左甲状腺素钠片治疗妊娠期甲状腺功能减退症的临床疗效观察

目的 研究左甲状腺素钠片治疗妊娠期甲状腺功能减退症的临床效果。方法 选取2014年1月~2017年12月在我院就诊的妊娠期甲状腺功能减退症患者80例,随机分为观察组和对照组,每组40例。对照组常规使用甲状腺素片治疗,观察组采用左甲状腺素钠片治疗,对比两组患者治疗前后TSH、FT3、FT4的变化,治疗后妊娠并发症（妊高症、产后出血、贫血、流产、早产）情况,以及围产儿不良结局（胎儿宫内窘迫、胎儿畸形、死胎、低体质量）发生率情况。结果 观察组治疗后TSH、FT3、FT4的改善均优于对照组,差异具有统计学意义（P＜0.05）。观察组妊高症、产后出血、贫血、早产发生率低于对照组,差异具有统计学意义（P＜0.05）;观察组治疗后妊娠并发症总发生率为15.00%,低于对照组的55.00%,差异具有统计学意义（P＜0.05）。观察组胎儿宫内窘迫、低体质量发生率低于对照组,差异具有统计学意义（P＜0.05）;观察组围产儿不良结局总发生率为5.00%,低于对照组的27.50%,差异具有统计学意义（P＜0.05）。结论 采用左甲状腺素钠片治疗妊娠期甲状腺功能减退症,可改善血清TSH、FT3、FT4指标,降低妊娠并发症和围产儿不良结局发生率,有利于改善妊娠结局。     

左甲状腺素钠片采用不同初始剂量治疗先天性甲状腺功能减退症的临床观察

目的 探讨分析左甲状腺素钠片采用不同初始剂量治疗先天性甲状腺功能减退症的价值。方法 以2015年7月~2016年6月收治的78例先天性甲状腺功能减退症患者研究,按数字随机法分为对照组和观察组,每组39例。对照组给予左甲状腺素钠片初始剂量为12 μg/（kg·d）,观察组给予左甲状腺素钠片初始剂量为8 μg/（kg·d）,对比两组患者甲状腺功能、生长发育指标及不良反应发生率。结果 观察组TSH水平（1.42±0.59）mU/L低于对照组的（3.77±0.72）mU/L,T4水平（43.19±3.25）nmol/L和FT4水平（163.06±6.22）pmol/L高于对照组的（25.78±2.16）nmol/L、（122.17±5.17）pmol/L,差异具有统计学意义（P＜0.05）;观察组发育指标总分（174.04±4.25）分高于对照组的（168.80±2.91）分,差异有统计学意义（P＜0.05）;观察组患者不良反应发生率12.82%与对照组的17.95%比较,差异无统计学意义（P＞0.05）。结论 甲状腺素钠片以8 μg/（kg·d）对CH患者进行治疗最为理想,可有效改善患者的甲状腺功能,促进其正常发育。     

CHF患者血清甲状腺激素异常及小剂量左甲状腺素钠治疗的效果

目的 探讨慢性心力衰竭（CHF）患者血清甲状腺激素水平及小剂量左甲状腺素钠治疗的效果。方法 选取2016年4月~2018年4月在我院治疗的CHF患者110例作为CHF组,同时选取健康志愿者100例作为正常组;同时根据治疗方案将CHF组分为观察组（52例）和对照组（58例）,对照组给予常规治疗,观察组在对照组的基础给予小剂量左甲状腺素钠治疗。比较各组血清甲状腺激素水平,比较观察组和对照组治疗前后甲状腺激素水平、心功能指标、hs-CRP和IL-6水平及不良反应等。结果CHF组T3和FT3水平低于正常组,差异有统计学意义（P＜0.05）;CHF组和正常组T4、FT4和FSH水平比较,差异无统计学意义（P＞0.05）。治疗后,观察组和对照组T4、FT4和FSH水平比较,差异无统计学意义（P＞0.05）;观察组和对照组T3和FT3均较治疗前升高,且观察组高于对照组,差异有统计学意义（P＜0.05）;观察组和对照组LVEF、CI和SV均较治疗前改善,且观察组LVEF、CI和SV高于对照组,差异有统计学意义（P＜0.05）;观察组和对照组hs-CRP、IL-6均较治疗前改善,且观察组hs-CRP、IL-6低于对照组,差异有统计学意义（P＜0.05）。观察组和对照组未发现有严重并发症发生。结论 CHF患者血清T3和FT3水平低于正常人群,给予小剂量左甲状腺素钠能改善患者甲状腺激素水平和心脏功能,抑制炎症反应,安全性良好,值得临床应用。     

