The effect of helicobacter pylori eradication on macrophage migration inhibitory factor, c-reactive protein and fetuin-a levels

OBJECTIVES:

To determine the effect of Helicobacter pylori (H. pylori) eradication on blood levels of high-sensitivity C-reactive protein (hs-CRP), macrophage migration inhibitory factor and fetuin-A in patients with dyspepsia who are concurrently infected with H. pylori.

METHODS:

H.pylori infection was diagnosed based on the ¹⁴C urea breath test (UBT) and histology. Lansoprazole 30 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily were given to all infected patients for 14 days; ¹⁴C UBT was then re-measured. In 30 subjects, migration inhibitory factor, fetuin-A and hs-CRP levels were examined before and after the eradication of H. pylori infection and compared to levels in 30 healthy subjects who tested negative for H. pylori infection.

RESULTS:

Age and sex distribution were comparable between patients and controls. Migration inhibitory factor and hs-CRP levels were higher, and fetuin-A levels were lower, in H. pylori-infected patients (p<0.05). Following eradication of H. pylori, migration inhibitory factor and hs-CRP levels were significantly decreased, whereas fetuin-A levels were increased. However, eradication of the organism did not change lipid levels (p>0.05).

CONCLUSION:

These findings suggest that H. pylori eradication reduces the levels of pro-inflammatory cytokines such as migration inhibitory factor and hs-CRP and also results in a significant increase in anti-inflammatory markers such as fetuin-A.     

Effects of thyroxine replacement on endothelial function and carotid artery intima-media thickness in female patients with mild subclinical hypothyroidism

BACKGROUND:

Previous studies have suggested an association between subclinical hypothyroidism and coronary artery disease that could be related to changes in serum lipids or endothelial dysfunction.

METHODS:

Thirty-two female subclinical hypothyroidism patients were randomly assigned to 12 months of L-thyroxine replacement or no treatment. Endothelial function was measured by the flow-mediated vasodilatation of the brachial artery, as well as mean carotid artery intima-media thickness, and lipid profiles were studied at baseline and after 12 months of follow-up.

RESULTS:

The mean (±SD) serum thyroid-stimulating hormone levels in the L-thyroxine replacement and control groups were 6.09±1.32 and 6.27±1.39 µUI/ml, respectively. No relationship between carotid artery intima-media thickness or brachial flow-mediated vasodilatation and free T4 and serum thyroid-stimulating hormone was found. The median L-T4 dose was 44.23±18.13 µg/day. After 12 months, there was a significant decrease in the flow-mediated vasodilatation in the subclinical hypothyroidism control group (before: 17.33±7.88 to after: 13.1±4.75%, p = 0.03), but there were no significant differences in flow-mediated vasodilatation in the L-thyroxine treated group (before: 16.81±7.0 to after: 18.52±7.44%, p = 0.39). We did not find any significant change in mean carotid intima-media thickness after 12 months of L-thyroxine treatment.

CONCLUSION:

Replacement therapy prevents a decline in flow-mediated vasodilatation with continuation of the subclinical hypothyroidism state. Large prospective multicenter placebo-controlled trials are necessary to investigate endothelial physiology further in subclinical hypothyroidism patients and to define the role of L-thyroxine therapy in improving endothelial function in these patients.     

孕前及孕期妇女甲状腺功能减退筛查的临床分析

目的探讨甲状腺功能减退与不良孕史的相关性及孕期甲状腺功能减退筛查的意义。方法选取2010年10月-2011年8月期间在我院门诊就诊的生育年龄妇女共243例,采用化学发光（CIA）进行甲状腺功能激素系列（TSH、FT4、TPOAb）测定。结果不良孕史中甲状腺功能低下所占比例明显高于无不良孕史组;亚临床甲状腺功能低下在临床上发生率相对较高。结论甲状腺功能减低与不良孕史有明显相关性;要重视亚临床甲状腺功能低下的发生;进行孕期甲状腺功能筛查很有必要。     

