甲状腺功能亢进症与妊娠

本文研究甲状腺功能亢进症(甲亢)伴妊娠的安全性,无论是妊娠或哺乳,首选丙基硫氧嘧啶,也可用他巴唑;调整抗甲状腺药物(ATD)剂量,以游离T_4为指标.甲亢患者应选择妊娠时机.妊娠早期病情会加重,ATD剂量需增加,晚期由于免疫耐受,甲亢可缓解,需减少剂量或停药,产后甲亢易复发.     

甲状腺功能亢进症与妊娠

本文研究甲状腺功能亢进症（甲亢）伴妊娠的安全性,无论是妊娠或哺乳,首选丙基硫氧嘧啶,也可用他巴唑;调整抗甲状腺药物（ATD）剂量,以游离T4为指标。甲亢患者应选择妊娠时机。妊娠早期病情会加重,ATD剂量需增加,晚期由于免疫耐受,甲亢可缓解,需减少剂量或停药,产后甲亢易复发。     

妊娠甲亢综合征

<正>前文已对妊娠期间甲状腺功能亢进症做了介绍,引起甲亢的原因很多,其原因之一是妊娠早期由于绒毛膜促性腺激素(HCG)过多分泌,刺激TSH受体所引起的甲亢,称为妊娠甲亢综合征(Syndrome of gestational hyperthyroidism,SGH)。特点是一过性高甲状腺素血症(GTT),故也称一过性高甲状腺素血症~([1])。在《妊娠期和产后甲状腺机能障碍的处理指南》中,提到其发生率为0. 5～10/1000。     

B超及总T3、总T3/总T4在鉴别Graves病和桥本病甲状腺功能亢进中的应用

Graves病(GD)是引起甲状腺功能亢进(甲亢)的主要病因。典型GD诊断不难，不典型者需和桥本病(HD)引起的一过性甲亢鉴别。吸^131I率是鉴别两者的“金指标”。由于吸^131I率检查耗时长，一般需要24h，且需专门设备和场地，此外，病人在妊娠、哺乳、碘致甲亢等情况下，不宜做此检查，在这些方面，B超独具优点。近年人们用彩色多普勒血流显像观察到GD患者的甲状腺血流丰富；HD的非甲亢期甲状腺血流不增加，甲亢期则血流丰富。     

Graves病患者血清氨基端-脑钠肽前体水平的变化

目的 研究Graves病(GD)甲亢患者血清氨基端.脑钠肽前体(NT-proBNP)的变化特点及临床意义.方法 入选GD患者269例,其中初发患者90例.测定血清甲状腺激素、促甲状腺素受体抗体(TRAb)和NT-proBNP水平.结果 血清NT-pmBNP与FT3(r=0.260,P<0.01)、FT4(r=0.297,P<0.01)和心率正相关(r=0.251,P<0.05);与超敏TSH(sTSH)负相关(r=-0.157,P<0.01).校正年龄、性别和体重指数(BMI)后,血清NT-pmBNP仍与FT3、FT4和TRAb正相关(均P<0.01).校正血清FT3,FT4、sTSH、TRAb、年龄、性别、BMI后,初发组和治疗组的血清NT-proBNP差异仍有统计学意义(P<0.01),血清FT4对NT-pwBNP有显著影响(P<0.01),NT-proBNP水平的升高在甲亢已经控制的患者中同样存在.结论 GD患者血清NT-pwBNP水平随着FT4的升高而明显上升,不受性别、年龄和BMI的影响.监测血清NT-pmBNP有助于了解GD患者的血管僵硬度和容量变化,为早期防治甲亢引起的心血管疾病提供依据.     

彩色多普勒显像在甲亢鉴别诊断中的应用

检测20例Graves病(GD)甲亢和19例非GD甲亢患者的甲状腺131I吸收率并用彩色多普勒血流显像(CDFI)测定甲状腺上动脉的收缩期最高血流速度(Vmax)和动脉舒张期内径宽度(φ)。GD组Vmax和φ明显高于非GD组。CDFI对GD的鉴别诊断有帮助。     

甲亢与糖尿病

甲状腺功能亢进(甲亢)和糖尿病是两个最常见的内分泌疾病。 弥漫性甲状腺肿伴甲亢(Grares’病,GD)约占甲亢的88％,GD与糖尿病的相关性成为关注热点。 GD患者常伴有不同程度的糖尿病代谢紊乱。GD病人口服葡萄糖耐量试验结果显示:口服葡萄糖后30分钟达血糖峰值,在40分钟及120分钟血糖值较正常人均有增高,故患者常有糖耐量低减(IGT),且甲亢病程越长,年龄越大,更易发生IGT。甲亢治愈后,糖耐量也随之恢复。有报道甲状腺激素水平与内生糖呈正相关,提示糖耐量异常程度与甲亢严重度密切相关。     

甲亢与妊娠

妊娠妇女患甲亢者颇为多见。妊娠时甲亢(尤其新发早期病例)在诊断上存在一定困难。甲亢与妊娠对孕妇和胎儿均不利,如诊断不及时或治疗不当,则易发生流产、早产、死胎、新生儿甲亢和妊娠中毒症等。故应及时诊断、妥善处理。一、甲亢合并妊娠的诊断:     

老年甲状腺功能亢进症的管理

近年来随着生育率下降和预期寿命延长,中国老年人口占比急剧增加.甲状腺功能亢进症(甲亢)作为常见的内分泌疾病,在老年人群中并不少见.碘充足地区老年甲亢以Graves病(Graves'disease,GD)为主,碘缺乏地区则以毒性多结节性甲状腺肿(toxic multinodular goiter,TMNG)更常见.老年甲...     

131I治疗甲状腺机能亢进症286例临床分析

1999～2004年,我科应用131I治疗甲状腺机能亢进症(甲亢)286例,取得了较好的效果.现报告如下. 临床资料:286例甲亢患者,男85例、女201例,年龄14～78岁、平均40.6岁.其中毒性自主功能性甲状腺结节(AFTN)8例,毒性多结节性甲状腺肿(TMNG)20例,Graves病(GD)258例(由原发性甲状腺机能减退症转化GD1例).     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

高血压降压治疗目标的再认识

根据传统的高血压水平的定义,1993年WHO高血压治疗指南提出血压控制目标为<140/90mm Hg(1mm Hg=0.133kPa),但是并非所有患者都必须将血压降至同一水平,而应根据患者情况进行个体化治疗。Framingham进行的一项长达10～12年的心血管事件研究发现,第5年后,正常上限血压[收缩压(SBP     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.