老年住院患者230例甲状腺功能分析

目的探讨因各种疾病就诊的老年患者甲状腺功能状况。方法230例因非甲状腺疾病就诊的老年住院患者,均于入院次日晨起时抽空腹静脉血检测三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)、血清白蛋白(ALb)。结果筛查出临床甲状腺功能减退症34例(14.78%);亚临床甲状腺功能减退症5例(2.17%);甲状腺功能正常性病变综合征(SES)95例(41.30%),其中低T3综合征患者78例(82.11%)、低T3/T4综合征17例(17.89%),甲状腺功能正常96例(41.74%)。结论老年住院患者甲状腺功能异常发病率高且易被漏诊,尤其SES的发生率较高,多表现为低T3综合征。     

某大型综合性医院甲状腺肿瘤住院病人流行病学特征分析

目的研究甲状腺肿瘤流行病学特征,为甲状腺肿瘤的预防和治疗提供参考。方法通过医院信息系统收集某大型综合性医院2015-2019年甲状腺肿瘤住院病人病例,采用回顾性病例研究方法对所收集病例的年龄、性别、居住地区、肿瘤类型、婚姻状况等信息进行分析。结果共收集7 663例病例,其中女6 192例,男1 471例,男女比例为1∶4.2。2015-2019年,女性病人的构成比始终大于男性。住院病人年龄6~103岁,40~60岁年龄段的住院病人占比最大,住院病人年龄趋于年轻化。未婚病人中男女比例为1∶2.5,已婚病人中男女比例为1∶4.3,离异病人中男女比例为1∶14,丧偶病人中男女比例为1∶3,不同婚姻状况病人的男女比例差异有统计学意义（P < 0.01）。农村病人5 841例（76.2%）,城镇病人1 822例（23.8%）,农村病人的构成比在5年期间持续增加。甲状腺恶性肿瘤住院病人和良性肿瘤住院病人所占比例分别为52.2%和47.8%,甲状腺恶性肿瘤住院病人构成比增长幅度较大。结论甲状腺肿瘤住院病人近年来趋于年轻化,女性病人高于男性病人,农村病人不同年份的构成比呈上升趋势,且甲状腺恶性肿瘤的检出率逐年升高。应进一步加强对农村地区甲状腺肿瘤的相关知识的宣传及普及,加大对高风险人群甲状腺肿瘤筛检的工作力度,以期降低甲状腺肿瘤的发病率,尽可能做到早发现、早治疗。     

Routine thyroid function tests as a case-finding tool

A comprehensive, multiphasic blood panel was used as a case-finding tool for 738 patients. The thyroid function tests T4 (total thyroxine), rT3U (resin T3 uptake), and FTI (free thyroxine index) were included in this panel. Among the 711 patients found to be clinically euthyroid without known thyroid disorder, 54 had at least one abnormal parameter. Of these patients, four new diagnoses of thyroid dysfunction were made. All four cases had an abnormal T4 and FTI. Two patients had a slightly elevated FTI and normal T4, and have remained clinically euthyroid. All other patients had a normal FTI, and no thyroid dysfunction was noted. This gives FTI in this study a sensitivity of 1.0 and specificity of 0.993, which is camparable to what others have found (1). The prevalence of unsuspected thyroid dysfunction was 0.56 per cent, again comparable to other studies (1-3). It would seem the high sensitivity/specificity of FTI offsets the relatively low prevalence of unsuspected thyroid dysfunction. Since FTI is a sensitive predictor of thyroid dysfunction, consideration should be given to the inclusion of thyroid function studies in existing multiphasic case-finding panels.     

精神病患者血清甲状腺激素水平测定

目的了解精神病患者血清甲状腺激素(TH)水平.方法对131例精神病患者的血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺激素(TSH)进行了测定.结果抑郁发作组的总亚临床甲状腺功能低下(SCHO)发生率显著高于非情感性精神障碍或精神分裂症组(P<0.05),与正常对照组的差异接近差异有显著性(x2=3.78).结论提示在抑郁症患者中存在相当一部分甲状腺功能低下.     

Characterization of thyroid function and antithyroid antibody tests among Saudis

Objective:

To determine the reference intervals for thyroid function tests and the prevalence of thyroid autoimmunity in the Saudi population.

Methods:

A cross-sectional prospective study was conducted in King Khalid University Hospital, Riyadh, Saudi Arabia from January to June 2013. History and physical examination were obtained. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were measured by Electro-chemiluminescence Immunoassay system-assay. Anti-thyroperoxidase, and anti-thyroglobulin antibodies were measured using enzyme-linked immunosorbent-assay. Subjects with previous or a family history of thyroid disorders, those taking medications affecting thyroid function, pregnant or lactating women, and those with goiter were excluded. Individuals with positive antibodies were excluded from the final analysis of the TSH reference range, but were used to determine the prevalence of thyroid autoimmunity.

Results:

Out of 337 Saudi subjects initially screened, 132 (aged 13-60 years) were candidates for reference calculation, the mean±standard deviation, and (2.5th-97.5th) percentile of TSH (mIU/L) was 1.96±0.9 (0.59-4.37), for FT4 (pmol/L) was 15.47±1.83 (12.04-19.13), and for FT3 (pmol/L) was 5.22±0.7 (4.07-6.76). The TSH was higher in the antibodies positive group (2.5±1.17 mIU/L) compared with the negative one (1.96±0.9 mIU/L) (p<0.05). Finally, 26% of subjects were tested positive for antithyroid antibodies.