颈动脉内膜中层厚度与亚临床甲状腺功能减退的Meta分析

背景：目前相关研究认为,亚临床甲状腺功能减退与颈动脉内膜中层厚度存在相关性,但此观点仍存在许多争议。 目的：评价分析亚临床甲状腺功能减退患者的颈动脉内膜中层厚度与甲状腺功能正常者的颈动脉内膜中层厚度是否存在差异。 方法：收集已公开发表的有关亚临床甲状腺功能减退患者颈动脉内膜中层厚度与甲状腺功能正常者比较的相关研究,按照Meta分析的要求对检索到的原始文献的研究方法及研究数据进行评价。 结果与结论：符合纳入标准的文献8篇,总样本量3 602例。合并结果提示,亚临床甲状腺功能减退组与甲状腺功能正常的对照组的颈动脉内膜中层厚度的差异有显著性意义[加权平均差WMD=0.056,95%CI(0.020,0.092)]。敏感性分析的合并结果采用7项质量更高的研究,进一步证明了亚临床甲状腺功能减退患者的颈动脉内膜中层厚度高于对照组[加权平均差WMD=0.064,95%CI(0.024,0.105)]。亚组分析中,在促甲状腺激素≥10 mU/L的患者,亚临床甲状腺功能减退与颈动脉内膜中层厚度更有显著性关联[加权平均差WMD=0.082,95%CI(0.049,0.116)]。同时,亚临床甲状腺功能减退也与收缩压增高、三酰甘油、总胆固醇、低密度脂蛋白及空腹血糖水平等存在相关性。结果提示,亚临床甲状腺功能减退与颈动脉内膜中层厚度存在相关性,这可能与促甲状腺激素水平的提高、血脂异常、高血压有关。尽管存在明显的个体差异,去进一步评估此观察的结论,大样本量的前瞻性研究是有必要的。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria

BackgroundOvert thyroid dysfunction is an accepted cause of female infertility. Its milder form, subclinical hypothyroidism have also been implicated as a contributing factor to disturbed reproductive function.ObjectiveTo determine the contribution of subclinical hypothyroidism (SCH) to the burden of infertility.MethodologyThis is a cross sectional, comparative study of One hundred and twenty women with primary or secondaryinfertility who presented for evaluation at gynaecological clinic and controls which are clients that came to access Family planning services.ResultsThe prevalence of infertility among gynaecological patients seen in the clinic was 38.8% (192/495). The prevalence of SCH among the studied infertile women was 11.7% (7/60) compared with 3.3% (2/60) of the control group (p=0.222). The commonest type of infertility was secondary, 76.7% (46/60). All thestudied infertile women with SCH presented with secondary infertility. There was an observed statistically significant difference in the mean serum TSH (3.19±4.38mIU /L vs 1.60±1.22mIU /L) and FT3, FT4 (0.29±0.074ng/dl vs 0.95±0.16ng/dl and 0.33±0.071ng/dl vs 1.09±0.19ng/dl respectively)ConclusionSubclinical hypothyroidism was found to be higher among infertile women but this finding was not statistically significant, therefore, the routine screening for SCH among infertile women might be unnecessary     

Prospective Observation of 5-Year Clinical Course of Subclinical Hypothyroidism in Korean Population

Subclinical hypothyroidism (SCH) is a common clinical condition, whereas it''s natural course has not been identified distinctly. We evaluated the natural history of 169 SCH patients over 5-yr and the prognostic factors including thyroid autoantibodies and thyroid ultrasonographic (USG) findings related to develop overt hypothyroidism. After 5 yr, 47.3% of patients showed normalization of TSH, while 36.7% of patients remained persistence of high level of TSH, and overt hypothyroidism developed in 11.2% of patients. There were painless thyroiditis (2.9%) and hyperthyroidism (1.7%) during 5 yr follow-up. The thyroid nodule was seen in 48.6% of patients. Most of patients had 1 to 2 nodules whereas only 3% of patients with thyroid nodule had more than 6 nodules. Overt hypothyroidism patients had more heterogenous echogenecity in USG compared to patients with normalization or persistent SCH (76.5% vs 50.0% vs 35.0%, P = 0.048) and higher prevalence positive anti-thyroid peroxidase (anti-TPO Ab) and anti-thyroglobulin antibody (anti-Tg Ab) and titer of anti-TPO Ab than other two groups. The cut off values for prediction of overt hypothyroidism were TSH > 7.45 µIU/mL, free T₄ < 1.09 ng/dL and Anti-TPO Ab > 560 IU/mL. SCH has various courses and initial TSH, free T₄, presence of thyroid autoantibody, titer of thyroid autoantibody; and thyroid USG findings can serve as a prognostic factor for progression of overt hypothyroidism. These parameters suggest consideration to initiate thyroid hormone treatment in SCH.     

