Clinical Utilization of Thyroid Function Tests

Although the availability of different thyroid function tests has increased our knowledge of thyroid disease, it has also presented problems for the physician who must decide what test to use in a given clinical setting. This paper reviews the various tests and makes specific recommendations for proper utilization of the readily available tests in assessing thyroid function.     

风险质量控制方案在甲状腺功能检测项目的应用

目的　设计风险质量控制方案应用于实验室甲状腺功能项目测定的质量控制（Quality Control, QC）中,并与传统QC方法比较。方法　首先评估实验室甲状腺功能五项的西格玛值(σ),基于风险质量控制策略设计QC方案。方案中:促甲状腺激素(TSH)和游离三碘甲状原氨酸（FT3）的质控规则采用13s, N2;游离甲状腺素(FT4)采用13s/22s/R4s,N2;三碘甲状原氨酸（T3）采用13s/22s/R4s/41s,N4;甲状腺素(T4) 采用13s/22s/R4s/41s/6x, N6。QC事件频率为每40份样本测定一次质控材料。传统质量控制规则采用13s/22s/R4s/41s/10x,N2作为对照。运行两种质量控制方案一个月并进行比较。结果　通过比较发现,σ值较高的TSH,FT3,FT4项目在质控监测过程中性能稳定,风险质量控制和传统质量控制均无失控点。而σ值较低的T3,T4项目在质控监测中稳定性略差,传统质量控制中虽未出现失控点,但风险质量控制过程中就发现失控点,且σ值越低的项目失控点就越多。结论　通过传统质量控制和风险质量控制的应用比较,风险质量控制更能有效的监测分析过程的稳定性。     

Pulmonary Function Abnormalities in Patients with Inflammatory Bowel Disease

The occurrence of lung disorders has been investigated in 102patiens with inflammatore bowel disease, by means of pulmonaryfunction testing, chest radiography and physical examination. Pulmonary function tests were abnormal in approximately 50 percent patients and 25 per cent of patients had a reduced lungtransfer factor. Radiological abnormalities compatible withfibrosing alveolitis were identified in six patients. Therewas no apparent correlation between these abnormalities andbowel disease sitse and activity, concurrent drug administrationor the presence or absence of circulating immune complexes andautoantibodies.     

甲状腺功能检测的临床应用——试验选择和评价

甲状腺功能障碍性疾病是一种临床常见病.典型的甲状腺功能亢进、亚临床型甲状腺功能亢进、典型的甲状腺功能低下和亚临床型甲状腺功能低下在成人中的发病率分别为2%、5%～17%、0.2%和0.1%～1.6%,在老年人群中的发病率更高.甲状腺功能障碍的临床表现(特征和严重性)差异很大;而且,其症状和体征常有非特异性和进展缓慢的特点.这就使甲状腺功能障碍的临床诊断受到限制.如果仅就病人症状和体征进行评价,许多有病的个体会被漏诊.所以,甲状腺功能障碍的诊断、治疗和监测依赖于实验室的常规试验,特别是对早期和亚临床甲状腺疾病,试验的敏感性明显优于临床诊断.当这些试验的使用和解释恰当时,几乎可识别绝大多数甲状腺功能障碍的病例.     

肺功能检查对上气道梗阻性疾病的诊断意义

1病例资料女,23岁。因咽痒、声嘶、轻咳1个半月就诊。来我院前在当地医院按咽喉炎、上呼吸道感染治疗2周末见好转,后到另一医院就诊,亦按上述疾病治疗2周仍未见好转。既往体健。查体：咽部稍充血,心肺听诊未闻及异常。查血常规正常;摄X线胸片未见异常;肺功能检查：用力肺活量(FVC)占102%,用力呼气峰流速(PEF)占48%,用力     

左西孟旦对重症瓣膜病术后肾功能的影响

目的:观察重症瓣膜病患者术后使用左西孟旦对肾功能的影响。方法:2012年12月至2014年9月术后使用左西孟旦的重症瓣膜病患者36例为治疗组,2011年10月至2012年12月术后未使用左西孟旦的重症瓣膜病患者36例为对照组,记录两组术前(T1)、术后返回ICU(T2)、术后24 h(T3)、术后3 d(T4)、术后7 d(T5)的血尿素氮(BUN)、血肌酐值(Cr)、肌酐清除率(Ccr)、ICU停留时间、术后住院时间及发生急性肾损伤(AKI)、使用肾脏替代治疗(CRRT)例数。结果:两组Ccr在T3(P=0.02)、T4(P=0.008)有明显差异;BUN在T2(P=0.03)、T3(P=0.01)、T4(P=0.007)有明显差异;两组AKI发生率(P=0.003)、CRRT使用率(P=0.01)、ICU停留时间(P=0.0008)和术后住院时间(P=0.007)均有明显差异。结论:重症瓣膜病患者术后使用左西孟旦可有效改善肾脏功能,降低术后AKI发生率及CRRT使用率,减少ICU和术后住院时间。     

A Comparative Study of Four Tests of Pancreatic Function in the Diagnosis of Pancreatic Disease

