.     

Pediatric thyroid testing issues

Thyroid problems are common in children. While serum thyroid function tests lead to an accurate diagnosis in most patients, unique patient situations can produce misleading results. Total T4 measurements can incorrectly suggest hypothyroidism in congenital thyroid binding globulin (TBG) deficiency and hyperthyroidism in TBG excess, as seen in high estrogen states. Free T4 (FT4) measurement techniques involve either physical separation of unbound thyroxine from serum binding proteins or estimation of FT4 levels in the presence of binding proteins. These estimation techniques are susceptible to under- or over-estimation of FT4 levels when binding proteins are low or high. Other complicating factors arise in the setting of prematurity or systemic non-thyroidal illness (NTI), simulating central hypothyroidism. Thyroid stimulating hormone (TSH) levels in children have a wider normal range than in adults and are affected by drugs and NTI. Additionally, heterophile and anti-T4 or anti-TSH antibodies can interfere with accurate T4 or TSH measurement.     

THYROXINE-BINDING GLOBULIN DEFICIENCY IN EARLY CHILDHOOD

ABSTRACT. Jacobsen, B. B., Hansted, L. C, Brandt, N. J., Haahr, J., Hummer, L., Munkner, T. and Sorensen, S. S. (Department of Paediatrics, Viborg Hospital, Children's Hospital Fuglebakken, Department of Paediatrics, Section of Clinical Genetics and Department of Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark). Thyroxine-binding globulin deficiency in early childhood. Postnatal changes in serum concentrations of thyroid hormones and thyroid hormone-binding proteins. Acta Paediatr Scand, 70:155, 1981. –Serial determinations of serum thyroxine (T4), triiodothyronine (T3), thyrotropin(TSH), thyroid hormone-binding globulin (TBG), prealbumin (TBPA) and albumin were performed in a euthyroid girl with TBG deficiency and in her mother for a period of 22 months after delivery. At 8 days old the child had a serum TBG concentration around 50% of normal level which remained essentially unchanged during infancy. Total serum T4 and T3 concentrations were low, the free serum T4, free serum T3 and serum TSH concentrations were normal. The mother had received thyroid hormone from the age of 15 years. Her serum TBG level at 6 weeks post partum was similar to that of non-pregnant adults but decreased to about 50% of normal level, indicating a TBG deficiency. She remained euthyroid after withdrawal of T4 therapy. Serum TBPA and albumin concentrations were normal in mother and child. An X-linked inheritance of the TBG deficiency was suggested from a study of the family.     

Developmental changes in pituitary-thyroid function in the human fetus and newborn

Maturation of the hypothalamic pituitary thyroid axis as reflected in cord serum thyroid hormone concentrations was assessed in premature and full term infants born between 26 and 43 weeks gestation. Measurements of thyroxine (T4), free T4 (FT4), thyrotropin (TSH) and thyroxine binding globulin (TBG) in cord sera were correlated with gestational age, sex and birthweight and compared to similar measurements in well two month old infants and adults.There were significant increases in T4, FT4, and TBG with increasing gestational age (GA) between 26 and 33–35 weeks (P < 0.001). After 34 weeks, none of these parameters varied with GA. When the infants were separated on the basis of sex the linear regression curves describing the relationships between hormone and TBG concentrations and GA were not different from the curves in the total population. The mean FT4/TSH ratio increased significantly with age throughout gestation (P < 0.01) and was significantly lower in cord blood samples than in blood samples from the 2-month-old infants or the adults.The results suggest that the set point for negative feedback control of TSH secretion at the pituitary level is changing between 26 weeks GA and 2 months of life. Thyroid gland sensitivity to TSH stimulation also appears to be increasing between 26 and 33 weeks GA.     

CHANGES IN SERUM CONCENTRATIONS OF THYROID HORMONES AND THYROID HORMONE-BINDING PROTEINS DURING EARLY INFANCY Studies in Healthy Fullterm, Small-for-gestational Age and Preterm Infants Aged 7 to 240 Days

Abstract. Serum concentrations of thyrotropin (TSH), thyroxine (T₄), triiodothyronine (T₃), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were determined in 492 blood samples from 127 fullterm (FT), 91 small-for-gestational age (SGA) and 88 preterm (PT) healthy infants aged 7 to 240 days. Serum T ₄ decreased about 20% during the first month of life. In infants aged 7–49 days, serum T₄ concentrations were significantly lower in SGA than in FT infants, and even lower values were found in PT infants. Serum T ₃ increased 50–70% reaching maximal values by 50–79 days of life. Serum T₃ levels were higher in FT than in SGA infants throughout the observation period. In PT infants serum T₃ increased from low values to levels which exceeded those of SGA and FT infants by 120–240 days of life. Serum TSH level did not change with age and was 5 mU/1 in all infants. Serum TBG values were high compared to normal adult values and did not change significantly with age. Comparable serum TBG values were found in FT, SGA and PT infants. Serum TBPA increased with age. Serum TBPA increased gradually in FT infants. In SGA infants serum TBPA increased from low values to levels which by 120–240 days of life exceeded those of PT and FT infants. In PT infants a decrease in serum TBPA appeared before the rise commenced. Serum Alb increased gradually in FT, SGA and PT infants during the observation period. Serum Alb in PT infants aged 30–119 days was lower than those in FT infants with similar ages. These physiological changes in serum concentrations of thyroid hormones and hormone-binding proteins during early infancy should be considered when interpreting thyroid function tests in infants with various maturity.