甲状腺机能减退和亚临床甲状腺机能减退时缺血修饰蛋白的变化

目的 探讨甲状腺功能减退和亚临床甲状腺功能减退时缺血修饰白蛋白(IMA)以及丙二醛(MDA)水平的变化,同时观察甲状腺激素与氧化应激之间的关系.方法 选取35例甲状腺功能减退和35例亚临床甲状腺功能减退患者作为病例组,35例健康人作为正常对照组,分别检测病例组和对照组的促甲状腺激素(TSH)、游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)、IMA、白蛋白(ALB)、IMA/ALB、MDA、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平.结果 与对照组相比,甲减组和亚临床甲减组MDA和IMA水平显著升高(P＜0.05),IMA/ALB也显著升高(P＜0.05).甲减组,TSH水平与MDA(r=0.372,P=0.043),IMA(r =0.409,P=0.025)和IMA/ALB比值(r=0.445,P=0.014)呈显著正相关;亚临床甲减组各变量之间没有显著相关性.结论 由于氧化应激的存在,甲减患者抗氧化状态降低导致IMA和MDA水平增加.     

孕前及孕期甲状腺功能减退筛查的临床分析

目的探讨甲状腺功能减退与不良孕史的相关性及孕期甲状腺功能减退筛查的意义。方法选取2010年10月-2011年8月期间在我院门诊就诊的生育年龄妇女共243例,采用化学发光（CIA）进行甲状腺功能激素系列（TSH、FT4、TPOAb）测定。结果不良孕史中甲状腺功能低下所占比例明显高于无不良孕史组;亚临床甲状腺功能低下在临床上发生率相对较高。结论甲状腺功能减低与不良孕史有明显相关性;要重视亚临床甲状腺功能低下的发生;进行孕期甲状腺功能筛查很有必要。     

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。     

Homocysteine and fibrinogen changes with L-thyroxine in subclinical hypothyroid patients

The aim of the present study was to evaluate plasma total homocysteine (Hcys) and serum fibrinogen concentrations in subclinical hypothyroid (SH) and overt hypothyroid patients before and after L-thyroxine (LT4) replacement and to compare them in euthyroid subjects. Fifteen SH and 20 hypothyroid premenopausal women were recruited in the study. We measured fasting plasma levels of Hcys and serum levels of free thyroxine (fT4), free triiodothyronine (fT3), thyrotropin (TSH), folate, vitamin B12, fibrinogen, renal functions, and lipid profiles in patients with SH and overt hypothyroid patients before and after LT4 treatment. Eleven healthy women were included in the study as a control group. Pretreatment Hcys levels were similar in SH and control subjects, whereas mean fibrinogen level of SH patients was higher than that of control subjects (p<0.05). Baseline Hcys (p<0.01) and fibrinogen (p<0.001) levels of the overt hypothyroid patients were significantly higher than those of the healthy subjects, and the pretreatment Hcys levels decreased with LT4 treatment (p<0.001). In conclusion, our data support that SH is not associated with hyperhomocysteinemia and Hcys does not appear to contribute to the increased risk for atherosclerotic disease in patients with SH.     

Oxidative stress and protein glycation in primary hypothyroidism. Male/female difference

Oxidative stress (OS) has recently been documented in hypothyroidism, a disease more prevalent in women. In general, OS is reported to be more prevalent in males. However, the effect of gender on OS and protein glycation in hypothyroidism has not been addressed. Blood samples from 37 recently diagnosed primary hypothyroid patients were collected before initiation of thyroxine therapy. Serum glucose, thyroid and lipid profiles were estimated. Glutathione (GSH), malondialdehyde (MDA), protein carbonylation (PCO) and fructosamine levels were analysed. GSH was found to be lower, whereas MDA, fructosamine and PCO levels were higher in male than in female patients. Level of MDA was significantly correlated with fructosamine, protein carbonyls, cholesterol, low-density and high-density lipoprotein cholesterol, triglyceride and GSH in hypothyroid patients. We found OS to be more prevalent in male hypothyroid patients. The positive association of MDA with fructosamine indicates that enhanced lipid peroxidation could be a plausible contributor for accelerated glycation of protein. Considering the negative influence of OS on health, extra attention should be paid to male hypothyroid patients in spite of the low prevalence of this disease in them.     

