TSH 在急性精神分裂症、单相抑郁症和双相障碍中的浓度水平结果分析

目的：探讨促甲状腺激素（TSH）的浓度水平在急性精神分裂症、单相抑郁症、双相抑郁症和双相躁狂症患者中的差异性。方法在1235位患者中检测T S H血清浓度水平（其中女性781位,占63．2％,平均年龄46．4岁）。结果各疾病平均血清TSH浓度为：精神分裂症（n＝563）1．71mIU／L ,单相抑郁症（n＝478）1．63 mIU／L ,双相障碍（n＝194）1．86 mIU／L ,双相抑郁症（n＝151）2．00 mIU／L ,双相躁狂（n＝53）1．38 mIU／L。根据所用的正常值范围,是高于或低于在正常范围的整体率为精神分裂症7．9％～22．3％,单相抑郁症13．9％～26．0％,双相障碍10．8％～27．6％,双相抑郁症12．2％～28．5％,双相躁狂11．4％～24．5％。我们还发现,在年龄组（≤20岁,＞20岁和≤40岁,＞40岁和≤60岁以及＞60岁）之间的T S H浓度水平差异有显著性。T S H水平与年龄（ r＝－0．23,P＜0．001）相关。随着年龄的变化,其弱相关性已经在精神分裂症（ r＝－0．21,P＜0．001）,单相抑郁症（ r＝－0．23,P＜0．001）,双相抑郁症（ r＝－0．25,P＝0．002）和双相障碍（ r＝－0．21,P＝0．005）中发现。结论甲状腺激素（TSH）的浓度水平在急性精神分裂症、单相抑郁症、双相抑郁症和双相躁狂症患者中的有一定的差异性,所以临床在诊治时要密切监测甲状腺激素（TSH）的浓度水平。     

各类肝硬化患者甲状腺激素检测的意义

目的：讨肝硬化患者血清中三碘甲腺原氨酸（T3）、甲状腺激素游离（T4）、游离T3（FT3）、游离T4（FT4）、促甲状腺激素（TSH）及反T3（RT3）测定的临床意义及评价。方法：T3、T4、TSH、FT3、FT4、rT3采用磁酶免法。结果：与对照组相比，肝炎后肝硬化患者血清T3、FT3浓度明显下降（P〈0．01）；rT3、FT4浓度明显增m／（P〈0．01、P〈0．05）；酒精性肝硬化患者血清中T3、FT3浓度明显降低（P〈0．01），TSH、rT3浓度明显升高（P〈0．01）。结论：联合检测T3、T4、FT3、FT4、RT3、TSH在不同种类肝硬化的鉴别诊断中有一定的临床意义。     

急性心肌梗死患者甲状腺激素水平与心功能及冠脉病变程度的关系

目的探讨急性心肌梗死患者甲状腺激素水平的变化与心功能和冠脉病变程度的关系。方法64例急性心肌梗死患者,据冠状动脉造影结果分为单支病变组（n=22）和多支病变组（n=42）,射血分数（EF）结果分为冠心病非心力衰竭组（n=36）和冠心病心力衰竭组（n=28）。选取同期经冠状动脉造影检查排除冠心病的30例患者为对照组。分别测定各组甲状腺激素水平和高敏C反应蛋白（hs—CRP）等。结果与对照组和冠心病非心力衰竭组相比,冠心病心力衰竭组血清三碘甲状腺原氨酸（TT3）、游离三碘甲状腺原氨酸（FT3）降低（P〈0．05,P〈0．01）,反三碘甲状腺原氨酸（rT3）和hs—CRP增高（P〈0．05,P〈0．01）;与单支病变组比较,多支病变患者FT3明显降低（P〈0．01）,rT3和hs—CRP增高（P〈0．05）。在校正其他因素后,FT3水平下降与冠脉病变严重程度相关（风险比为0．72,P〈0．05）。结论急性心肌梗死患者的甲状腺激素水平在心功能不全时会有改变,T13,FT3降低,rT3升高,且FT3水平与冠状动脉病变严重程度相关,因此其可作为反映心肌梗死患者病情严重程度的重要指标之一。急性心肌梗死患者hs—CRP升高,反映炎症在急性心肌梗死患者的发生、发展过程中发挥一定的作用。     

