Graves病表观遗传学的进展

Graves病（GD）又称毒性弥漫性甲状腺肿,是引起甲状腺功能亢进最常见的原因。最近研究表明遗传易感性和环境诱发因素的相互作用被认为是导致GD发病的关键原因;而表观遗传学是环境与遗传之间的桥梁,越来越多的证据表明表观遗传修饰,包括DNA甲基化、组蛋白共价修饰以及由非编码的RNA分子介导的基因沉默,在GD的发病机制中扮演着重要的角色。本文主要阐述表观遗传学参与GD发病的机制以及相关的临床潜在应用。     

甲状腺动脉栓塞治疗Graves病

目的探讨甲状腺动脉栓塞治疗难治性Graves病的临床应用。方法30例难治性Graves病患者经超选择插管至甲状腺上、下动脉造影,根据动脉管径选择不同直径的聚乙烯醇分步栓塞,并用钢圈加强。栓塞体积达80％以上。结果30例患者栓塞术均成功。栓塞2周后,临床症状消失,甲状腺体积缩小,4周后甲状腺功能正常。随访24～40个月,26例临床治愈,无甲状腺功能减低或甲状旁腺功能减低,突眼无加重。4例复发,其中3例服抗甲状腺药物治疗,1例手术治疗。结论介入栓塞甲状腺上、下动脉治疗难治性Graves病简单、安全、疗效显著,为Graves病的治疗提供了一种有效的新方法。     

^131I治疗Graves病早期反应的观察与护理

Graves病即甲状腺功能亢进症，是一种常见的内分泌系统疾病。目前主要治疗方法有抗甲状腺药物治疗、手术治疗和放射性核素^131I治疗，其中^131I治疗甲亢以其方法简单、疗效确切已被广大临床医师接受。本研究观察^131I治疗后1周内Graves病患者在心血管、消化系统及甲状腺局部早期反应的发生情况，探讨使患者平稳渡过^131I治疗后早期反应阶段的有效治疗和护理措施。     

Diagnosis and treatment of Lyme disease

Lyme disease is the most common tick-borne disease in the United States. This review details the risk factors, clinical presentation, treatment, and prophylaxis for the disease. Information was obtained from a search of the PubMed and MEDLINE databases (keyword: Lyme disease) for articles published from August 31, 1997, through September 1, 2007. Approximately 20,000 cases of Lyme disease are reported annually. Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk. Children and those spending extended time outdoors in wooded areas are also at increased risk. The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus). Typically, the tick must feed for at least 36 hours for transmission of the causative bacterium, Borrelia burgdorferi, to occur. Each of the 3 stages of the disease is associated with specific clinical features: early localized infection, with erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias; early disseminated infection (occurring days to weeks later), with neurologic, musculoskeletal, or cardiovascular symptoms and multiple erythema migrans lesions; and late disseminated infection, with intermittent swelling and pain of 1 or more joints (especially knees). Neurologic manifestations (neuropathy or encephalopathy) may occur. Diagnosis is usually made clinically. Treatment is accomplished with doxycycline or amoxicillin; cefuroxime axetil or erythromycin can be used as an alternative. Late or severe disease requires intravenous ceftriaxone or penicillin G. Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients. Preventive measures should be emphasized to patients to help reduce risk.     

克雅病诊治

克雅病（Creutzfeldt—Jakobdisease,CJD）是最常见的人传染性海绵状脑病（tranmissiblespongi—formencaphalopathies,TSE）,后者又称人朊蛋白病（priondisease）,是一类少见的、致死性、亚急性中枢神经系统退行性疾病。     

弥漫性毒性甲状腺肿患者白细胞减少/缺乏的机制及治疗

弥漫性毒性甲状腺肿(Graves病)是内分泌常见疾病,白细胞减少/缺乏是Graves病常见的合并症之一,可以发生在治疗之前和抗甲状腺药物治疗之后,在临床上经常被延误诊断和治疗,有时导致严重感染而使病情加重。本文就近几年来的研究进展,主要对其诊断、发病机制和治疗方面进行综述,着重论述临床如何早期发现与及时治疗。     

Graves 病患者实施临床护理路径的效果探讨

目的 探讨Graves 病患者实施临床护理路径的效果。 方法 选择Graves 病患者66例,将其随机分为观察组和对照组各33例。对照组患者进行常规护理,观察组患者根据临床护理路径表进行护理, 比较2组患者的平均住院费用、平均住院日、满意度。 结果 观察组患者平均住院日和平均住院费用少于对照组,患者健康教育知识掌握情况和满意度好于对照组。 结论 对Graves病患者实施临床护理路径,缩短了患者的住院天数,降低了患者的住院费用,减轻了患者的经济负担,提高了患者的满意度和健康知识水平。     