左甲状腺素钠治疗先天性甲状腺功能低下的疗效

目的 探讨左甲状腺素钠治疗先天性甲状腺功能低下的疗效。方法 选取2012年1月~2017年12月在我院接受治疗的先天性甲状腺功能低下患儿210例作为研究对象,所有患儿均接受低剂量左甲状腺素钠治疗。观察患儿甲状腺功能（TSH、FT3、FT4）、智力状况、身高和体重。结果 治疗后患儿TSH水平降低,FT3、FT4水平升高,差异有统计学意义（P＜0.05）;治疗后患儿大运动、精细动作、语言发育和社会适应能力均达到正常水平,经丹佛儿智力筛查84.29%患儿发育商达85分以上,99.52%患儿达70分以上,仅有1例异常;93.81%患儿身高达到正常水平,96.19%患儿体重达正常水平。结论 低剂量左甲状腺素钠治疗先天性甲状腺功能低下效果确切,可以改善患儿的甲状腺功能,促进患儿体格和智力的发育。     

左甲状腺素片在老年甲状腺癌根治术后应用的价值

目的:探讨左甲状腺素片在甲状腺癌根治术后应用的价值。方法:选取2015年12月至2019年1月江苏省人民医院宿迁分院甲状腺癌患者92例,随机数字表法进行分组,每组46例。两组患者均采取甲状腺癌改良根治术,术后研究组加用左旋甲状腺素片辅助治疗。统计两组临床疗效、治疗前及治疗一个月后甲状腺功能指标、免疫功能指标、p27蛋白...     

哌拉西林钠他唑巴坦钠联合左氧氟沙星治疗慢性支气管炎的临床疗效及安全性观察

目的 观察哌拉西林钠他唑巴坦钠（PS/TS）联合左氧氟沙星治疗慢性支气管炎（CB）的临床疗效及安全性。方法 选取2019年1月-2021年5月吉水县人民医院收治的68例CB患者为研究对象,按照随机数字表法分为对照组与观察组,各34例。对照组给予PS/TS治疗,观察组在其基础上加用左氧氟沙星治疗,比较两组临床疗效、症状缓解时间、肺功能[呼气流量峰值（PEF）、最大通气量（MVV）、第1 s用力呼气量（FEV1）]、实验室指标[白细胞（WBC）、中性粒细胞百分比（NEUT）、C反应蛋白（CRP）]、不良反应。结果 观察组治疗有效率较对照组高（P＜0.05）;观察组症状（咳嗽、咳痰、喘息）缓解时间短于对照组（P＜0.05）;两组治疗后PEF、MVV、FEV1均有所升高,且观察组较对照组高（P＜0.05）;两组治疗后WBC、NEUT、CRP水平均有所下降,且观察组较对照组低（P＜0.05）;两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 PS/TS联合左氧氟沙星治疗CB效果确切,可缩短症状缓解时间,改善患者肺功能及实验室指标,且不良反应少。     

氢化可的松在肾上腺皮质功能不全危重患者治疗中的应用

自1855年Addison发现下丘脑-垂体-肾上腺皮质轴（hypothalamic—pituitary—adrenal axis,HPA）以来,随着应激反应机理研究的不断加深,对于糖皮质激素替代疗法的看法也在不断改变。同时,在危重疾病中氢化可的松与炎症因子之间相互作用机制的研究也有了很大的进展。     