糖尿病急性代谢紊乱与血清甲状腺激素的关系探讨

目的：探讨糖尿病急性代谢紊乱与血清甲状腺激素的关系。方法：用放射免疫法测定受试者血清T3、T4、FT3、TSH的水平,用己糖激酶法测定血糖。结果：糖尿病急性代谢紊乱患者血清T3、FT3水平明显降低（P＜0．01）,T4、FT4、TSH变化不明显（P＞0．05）,治疗后T3、FT3明显上升（P＜0．001）。治疗前T3、FT3均与空腹血糖（FBG）、餐后2h血糖（PBG)呈负相关（P＜0．001）。结论：血清甲状腺激素水平变化与糖尿病急性代谢紊乱、病情轻重有关,测定血清T3、FT3、T4、FT4对糖尿病病情估计、判断预后以及疗效有重要意义。     

脑外伤后血浆和肽素的变化及其临床意义

目的探讨脑外伤患者血浆和肽素（ copeptin）浓度的变化及其临床意义。方法入选脑外伤患者98例,依据入院时GCS评分不同将脑外伤患者分成3～5分组（30例）,6～8分组（32例）,9～12分组（36例）,另选取30例健康人为正常对照组。各组均采用ELISA法检测血浆和肽素浓度。对比分析血浆和肽素浓度与GCS评分的关系,记录患者30 d死亡率,分析血浆和肽素浓度及GCS评分在死亡组和存活组的差别。采用受试者工作特征曲线（ receiver operating characteristic, ROC）评估血浆和肽素浓度及GCS评分对患者预后的预测价值。结果①脑外伤组血浆和肽素浓度（13．6±3．7）ng/mL,较对照组（0．9±0．4）ng/mL显著增高（P＜0．01）。入院时GCS评分越低,血浆和肽素浓度越高,三组间血浆和肽素浓度差异有统计学意义（ P＜0.05）。②相关分析显示,脑外伤患者血浆和肽素浓度与入院时 GCS评分呈负相关（ r ＝-0．79, P＜0.01）,与血糖浓度呈正相关（r＝0．68,P＜0．01）。③植物生存或死亡组患者血浆和肽素浓度显著高于预后良好及预后差组（ P＜0．01,P＜0．05）;植物生存或死亡组及预后差组GCS评分均低于预后良好组（P＜0．05）,但两组比较差异无统计学意义（P＞0．05）。④以30 d为研究终点,植物生存或死亡患者10例,和肽素的曲线下面积（ AUC）为0．803（95％CI 0．712～0．893）;分界值为8．5 ng/mL时敏感度为84．2％,特异度为67．3％。结论脑外伤患者血浆和肽素浓度显著上升,且该指标与患者病情的严重程度密切相关,对预后有一定的预测价值。     

老年脓毒症患者凝血功能紊乱及与预后的关系

目的探讨老年脓毒症患者凝血功能变化及其与预后的关系。方法采用随机病例对照研究,回顾性分析2011-05～2013-06本院重症监护病房（ ICU）收治的62例老年脓毒症患者,根据28 d转归将病例组分为生存组（ n＝39）和死亡组（ n＝23）。入院24 h内检测蛋白C （ PC）活性、血小板计数（ PLT）、D-二聚体（ DD）、凝血酶原时间（ PT）、凝血酶时间（ TT）、活化部分凝血活酶时间（ APTT）和纤维蛋白原（ FBG）,计算急性生理学与慢性健康状况评分Ⅱ（ APACHEⅡ）。比较两组患者凝血指标及与病情严重程度（ APACHEⅡ评分）的关系。以同期30例老年健康体检者作为对照组。结果与生存组比较,死亡组PC活性、PLT水平降低（ P＜0．05或P＜0.01）,DD水平升高（ P＜0．01）,PT、APTT、TT及FBG差异无统计学意义（均P＞0．05）。死亡组APACHEⅡ评分显著高于生存组（ P＜0.01）, APACHEⅡ评分与 PC、PLT 呈显著负相关性（r＝-0.690,r＝-0．461,均P＜0．01或0.05）,与DD呈显著正相关性（r＝0．477,P＜0．01）。经Logistic回归分析,PC活性（OR＝1．104,P＝0.006）、APACHEⅡ评分≥20分（OR＝15．556,P＝0.003）为老年脓毒症死亡危险因素。结论老年脓毒症患者存在凝血功能异常,PC活性降低与病情严重程度相关,是老年脓毒症患者死亡危险因素之一,对判断患者预后有重要意义。     