成人斯蒂尔病诊断与治疗

成人斯蒂尔病（AOSD）是一种自身免疫性风湿病，临床上以发热、关节痛、皮疹、白细胞增高为主要特征，实验室检查主要显示非特异性的炎症反应。非甾体抗炎药联合激素治疗AOSD取得了较好的疗效。本文就AOSD的诊断和治疗进行阐述。     

人类重组粒细胞集落刺激因子治疗抗甲状腺药物所致白细胞减少症疗效观察

目的探讨人类重组粒细胞集落刺激因子(rhG-CSF)对抗甲状腺药物所致白细胞减少症的疗效.方法对我院1996～2001年收治的32例抗甲状腺药物所致的白细胞减少症患者,采用常规升白细胞治疗(对照组)和rhG-CSF治疗(治疗组),观察两组疗效.结果 rhG-CSF具有明显促进白细胞恢复的疗效,其时间长短与白细胞下降的程度有关.对Ⅲ度和Ⅳ度白细胞减少者有效率显著高于对照组.结论 rhG-CSF是治疗抗甲状腺药物所致白细胞减少症的安全、快速、有效的药物.     

568例格雷夫斯病行131碘治疗1年随访研究

目的：探讨个体化131碘(131 I)治疗格雷夫斯病(Graves 病)疗效和观察促甲状腺激素受体抗体(TRAb)及过氧化物酶抗体(TPOAb)对其疗效的影响。方法选取568例首次行131 I 治疗患者,治疗前检测甲状腺功能及相关抗体,结合触诊法经99 m 锝(99 mTc)甲状腺平面显像或超声计算甲状腺质量或容积;根据治疗经验,给予每克甲状腺组织131 I 剂量范围为1.38~4.28 MBq,用以下公式计算131 I 使用剂量：131 I 使用剂量 MBq=甲状腺质量(g)×每克甲状腺组织131 I 剂量(MBq)/24小时摄131 I 率(%),共计随访568例患者,随访时间为1年。结果本研究将痊愈、好转、甲状腺功能减退(甲减)归为有效,131 I 治疗甲状腺功能亢进(甲亢)总体有效率高达98.9%;首次131 I 治疗后1年甲状腺功能恢复正常226例(39.8%),甲亢部分缓解180例(31.7%),甲状腺功能减退156例(27.4%),治疗无效6例(1.1%)。能够有效缓解甲亢性心脏病及周期性麻痹;对于合并突眼的 Graves 病患者,治疗后加用泼尼松能够有效预防突眼恶化;131 I 治疗 TRAb 阴性 Graves 病效果优于 TRAb 阳性患者(P <0.01);131 I 治疗 TPOAb 阳性 Graves 病,甲减发生率高于阴性组(P <0.01)。结论个体化131 I 剂量治疗 Graves 病效果良好,有效缓解甲亢相关并发症;对于TRAb 阳性患者,可适当增加131 I 剂量,提高其疗效;TPOAb 阳性患者可适当减少剂量,避免严重甲减的发生概率。     

Diagnosis and treatment of Paget's disease of bone

Paget's disease of bone (also known as osteitis deformans) is a nonmalignant disease involving accelerated bone resorption followed by deposition of dense, chaotic, and ineffectively mineralized bone matrix. The origin of the disease is unknown, and it is frequently asymptomatic; however, the patient may present with symptoms depending on the bones involved. The most common symptom is pain in the affected bone; neurologic, hearing, vision, cardiac, and oncologic complications are possible. Diagnosis is primarily made by radiographs. Bisphosphonates are the most common treatment.     

Diagnosis and treatment of Paget's disease of bone

Paget's disease of bone (PDB) is a metabolic bone disease characterized by increased bone resorption followed by excessive unregulated bone formation. This results in weakened, deformed bones of increased mass in which the collagen fibres assume a haphazard irregular mosaic pattern instead of the normal parallel symmetry. PDB rarely occurs before middle age and its prevalence increases steadily with age. The overall prevalence in Caucasians is approximately 3%; although it appears to be declining. There is a geographic variation in prevalence, with highest rates found in the UK. PDB affects both men and women, with a slight predominance in men. PDB may be asymptomatic or symptomatic, depending on the bones involved; the most common symptom is pain in the affected bone. While its aetiology remains elusive, genetic factors and environmental influences are implicated. In 2002, guidelines for PDB management were developed in Great Britain and have gained worldwide acceptance. In this position paper, an Expert Panel of Canadian endocrinologists and rheumatologists examines current evidence on the diagnosis and treatment of PDB to provide Canadian recommendations. In general, diagnosis may be confirmed both by X-ray and by the biochemical marker serum alkaline phosphatase, which is elevated in 85% of individuals with untreated active PDB. Treatment is indicated for all patients with symptoms and for asymptomatic patients with active PDB in areas of the skeleton with the potential to produce complications of clinical importance. The Panel recommends treating PDB with bisphosphonates that have demonstrated superior efficacy and remission rates.