左甲状腺素钠片联合厄贝沙坦氢氯噻嗪治疗重症心力衰竭的效果及对心功能、血流动力学的影响

目的 研究左甲状腺素钠片联合厄贝沙坦氢氯噻嗪（IBST/HCZ）治疗重症心力衰竭（SHF）的效果及对心功能、血流动力学的影响。方法 以2019年12月-2022年12月石城县人民医院收治的60例SHF患者为研究对象,采用随机数字表法分为对照组（30例）与观察组（30例）,对照组给予IBST/HCZ治疗,观察组在其基础上联合左甲状腺素钠片治疗,比较两组临床疗效、心功能[左室射血分数（LVEF）、左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）]、血流动力学[中心静脉压（CVP）、平均动脉压（MAP）]、主要不良心血管事件（MACE）、心力衰竭症状状态问卷（SSQ-HF）、明尼苏达心力衰竭生活质量（MLHFQ）评分。结果 观察组治疗总有效率为96.67%,高于对照组的83.33%（P＜0.05）;两组治疗后LVEF大于治疗前,LVESD、LVEDD小于治疗前,且观察组LVEF大于对照组,LVESD、LVEDD小于对照组（P＜0.05）;两组治疗后CVP高于治疗前,MAP低于治疗前,且观察组CVP高于对照组,MAP低于对照组（P＜0.05）;观察组MACE发生率为6.67%,低于对照组的26.67%（P＜0.05）;两组治疗后SSQ-HF、MLHFQ评分均低于治疗前,且观察组SSQ-HF、MLHFQ评分低于对照组（P＜0.05）。结论 左甲状腺素钠片联合IBST/HCZ治疗SHF的效果良好,可改善患者心功能与血流动力学水平,降低MACE风险,减轻心衰症状,进而提升患者生活质量。     

用琥珀酸氢化可的松治疗急性发作哮喘患儿血清皮质醇浓度的观察

通过对长期吸入肾上腺皮质激素的哮喘患儿在哮喘急性发作时静脉注射琥珀酸氢化可的松,并检测治疗前、后血清皮质醇含量,以了解其对肾上腺皮质功能的影响,探讨其应用价值,现报道如下.     

氢化可的松对胎鼠和新生鼠郎格汉斯细胞的影响——酶组化、电镜组化和图像分析

用免疫抑制剂氢化可的松体外处理胎鼠和新生鼠表皮.观察它对郎格汉斯细胞数量和结构的影响.结果如下:(1)经氢化可的松处理的表皮内郎格汉斯细胞数量减少,细胞结构发生退行性变化.(2)图像分析显示,随氢化可的松浓度增大,郎格汉斯细胞数量和ATP酶组化染色反应的灰度逐渐下降.(3)经lmg/ml的氢化可的松处理后,郎格汉斯细胞线粒体肿胀,粗面内质网扩张,细胞膜上的ATP酶反应减弱.但表应用质形成细胞超微结构未见改变.该研究为临床延长移植异体皮片存活期提供了形态学资料.     

Clinical molecular-genetics for endocrine and metabolic diseases

Recently developed methods for the DNA-based diagnosis of endocrine and metabolic diseases, particularly genetic diseases, were reviewed. The molecular-diagnostic methods for a base substitution include the direct sequencing of a mutant gene, detection of a newly made RFLP site, the oligonucleotide method, the segregation analysis with RFLPs based on the linkage between and RFLP-allele and a disease locus, and the DNA/RNA mismatch method. Several examples of families with genetic diseases in which the diagnosis was successfully made are presented. Another gene mutation is a gene deletion. To detect such a deletion, the Southern hybridization method is useful. Several families with a disease, especially those with Duchenne muscular dystrophy, in which the diagnosis with deletion study was successful are presented. Finally, the method of prenatal diagnosis with the DNA technique was reviewed.     

Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis

The purpose of this study was to determine the effectiveness of Lactobacillus -containing vaginal tablets in the treatment of bacterial vaginosis (BV) and in the restoration of a healthy vaginal flora. Thirty-nine women with BV were enrolled in a double-blind, placebo-controlled clinical trial. Patients received either one Lactobacillus -containing tablet or placebo daily for 7 days. Clinical criteria, vaginal Gram stain scores and symptoms were compared with those at the initial visit and those at completion of therapy and 2 weeks later. After completion of therapy, all of the patients in the Lactobacillus -treated group ( n  = 18) were free of BV, showing a normal (83%) or intermediate (17%) vaginal flora, as compared with only two patients free of BV with intermediate flora (12%) from among the 16 placebo-treated women (p   <0.001). Two weeks after completion of therapy, treatment was successful (score <7) in 61% of Lactobacillus -treated patients as compared with 19% of those in the placebo group (p   <0.05). In the treatment group, the total number of symptomatic patients and the intensity of their symptoms, in particular vaginal malodour, were significantly reduced at both follow-up visits. The data indicate that intravaginal administration of exogenous selected strains of lactobacilli can restore a normal vaginal microbiota and be used in treating bacterial vaginosis.     