河南省正常孕妇甲状腺激素水平参考值

目的建立河南省不同孕期的健康孕妇血清甲状腺激素的正常参考范围,研究其变化规律。方法选取2012年12月至2013年5月在郑州大学第三附属医院就诊的本省健康妊娠期妇女583名和非妊娠妇女187名,采用化学发光法检测血清TSH、TT4、FT4、TT3、FT3水平,建立不同孕期孕妇的甲状腺激素参考值范围。结果（1）各孕期甲状腺激素水平与非孕期比较有统计学差异（P均〈0．01）。（2）孕早期血清TSH水平比非孕期和孕中晚期明显降低（P均〈0．01）,孕中晚期逐渐回升（P〈0．01）。（3）FT4孕期各组比较差异有统计学意义（P〈0．01）,孕中期及晚期呈下降趋势,显著低于非孕期（P〈0．01）。（4）TT4整个孕期明显高于非孕期（P〈0．01）,孕中期达高峰,孕晚期略下降。（5）FT3和TT3孕早期明显高于非孕期（P〈0．01）,孕中期较孕早期增高（P〈0．01）并持续至孕晚期。结论孕期甲状腺激素水平与非孕期存在明显差异,各孕期之间亦存在明显差异,因此建立孕期甲状腺激素参考值对于妊娠期甲状腺疾病的早期诊断具有临床意义。     

老年慢性阻塞性肺疾病患者血清甲状腺素动态改变及意义

目的：观察老年慢性阻塞性肺疾病患者急性加重期和治疗后稳定期的血清甲状腺激素变化。方法：对62例慢性阻塞性肺疾稿急性加重期患者，于入院时和治疗2周后分别检测血清甲状腺素（TT4）游离T4（FT4）、三碘甲状腺原氨酸（TT3）、游离T3（FT3）及促甲状腺激素含量，并与对照组比较。结果：入院时慢性阻塞性肺疾痛组血清中TT3，FT3，TT4均较对照组显著下降（P〈0．05），治疗2周后54例痛情缓解者，TT4,TT3，FT3均明显上升（P〈0．05），死亡的8例TT3，FT3,TT4均低于生存组（P〈0．05）。结论：动态观察血清甲状腺激素的变化，对慢性阻塞性肺疾病急性加重期患者的病情判断及预后具有一定的临床应用价值。     

重症肺炎患者甲状腺激素与疾病严重程度及预后的相关性

目的 探讨重症肺炎患者血清中甲状腺激素与病情严重程度和预后的相关性.方法 采用APACHEⅡ评分将69例重症肺炎患者分为重度组、中度组、轻度组,入院第2天采血检测血清甲状腺功能[三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)、反三碘甲状腺原氨酸(rT3)和促甲状腺激素(TSH)].结果 APACHEⅡ评分与T3(r =0.46,P＜0.01)、FT3(r =0.44,P＜0.01)和T4(r=0.29,P＜0.05)呈正相关,与FT4和rT3无明显相关性.结论 重症肺炎患者T3、FT3、T4的变化与疾病严重程度相关,血清T3、T4水平越低病情越重,病死率越高.     

纳洛酮血肿腔内注射对中重度颅脑损伤患者血浆β-内啡肽的影响

目的探讨血肿腔内注入盐酸纳洛酮治疗中重度颅脑损伤的疗效及安全性。方法86例中重度颅脑损伤患者随机分成对照组（n＝26）、静脉滴注纳洛酮组（n＝30）和血肿腔内灌注纳洛酮组（n＝30）,观察各组生命体征、意识复苏时间、血浆β-内啡肽（β-EP）的变化,3个月后进行格拉斯哥预后评分（GOS）。结果纳洛酮治疗组患者的血液及呼吸循环恢复稳定较快。腔内注入纳洛酮组的意识复苏时间比对照组和静脉滴注纳洛酮组明显缩短（P＜0．01）。治疗后第10天,纳洛酮治疗组比对照组的 GCS 上升,且血肿腔内灌注组较静脉滴注纳洛酮组升高明显（P＜0．05）。而血肿腔灌注纳洛酮组β-EP 含量显著低于静脉滴注组及对照组（P＜0．05）。随访3个月后静脉滴注组患者 GOS 比对照组升高,而且血肿腔内灌注组较静脉滴注纳洛酮组升高明显（P＜0．05）。结论血肿腔内灌注纳洛酮可能通过拮抗β-EP 的作用,缩短中重度颅脑损伤昏迷时间,促进患者神经功能恢复,改善预后。     

Evaluation of serum triiodothyronine and adjusted triiodothyronine (free triiodothyronine index) in pregnancy.