Conclusion:

The TSH reference range was similar to laboratory references. Thyroid antibodies were prevalent in Saudis, necessitating further work in larger scale studies.Abnormalities of the thyroid gland are known to affect a considerable portion of the population worldwide. Precise diagnosis mandates accurate testing for thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), commonly known as thyroid function tests, and in some cases an evaluation of thyroid antibodies titer. These tests have to be interpreted while keeping in mind the population specific reference range.1 In adult Saudis, there is a lack of previous studies conducted to define the reference range of thyroid function tests. Furthermore, the prevalence of antithyroid antibodies among the adult Saudi population has not been estimated. Thyroid-stimulating hormone is the most sensitive test for the diagnosis of primary hypothyroidism. Debate over the definition of the upper limit of TSH calls for the establishment of a reference range among the adult Saudi population. Several factors result in variable TSH levels, such as ethnicity,1 geographic location,2 and specificity, and sensitivity of laboratory tests.3 For example, the National Academy of Clinical Biochemistry (NACB) has proposed lowering the upper limit to 2.5 mIU/L4 based on the 20-year cohort Whickham study,5 which found that subjects with serum TSH level >2 mIU/L at initial evaluation had an increased odds ratio for developing hypothyroidism, especially if thyroid antibodies were elevated.5 Furthermore, the American Association of Endocrinologists stated that although a TSH level between 3.0-5.0 uU/ml is within the normal range, it should be considered a sign of evolving thyroid underactivity.6 Additionally, the presence of thyroid antibodies, which is the main pathological determinant of progression to hypothyroidism, has not been estimated in our local population. In a study conducted on Saudi children,7 the prevalence of antithyroid antibodies was estimated to be 14%; however, this was an old study conducted in the pediatric age group. In the USA, for example, the prevalence among adults was estimated to be 10%.1 In view of the lack of studies measuring normal values for thyroid function tests, we aimed to determine the normal ranges of TSH, FT4, and FT3, and predict the prevalence of antithyroid antibodies in a Saudi adult population living in the Riyadh area.     

精神科住院患者医院感染现状分析

目的：调查精神科病房医院感染病例的分布及易感因素,加强精神科医院感染的防治。方法：回顾调查精神科病房2006年8月至2009年8月住院的3 230例患者的临床资料,分析发生医院感染的危险因素、感染分布及防治对策。结果：3 230例患者发生医院感染265例,医院感染发生率为8.20%。感染部位以呼吸道感染为主,占58.49%;其次为胃肠道,占31.32%;其后依次为皮肤与软组织,占5.66%;泌尿道感染占4.15%;血液感染占0.38%。住院时间〉60天的医院感染发生率较高,感染率为76.23%;医院感染部位分布与季节关系密切,1~3月份和10~12月份以呼吸道感染为主,4~9月份以胃肠道感染为主。结论：精神科医院感染的发生与精神疾病、封闭式的病房管理、抗精神病药物的使用、住院时间、季节关系密切。     

白细胞亚型和甲状腺功能检测在甲状腺毒症鉴别诊断中的意义

目的：探讨不同甲状腺毒症患者血白细胞亚型和甲状腺功能的差异,阐明血白细胞亚型和甲状腺功能检测鉴别诊断Graves病甲状腺毒症和破坏性甲状腺毒症的实用意义。方法：回顾性分析经临床和实验室检查确诊的33例Graves病患者和30例破坏性甲状腺毒症患者的中性粒细胞（Ne）、淋巴细胞（Ly）、嗜碱性粒细胞（Ba）、嗜酸性粒细胞（Eo）、单核细胞（Mo）、血清游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）和甲状腺刺激激素（TSH）值;采用受试者工作曲线（ROC）评价有统计学意义的检查指标对Graves病和破坏性甲状腺毒症的鉴别诊断价值。结果：Graves病组患者血清Eo、FT4与FT3值和改良后的数据Eo/Mo、Eo×FT3/Mo均明显高于破坏性甲状腺毒症组（P < 0.05）,而TSH和Mo值低于破坏性甲状腺毒症组（P < 0.05）。ROC曲线分析,Eo、Eo/Mo、Eo×FT3/Mo在2种疾病鉴别诊断中的灵敏度和特异度良好,最佳诊断界点分别为1.54、0.34和3.94。结论：Eo、Mo、TSH、FT3、FT4、Eo/Mo和Eo×FT3/Mo均可作为鉴别诊断2种疾病的依据,其中Eo、Eo/Mo和Eo×FT3/Mo对于Graves病与破坏性甲状腺毒症的鉴别诊断实用意义较大。     

Prevalence of abnormal thyroid function tests in a Down’s syndrome population

As thyroid function has been documented to be of a higher prevalence in individuals with Down’s syndrome, a study was set up to assess the thyroid status of these individuals. Thyroid function tests (T.F.T.s) were initially reviewed on 100 individuals with Down’s syndrome in the community and on 36 individuals who were residentially based. Abnormal T.F.T.s were then reviewed 3 yr later. In total sample of 136, initially 13 per cent [n=18] of individuals with Down’s syndrome had abnormal T.F.T.s, 5 per cent [n=7] were established cases of thyroid disease and 8 per cent [n=11] were newly identified cases who had abnormal T.F.T.s. Three yr later 6.5 per cent [n=9] of the group who had had abnormal T.F.T.s continued to have abnormal T.F.T.s, 5 per cent [n=7] had thyroid disease and 1.5 per cent [n=2] still had biochemical evidence of thyroid dysfunction. There was a statistically significant increase in abnormal T.F.T.s in the residential sample compared to the community sample on both occasions. The incidence of thyroid dysfunction has been found to increase with age, particularly over the age of 40, however in this study the majority were under the age of 40 with an age range between 28.3 yr and 33.8 yr. The results in this study, coupled with the variability of T.F.T.s over time, highlights the need for regular monitoring of the thyroid status of individuals with Down’s syndrome.