Validation and application of solid-phase chemiluminescent immunoassays for diagnosis of endocrine diseases in animals

Significant progress has been made in the ability of veterinarians to diagnose endocrine diseases since introduction and development of the radioimmunoassay (RIA) in the 1960s. Alternatives to the radioactive label have been commercialised for human diagnostic applications. Because healthy animals have concentrations of several hormones in serum that are lower than in humans, these non-isotopic assays generally lack the sensitivity for measuring hormones in animals. However, the chemiluminescent enzyme immunoassay may provide this needed sensitivity. We validated the DPC-Cirrus Immulite® automated chemiluminescent immunoassay system for measurement of cortisol in dogs, cats and horses. Serial dilutions of serum inhibited binding of alkaline phosphatase-labelled cortisol in a manner that was parallel with inhibition produced by the stored master calibration curve. Six dogs were injected with adrenocorticotropin (ACTH; 2.2 IU/kg i.m.) and five dogs were injected with dexamethasone (0.015 mg/kg i.v.). Changes in cortisol concentrations measured with the Immulite® were as expected based on published results. Similar tests of biological specificity in other species yielded similar results. Accuracy of the Immulite® cortisol assay was evaluated by comparing cortisol concentrations in serum with concentrations obtained by a validated RIA. The regression equations were: y = 14.6 + 0.8 for dogs (n = 59, r ² = 0.91), y = 13.5 + 0.9 for horses (n = 23, r ² = 0.90), and y = 29.8 + 1. O for cats (n = 18, r ² = 0.96), where y = Immulite® result (nmol/l) and = RIA result (nmol/l). The regression equation for the canine urinary cortisol: creatinine ratio was y = 0.43 + 1.55, where y = ratio calculated from Immulite® cortisol concentrations and = ratio using RIA concentrations (n = 35, r ² = 0.93). Initially, the lower limit of the reportable range by the Immulite® was 27.6 nmol/l, a value that was unacceptable for veterinary diagnostics. After consultation with DPC-Cirrus, we adjusted the lower limit to 1.4 nmol/l. Coefficients of variation for two canine, one feline, and two equine quality-control serum samples included in 73 consecutive Immulite® assays ranged from 0.29 (mean = 29.0 nmol/l) to 0.09 (mean = 261.6 nmol/l). We are using the Immulite® routinely for the diagnosis of adrenal disease in animals and have found it to provide diagnostically useful cortisol results for dexamethasone-suppression and ACTH-stimulation tests. Its diagnostic accuracy on single baseline samples is probably less than for the RIA, particularly at concentrations of cortisol less than 27.6 nmol/l.     

Sleep apnoea in endocrine diseases

The pertinent literature on the prevalence, clinical manifestations and pathogenic mechanisms of sleep apnoea (SA) in endocrine diseases, namely acromegaly, Cushing syndrome, hypothyroidism and diabetes mellitus was reviewed. An increased prevalence is well documented in patients with active and treated acromegaly. While most authors report peripheral obstruction, due to hypertrophy of tongue and pharyngeal tissues, to be the cause of SA in acromegaly, some findings argue for a role of hormone-induced changes of central respiratory control. SA is also more common in hypothyroidism, especially when myxedema is present. The associated edema and myopathy appear to be of pathogenic importance. Thyroxin substitution is frequently effective for the treatment of SA but nCPAP can be necessary initially and in some patients even after remission of clinical signs of hypothyroidism. In Cushing disease and syndrome, parapharyngeal fat accumulation can cause SA, but no epidemiological information is available. In non insulin dependent diabetes (NIDDM), obesity is the common risk factor for both, nocturnal hypoxia and insulin resistance. In IDDM, the development of autonomic neuropathy may predispose to SA. Where treatment of the underlying endocrine disease is unable cure the associated SA, nCPAP is usually the treatment of first choice. More prospective studies are clearly needed to establish prevalences and resolve the controversies regarding pathogenesis.     

miRNA与内分泌代谢病

miRNA是近年来发现的一种内源性短序列非编码单链RNA,成熟的miRNA通过两种依赖于序列互补性的机制引起靶mRNA的降解或者抑制其翻译,在基因表达调控中扮演重要的角色。miRNA与内分泌代谢病关系密切,有潜在的生物治疗价值。