We measured serum thyroxine (free and total), triiodothyronine (free and total), thyroxine-binding globulin, and triiodothyronine uptake by talc in 97 normal men and 50 pregnant women. Mean serum thyroxine and triiodothyronine concentrations were higher in the pregnant subjects (104 vs. 78 mug/liter and 1.69 vs. 1.30 mug/liter) because of a higher mean thyroxine-binding globulin concentration (70 vs. 38 mg/liter). Mean triiodothyronine uptake by talc was lower in the pregnant subjects (0.82 vs. 1.03). Mean free thyroxine concentrations were similar in the two groups, but mean free triiodothyronine concentrations were 10% lower in the pregnant subjects. Triiodothyronine uptake by talc and the diayzable thyroxine and triiodothyronine fractions were highly correlated (r = 0.85 and r = 0.82, P less than 0.001). Calculated free thyroxine index and free triiodothyronine index values (hyroxine and triiodothyronine indirectly adjusted, using triiodothyronine talc uptake to compensate for differences in thyroxine-binding globulin concentration), were statistically similar (84 vs. 82 and 1.38 vs. 1.34) in pregnant and male subjects. The results indicate that the total triiodothyronine concentration can be normalized on the basis of the triiodothyronine uptake by talc to correct for variations in thyroxine-binding globulin concentration.     

Association between increased concentrations of free thyroxine and unsaturated free fatty acids in non-thyroidal illnesses: role of albumin

We measured the concentrations of non-esterified free fatty acids and free and total thyroid hormones in serum from patients with various non-thyroidal illnesses (NTI) and chronic renal failure (CRF). The total concentration of free fatty acids was measured enzymatically and the eight most abundant fractions were determined by gas-liquid chromatography. The concentration of total free fatty acids was significantly increased in the NTI group as compared with controls (p less than 0.01); the concentrations of oleic, linoleic and linolenic acid were increased more than those of the other fractions. In NTI the serum-free thyroxine (FT4) concentration was increased (p less than 0.01) and the free triiodothyronine (FT3) concentration was decreased (p less than 0.001); these concentrations were measured by equilibrium dialysis. There was a significant correlation between the levels of total free fatty acids and FT4 in the NTI (n = 43) group (r = 0.45, p less than 0.01), and also between the levels of linoleic acid and FT4 (r = 0.35, p less than 0.05). The serum albumin concentration was decreased in the NTI group, and when free fatty acid to albumin molar ratios were calculated stronger correlations with FT4 were observed (total free fatty acids: r = 0.55; p less than 0.001; oleic acid: r = 0.30, p less than 0.05; linoleic acid: r = 0.46, p less than 0.01; linolenic acid: r = 0.35, p less than 0.05). There was no correlation between FT4 and unsaturated FFA concentrations in CRF patients, who had normal mean FT4 and total FFA levels. These results support the hypothesis that unsaturated fatty acids are involved in the increase of serum FT4 in NTI, especially when albumin levels are low.     

低T3水平与大动脉粥样硬化型脑梗死患者短期预后的关系

目的 探讨大动脉粥样硬化型（LAA）脑梗死患者三碘甲状腺原氨酸（T3）水平与其短期预后的相关性。方法 LAA脑梗死患者191例分为低T3组（n=76）和正常T3组（n=115）。比较两组甲状腺功能实验室指标,人口学资料和临床资料。随访90天时NIHSS评分和改良Rankin（mRS）评分,mRS评分≤2分定义为预后良好,mRS评分>2分定义为预后不良。结果 低T3组血清总三碘甲状腺原氨酸（TT3）,游离三碘甲腺原氨酸（FT3）,总甲状腺素（TT4）水平低于正常T3组,低T3组年龄和入院时NIHSS评分明显高于正常T3组（P<0.01）。入院时NIHSS评分与TT3和FT3水平负相关（r=-0.267,P<0.01和r=-0.306,P<0.01）。低T3组90天NIHSS评分和mRS评分高于正常T3组（P<0.01）。90天mRS评分与TT3和FT3水平负相关（r=-0.400,P<0.01和r=-0.379,P<0.01）;而90天mRS评分与年龄和入院NIHSS评分正相关（r=0.217,P<0.01和r=0.765,P<0.01）。结论 低水平T3可能与LAA脑梗死短期不良预后相关。     