The effects of L-thyroxine treatment on QT dispersion in primary hypothyroidism

Hypothyroidism has various cardiovascular manifestation and exhibits electrocardiographic change. The QT dispersion on surface ECG reflects regional variations in myocardial repolarization. The effect of L-thyroxine treatment on ECG parameters, such as QT dispersion, in patients with primary hypothyroidism were investigated. This study involved 18 patients (3 men, 15 women, ages: 48+/-18 yr) with primary hypothyroidism. All patients were checked with a standard 12-lead ECG before and after L-thyroxine treatment. Various ECG parameters were then measured twice. The mean L-thyroxine treatment duration was 22+/-2.7 months. The mean thyroid-stimulating hormone levels of patients before and after therapy were 40.2+/-29.8 microU/mL, 3.6+/-4.6 microU/mL (p<0.001) and free-T4 levels were 0.44+/-0.38 ng/dL, 1.51+/-0.39 ng/dL (p<0.001). After L-thyroxine treatment, QT interval (395+/-42 vs. 380+/-24 msec, p<0.05), QTc interval (434+/-32 vs. 417+/-23 msec, p<0.05), QT dispersion (45+/-23 vs. 30+/-13 msec, p=0.008), QTc dispersion (49+/-23 vs. 32+/-14 msec, p=0.005) significantly decreased. There were no significant changes in the PR and RR intervals, as well as the QRS duration. Our findings suggest that the thyroid hormone affects ventricular inhomogenicity, and that L-thyroxine replacement therapy may reduce malignant ventricular arrhythmia and sudden cardiac death in primary hypothyroidism.     

亚临床龋变的早期诊断与干预

近年来早期龋变的定义和诊断阈值发生了重要的变化,向着更早期的亚临床水平延伸.从亚临床龋变概念的提出、亚临床龋变的早期诊断标准、亚临床龋变诊断研究面临的问题和挑战、亚临床龋变的早期干预和效果评估、前景展望6个方面介绍这一国际龋病研究领域有意义的变化,以提高人们对龋病的认识水平、早期诊断水平和干预能力.     

Treatment of hypothyroidism improves glomerular filtration rate (GFR) in geriatric patients

Background/aimRenal function of patients with hypothyroidism increases after reaching euthyroid state. There is no data regarding geriatric age group. The aim of the study was determined to investigate whether renal function of geriatric patients with hypothyroidism increases after they become euthyroid.Materials and methodsPatients who were sixty-five years or older were retrospectively screened in two centers. TSH, T3, T4, creatinine, and eGFR calculated by CKD-EPI formula were recorded under the presence of accompanying hypothyroidism. The same variables were recorded after the patients became euthyroid.Results285 patients were included in the study, the median age was 73(65–84), and 234 patients were female. Patients were examined in four groups according to TSH values. There were 160 (56.1%) patients with TSH 5–9.9 uIU/mL, 60(21.1%) patients with TSH between 10–19.9 uIU/mL, 41(14.4 %) patients with TSH between 20–49.9 uIU/mL and 24(8.4%) patients with TSH> 50uIU/mL. There was a significant and negative correlation between the initial TSH values and the first calculated eGFR values (p: 0.001; r: –0.191). The median eGFR of the patients in hypothyroid cases was 66.59 (14.62–116.07), while the median eGFR value of patients was 69.6 (12.91–109.31) in the euthyroid state. This value obtained after thyroid replacement was significantly improved when compared to the first eGFR (p: 0.001). In logistic regression analysis, pretreatment TSH value was found to independently affect eGFR (p: 0.009; Exb: 1.017). Conclusion It has been observed that hypothyroidism treatment increases eGFR in geriatric patients. Similar results were obtained after studies with younger patients in the literature. This study is a study in which only geriatric age group patients were examined. It should be kept in mind that hypothyroidism which is not corrected in geriatric patients may also contribute to a decrease in eGFR.     

Serum-"free"-thyroxine and triiodothyronine levels: their significance in preclinical hyperthyroidism and subclinical hypothyroidism

A study was performed to establish whether the serum-"free" T4 and T3 levels contributed to the diagnosis of latent thyroid disease. The results suggested that in case of autonomous adenoma an increase in the serum free T3-level is the most reliable indicator of the transformation of the thyroid nodule, and that this hormone concentration, in addition to the TSH--IRMA procedure contributed to the differentiation between euthyroid and hyperthyroid state. In subclinical hypothyroidism, regarded as a heterogeneous subgroup, the mean "free" T4 levels, though still within the normal range, were below those of the controls. Measurement of "free" T4 alone was, however, not sufficient for the diagnosis of subclinical hypothyroidism, but contributed to the differentiation of subclinical from manifest hypothyroidism. Subclinical hypothyroidism raised the possibility that a reduction in the serum hormone levels, though still within the normal limits, may be perceived by the peripheral tissues. Preliminary studies indicated that measurement of the systolic time interval may offer information on this issue.     