Four tests of pancreatic function—the conventional andsubtraction pancreas scans, the Lundh test, and the radioseleniumtest—were performed in 80 patients in an attempt to clarifythe indications for performing one or more of these tests inthe diagnosis of pancreatic disease. All four tests were performedsimultaneously in a single two-hour session. The scans weremarked blindly by three independent observers. The radioselenium and Lundh tests were equally accurate in distinguishingbetween the normal and the abnormal pancreas. Thus only oneof these two tests need be performed in a patient referred forpancreatic investigation. Routine performance of both a conventional and a subtractionscan is, however, indicated because the subtraction scan gavefewer false positive results in normal patients whereas theconventional scan yielded better resolution of filling defects. A normal pancreatic scan indicated a 94 per cent probabilitythat the pancreas was normal. If the scan was normal the intubationtest was always normal. An abnormal intubation test indicateda 100 per cent probability that the pancreas was abnormal. Ifthe intubation test was abnormal the scan was always abnormal.However, abnormal (false positive) scans were seen in 25 percent of the normal subjects and normal (false negative) intubationtests were seen in 35 per cent of patients with pancreatic carcinoma.Abnormal scans were seen in 95 per cent of patients with pancreaticcarcinoma and in some instances the scans were very suggestiveof carcinoma as a localized filling defect was seen. Thus thepancreatic scan is more reliable than an intubation test inestablishing a diagnosis of pancreatic carcinoma. Diagnosticability can, in general, be best improved by performing eitherone of the duodenal intubation tests together with both theconventional and the subtraction scan. But for some patients,either the scans on their own (if normal) or an intubation testalone (if abnormal) will suffice. ¹This work formed part of an M.D. thesis submitted to CambridgeUniversity by G. R. Youngs.     

Intractable Exophthalmos in Thyroid Disease

The incidence of progressive exophthalmos in cases of thyroid disease and the pathologic changes that initiate the condition are discussed. Results of bilateral orbital decompression in 78 cases are reported, and the technic of the procedure is outlined.     

妊娠妇女甲状腺自身抗体与甲状腺功能的相关性分析

[目的]探讨沧州地区妊娠妇女血清抗甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)的阳性率与促甲状腺素(TSH)水平的关系.[方法]选取妊娠妇女786例,按孕周分为T1、T2、T3期三组,采用电化学免疫分析法测定其血清TSH及TPOAb、TGAb水平.根据TSH水平分为TSH异常组和TSH正常组;根据TPOAb、TGAb水平分为TPOAb和TGAb阳性组(双阳性)、TPOAb阳性组、TGAb阳性组、TPOAb和TGAb阴性组(双阴性).[结果]妊娠妇女在T1、T2、T3期TPOAb阳性率分别为:9.95％、11.07％、11.22％,TGAb的阳性率分别为:8.14％、9.09％0、8.65％;TSH异常组TPOAb、TGAb阳性率升高,与TSH正常组比较,差异均具有统计学意义(P＜0.05);双阳性组TSH水平升高,且与TPOAb阳性组、TGAb阳性组、双阴性组比较,差距均具统计学意义(P＜0.05).[结论]TSH异常组TPOAb和TGAb阳性率高,TPOAb、TGAb均阳性者TSH水平升高,TPOAb、TGAb和TSH水平均可作为评估妊娠期妇女甲状腺功能的指标.     

冠心病并慢性肾功能不全患者介入诊疗围术期的肾功能保护

目的:观察丹参酮注射液与小剂量多巴胺对冠心病并慢性肾功能不全患者介入诊疗围术期的肾功能保护作用.方法:将52例有慢性肾功能不全需行介入诊疗的冠心病患者分成冠状动脉造影(CAG)组和经皮冠状动脉介入治疗(PCI)组.CAG组未予特殊处置,PCI组围术期给予丹参酮注射液与小剂量多巴胺静脉滴注.观察两组介入诊疗前后肾功能和尿量变化及造影剂相关性肾病(CIN)发生情况.结果:CAG组CIN发生率38.4%,PCI组发生率15.4%,两组比较差异具有显著性意义(P＜0.01);PCI组治疗后血尿素和Cr明显低于CAG组(P＜0.01).结论:冠心病并慢性肾功能不全患者应用丹参酮注射液与小剂量多巴胺后可耐受介入诊疗,并可改善肾功能,值得临床推广使用.     

Significance of Abnormalities of Serum Complement in Human Disease

Measurement of qualitative or quantitative changes in components of the serum complement system may provide characteristic profiles of diseases associated with host defense.     

Serum Measurements of Thyroid Function

It is often difficult to assess the thyroid status of a patient by using only a PBI determination. Measurement of thyroxine-iodine, free thyroxine, thyroid-binding proteins, or total T4-binding proteins gives the physician additional parameters for an accurate evaluation of thyroid function.     

Immunologic Features of Thyroid Disease

There is considerable reason to believe that immunologic processes are involved in the pathogenesis of Hashimoto's and Graves' diseases, since many immunologic abnormalities have been demonstrated in such patients. Current theories on the disordered immunity and indications for pertinent tests are presented here.