百合地黄平亢汤对甲状腺功能亢进症患者的疗效

目的探讨甲状腺功能亢进症(甲亢)患者在西药治疗基础上给予百合地黄平亢汤治疗的临床效果。方法选取2017年4月至2018年3月门诊甲亢患者90例,随机分为对照组和观察组,各45例。对照组给予常规西药治疗,观察组在西药治疗基础上加用百合地黄平亢汤治疗。观察两组患者甲状腺激素水平、中医症候积分、血脂水平和不良反应、复发情况等。结果观察组治疗后血清促甲状腺素(TSH)水平高于对照组,游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)水平低于对照组,差异有统计学意义(P<0.01);观察组治疗后中医症候积分显著低于对照组[(1.74±0.75)分vs(6.46±3.21)分,t=9.605,P<0.01]。观察组患者治疗后血清TG、TC、HDL-C、LDL-C水平显著优于对照组(P<0.01)。观察组治疗总有效率高于对照组(95.56%vs 75.56%,χ²=7.282,P<0.01),不良反应总发生率低于对照组(2.22%vs 17.78%,χ²=6.409,P<0.05),复发率低于对照组(0 vs 13.33%,χ²=6.429,P<0.05)。结论在常规西药治疗基础上联合百合地黄平亢汤治疗甲亢,可提高疗效,降低不良反应和复发率。     

Thyroid function tests in patients with acquired immune deficiency syndrome and healthy HIV1-positive out-patients

The thyroid function tests as well as evidence of thyroiditis were studied in 18 male patients with acquired immune deficiency syndrome (AIDS) and 12 healthy HIV1-positive persons compared with an age-matched control group. Serum total thyroxine was not significantly different between the groups, but both serum total triiodothyronine, triiodothyronine uptake test, and free thyroid hormone indices showed significantly decreasing values from HIV1-positive healthy persons to AIDS patients compared with controls (P value from less than 0.05 to less 0.001). Serum TBG was elevated in HIV1-positive subjects and in patients with AIDS, with a significant inverse correlation with the T3-uptake test (Spearman's rho = 0.657, P less than 0.01). There was no correlation between thyroxine binding globulin and the other measured variables. The serum level of thyrotropine was not significantly different in the groups, whereas serum thyroglobulin was significantly lowered in the AIDS group. There was no correlation between thyroid function variables and survival time, hepatic function and ratio of T-helper to T-suppressor cells. No evidence of thyroiditis was observed. In conclusion thyroid tests showed an atypical outcome in HIV1-positive patients with or without AIDS compared with the pattern normally seen in non-thyroid illness, and should, therefore, caution the interpretation of the biochemical changes when diagnosing abnormal thyroid function in these patients.     

Cardiac systolic time intervals and thyroid hormone levels during treatment of hypothyroidism.

This study was undertaken to compare results of modern serum thyroid hormone assays with cardiac systolic time intervals (STI) during thyroxine treatment in hypothyroid patients. The patients were assessed clinically (Billewicz index) and the STI and serum thyrotropin (TSH), total and free thyroxine (T4) and total and free triiodothyronine (T3) were determined in 16 hypothyroid women (Group I) treated with 50 micrograms increments of thyroxine, and in 13 women who had a history of thyroid carcinoma and high-dose thyroxine replacement therapy and had elevated thyroid hormone concentrations (Group II). The STI of 24 matched healthy female controls were used for reference of STI. The pre-ejection period (PEP) index and the PEP/LVET ratio (left ventricular ejection period) were greater in untreated overtly and mildly hypothyroid patients (p less than 0.05) than in the controls. During stable thyroxine therapy [mean daily dosage for Group I 137.5 (7.3) micrograms and for Group II 220 (61) micrograms] the PEP correlated with serum free T4 (FT4), as measured by a two-step method (SpectriaR) (r = -0.55, p less than 0.01, n = 29) and total T4 (r = -0.51, p less than 0.05, n = 29), but not with TSH, T3, FT3 or FT4 measured by an analogue method Amerlex-M(R). The TRH test was not valuable in follow-up because of the strong correlation between basal TSH and stimulated TSH values (r = 0.95). In conclusion, STI are useful for assessment of the thyroid state in untreated hypothyroid patients. Serum TSH becomes normal in the same time as STI and is the best for follow-up. If serum TSH is low and the patient is on stable thyroxine therapy, we recommend serum FT4 for monitoring thyroxine replacement. Two-step FT4 assays had the best correlation with STI, which has significance in patients with non-thyroidal illness.     