Age and hypothyroidism affect dopamine modulation of breathing and D2 receptor levels

During and following hypoxic exposure young male hypothyroid hamsters treated with the dopamine D₂ receptor agonist bromocriptine increased breathing, while ventilation was depressed in bromocriptine-treated euthyroid hamsters. Moreover, D₂ receptor expression was increased in carotid bodies and striatum, but not in the nucleus tractus solitaries (NTS) of hypothyroid relative to euthyroid hamsters. Here ventilation was determined in older male hypothyroid and euthyroid hamsters given vehicle or bromocriptine, and exposed to baseline air, hypoxia, and then air. Bromocriptine without hypoxia served as a time control. Relative to vehicle, bromocriptine depressed ventilation in both groups exposed to air or to hypoxia, but hypothyroid bromocriptine-treated hamsters increased ventilatory responsiveness to hypoxia, while euthyroid hamsters decreased ventilatory responsiveness to hypoxia and exhibited post-hypoxic depression. Hypothyroidism had no effect on D₂ receptor expression in carotid bodies or striatum, but increased it in the NTS. Thus, in hamsters bromocriptine modulates breathing and expression of D₂ receptor depending on the length of hypothyroidism.     

Subclinical hypothyroidism: neurobehavioral features and beneficial effect of l-thyroxine treatment

Summary Frank hypothyroidism is known to induce neurological and mental dysfunction. The aim of this study was to assess selected neuropsychological and behavioral features by means of standardized tests in a group of 14 patients with subclinical hypothyroidism who were free from neuropsychological complaints and to evaluate the possible effects of l-thyroxine treatment on their performance. Patients were submitted to the Crown and Crisp Experiential Index and to the Wechsler Memory Scale; their ratings on the neurobehavioral tests and their thyroid hormone profile were compared to those of a control group of 50 age- and sex-matched subjects. Comparison was also carried out between pretreatment ratings and those obtained following a 6-month l-thyroxine course (0.1–0.15 mg/day). The Wechsler Memory Scale ratings showed a significant impairment in patients' memory-related abilities [memory quotient (MQ)=89.1 ± 2.9; P=0.002 (patients versus controls)]; the Crown and Crisp Experiential Index ratings demonstrated moderate differences between untreated patients and controls with respect to hysteria (P=0.03), anxiety (P=0.05), somatic complaints (P=0.0005), and depressive features (P=0.002) scales; the total score was also significantly higher (42.0±3.8; P=0.005). After l-thyroxine treatment the patients' performances showed an improvement in memory skills, as evaluated by the Wechsler Memory Scale [MQ = 99.9±4.0; P=0.002 (treated versus untreated)]; somatic complaints (P=0.02) and obsessionality (P = 0.04) ratings and the Crown and Crisp Experiential Index total score (P=0.04) significantly decreased with respect to untreated patients. The remarkable effects of l-thyroxine treatment observed in the present study indicate that patients with subclinical hypothyroidism may require early therapy to provide specific treatment for their neuropsychological alterations and to avoid progression toward frank hypothyroidism.Abbreviations TSH thyrotropin - TRH thyrotropin-releasing hormone - l-T₄ levothyroxine - TT₄ total thyroxine - FT₄ free thyroxine - TT₃ total 3,5,3-triiodothyronine - FT₃ free 3,5,3-triiodothyronine - WMS Wechsler Memory Scale - CCEI Crown and Crisp Experiential Index     

亚临床肝性脑病患者躯体感觉事件相关电位研究

目的：观察原发性肝癌患者躯体感觉事件相关电位（ERP）的变化规律，探讨ERP在肝性脑病中的临床意义。方法：对48例原发性肝癌病人在肝动脉化疗栓塞（TACE）术前、后进行躯体ERP检测，并以50名健康人作对照。结果：在肝动脉化疗栓塞后及部分合并亚临床肝性脑病（SHE）患者中N2、P3波的潜伏期延长，P3波幅降低，与对照组比较有显著差异。结论：躯体感觉ERP可作为诊断大脑智能障碍的一种客观指标，有助于亚临床肝性脑病患者的脑功能判断。     

108例冠心病患者的血脂分析和hs-CRP测定的临床应用

目的：探讨冠心病患者血脂和超敏C-反应蛋白分析的临床意义。方法：生化法和RIA对108例冠心病患者和60例正常对照组中血清胆固醇（total cholesterol,TC）、三酰甘油（triglycerides,TC）,低密度脂蛋白胆固醇（lowdensity lipoprotein cholesterol,LDL-C）,高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）和超敏C-反应蛋白（high sensitivity C-reaction protein,hs-CRP）水平。结果：108例冠心病患者较之60例正常对照组血清TC、TG、LDL-C和hs-CRP显著增高（TC、TG和LDL-C之P〈0.05,而hs-CRP之P〈0.01）,而HDL-C显著降低（P〈0.05）。结论：血清TC、TG、LDL-C,HDL-C和hs-CRP与冠心病密切相关,而且这些因素是冠心病诊断的重要标志物,并能反映严重程度。