原发性甲状腺功能减退症患者的血清肌酐水平和影响因素

  目的  探讨原发性甲状腺功能减退症(甲减)患者血清肌酐(creatinine, Cr)水平变化及其影响因素。  方法  回顾性分析北京协和医院内分泌科2006年1月至2010年12月诊治的27例甲减患者的临床资料, 并根据血清游离甲状腺素(free thyroxine, FT₄)水平将患者分为临床甲减组和亚临床甲减组。使用Cockcroft-Gault公式计算患者肌酐清除率(creatinine clearance rate, CCr)。分析患者血清Cr、尿素氮、CCr与甲状腺功能以及血清肌酸激酶间的关系。  结果  14.8%的患者血清Cr水平超过正常上限。本组患者血清Cr和血清游离三碘甲腺原氨酸(free triiodothyronine, FT₃)(P < 0.001, r=-0.628)、FT4(P=0.016, r=-0.458)间均呈负相关。临床甲减组血清Cr水平明显高于亚临床甲减组[(99.89±28.93)μmol/l比(74.67±8.03)μmol/l, P < 0.01]。而甲状腺激素治疗后, FT₄明显升高(P=0.005), 血清Cr明显降低(P=0.001)。Cr和经对数转换的血清肌酸激酶间呈正相关(P=0.032, r=0.596), CCr和FT₄呈正相关(P=0.043, r=0.527)。  结论  临床上发现血清Cr水平增高的患者应常规筛查甲状腺功能。血清Cr水平的增高与CCr的下降以及肌肉的破坏均有关。甲状腺功能纠正后, 甲减引起的血清Cr水平的增高可恢复正常。     

Maternal anxiety and fetal behavior at 15 weeks' gestation.

OBJECTIVE: To analyze the relationship between maternal anxiety and fetal behavior at 15 weeks' gestation. METHODS: Twenty women in two groups were studied: 10 women underwent amniocentesis and 10 controls did not. Maternal anxiety was evaluated using the State Trait Anxiety Inventory questionnaire. Maternal plasma catecholamines (noradrenaline, adrenaline, dopamine) and maternal serum adrenocorticotropic hormone, cortisol, glucose, insulin, triiodothyronine, thyroxine and thyroid-stimulating hormone were measured. Catecholamines were also measured in the amniotic fluid of women undergoing amniocentesis. Compiled actograms of 40-min observations were done using ultrasonography. RESULTS: Maternal state-anxiety was significantly increased in the amniocentesis group. Except for fetal hiccups (r = 0.49, P = 0.03) there was no significant correlation between maternal anxiety and any of the other studied fetal movements. Maternal glucose was significantly correlated with hiccups (r = -0.59, P = 0.01), isolated leg movements (r = -0.52, P = 0.03), startles (r = -0.47, P = 0.04) and the total of the studied movements (r = -0.47, P = 0.04). Amniotic fluid catecholamines were significantly correlated with hand-face contact (r = 0.71, P = 0.02 for adrenaline), startles (r = 0.75, P = 0.01 for noradrenaline and r = 0.64, P = 0.04 for dopamine) and general movements (r = 0.89, P = 0.001 for noradrenaline). CONCLUSIONS: This study does not support a relationship between maternal anxiety and fetal behavior in early pregnancy. Maternal glucose and plasma catecholamines could be related to fetal movements at 15 weeks' gestation.     

Thyroid function in hospitalized patients: effect of illness and serum albumin concentrations

We assessed the clinical utility of measuring thyrotropin (TSH) in serum by immunoradiometry and of measuring total thyroxin (TT4), total triiodothyronine (TT3), free thyroxin (FT4), and free triiodothyronine (FT3). We used a group of 110 healthy volunteers, 45 ill hypoalbuminemic patients, and 42 ill normoalbuminemic patients. In addition, the free thyroxin index (FTI) and TT4:thyroxin-binding globulin (TBG) ratio were also calculated. The hypoalbuminemic group had significantly lower FT4, FT3, TT4, TT3, and FTI concentrations, but only FT3 and TT3 were significantly lower in the ill normoalbuminemic group as compared with controls. We found significant correlation between FT4 and albumin (r = 0.372, P less than 0.001) and FT3 and albumin (r = 0.465, P less than 0.001). TSH concentrations were undetectable in two of 45 hypoalbuminemic patients, significantly higher in the rest. The TT4/TBG ratio was the only parameter of thyroid function that remained unchanged in the ill patients.     

临床甲亢和亚临床甲亢患者血清 Nrg4，TSK水平与血脂、甲状腺激素和基础代谢率的相关性分析

目的　探讨临床甲状腺功能亢进症（ hyperthyroidism,HT）、亚临床甲状腺功能亢进症（简称亚甲亢）患者血清神经调节蛋白 4（Nrg4）、Tsukushi（TSK）水平与血脂、甲状腺激素、基础代谢率（ basal metabolic rate,BMR）的相关性。方法　纳入黑龙江省红十字（森工总）医院 2018年 12月～ 2020年 12月收治的 HT患者 150例、亚甲亢患者 130例分别作为 HT组、亚甲亢组,选取同期该院体检的健康志愿者 80例作为表观健康组。比较三组血清 Nrg4, TSK水平以及血脂指标 [总胆固醇（ TC）、三酰甘油（ TG）、低密度脂蛋白胆固醇（ LDL-C）、高密度脂蛋白胆固醇（HDL-C）]、甲状腺激素指标 [TSH、甲状旁腺素（ PTH）、游离甲状腺素（ FT4）、游离三碘甲状腺原氨酸（ FT3）、总三碘甲状腺原氨酸（ TT3）,总甲状腺素（ TT4）]和 BMR,分析患者血清 Nrg4,TSK水平与血脂、甲状腺激素、 BMR的相关性,观察血清 Nrg4与 TSK的相关性。结果　HT组血清 Nrg4,TSK,PTH,FT4,FT3,TT3,TT4和 BMR高于亚甲亢组（ t=9.591～ 29.295,均 P＜ 0.05）和表观健康组（ t=11.543～ 26.872,均 P＜ 0.05）,而血清 TSH,TC, TG,LDL-C和 HDL-C水平低于亚甲亢组（ t=3.776～ 27.429,均 P＜ 0.05）和表观健康组（ t=3.531～ 17.533,均 P＜ 0.05）,差异均有统计学意义。亚甲亢组血清 Nrg4,TSK水平高于表观健康组（ t=5.277,7.008,均 P＜ 0.05）,但 HDL-C, TSH水平低于表观健康组（ t=10.358,28.220,均 P＜ 0.05）,差异均有统计学意义。 Pearson线性相关分析提示 HT患者血清 Nrg4,TSK水平与血清 TC,LDL-C,HDL-C和 TSH水平呈负相关（ r=-0.652～ -0.371,均 P＜ 0.05）,与血清 PTH,FT4,FT3,TT3,TT4及 BMR呈正相关（ r=0.349～ 0.593,均 P＜ 0.05）;亚甲亢患者血清 Nrg4,TSK水平与 HDL-C,TSH水平呈负相关（ r=-0.615～ -0.489,均 P＜ 0.05）;HT,亚甲亢患者血清 Nrg4与 TSK水平均呈正相关（r=0.581,0.563,均 P＜ 0.05）。结论　针对性别、年龄、吸烟史、饮酒史混杂因素进行校准,并将上述因素剔除后发现 HT,亚甲亢患者血清 Nrg4,TSK水平均增高,且 HT患者的 Nrg4,TSK与血脂、甲状腺激素和 BMR有明显相关性,而亚甲亢患者的 Nrg4,TSK仅与 HDL-C,TSH有关。