粘肿型地方性克汀病治疗前后的临床观察

本文报告对19例粘肿型地克病患者,用甲状腺素片治疗前后血清 TSH、T_3及 T_4的变化。结果表明:治疗后病人的临床表现、体格发育及性发育等方面均有不同程度的改善。血清 TSH、T_4及 T_3均恢复至正常范围内,且三种变量之间的相关关系也发生了变化。说明用甲状腺素片治疗粘肿型地克病取得良好效果,年龄越小,效果越好。     

湘西北地区神经型地方性克汀病病人血清甲状腺激素及抗体水平的分析

在对地方性克汀病(下称地克病)的研究中,许多学者发现甲状腺有不同程度的发育不良或损伤,推测可能为自身免疫所致。王维忱等还发现部分地克病人血清IgG含量较正常者高,认为可能系甲状腺球蛋白抗体(TGab)。为了探讨供给碘盐四年后的湘西北地区神经型地克病人的甲状腺功能及其自身抗体和体液免疫水平,作者采用病例对照研究,运用放射免疫等手段,对96例神经型地克病人的血清T_3、T_4、TSH、TGab、甲状腺微粒体抗体(TMab)、IgG、IgA、IgM进行了测定,现报告如下。     

两型地克病的心理评价

采用正规的心理学测量技术,对青海省两型地克病患者进行定量检查,结果证实:一、神经型患者平均智商为21.3,属重度智低,粘肿型患者智力显著较优(P<0.02),平均智商为37.9,属中度智低。二、用神经心理功能测试仪,测查患者敲击次数、动作稳定和选择反应时间均表明粘肿型患者的精神运动功能优于神经型,并与智商呈正相关。三、粘肿型患者 TSH有升高趋势,T_4有下降趋势,T_3显著低于神经型(P<0.01),表明存在明显现症甲低。     

28例以神经型为主的地方性克汀病患者血清胆固醇分析

２８例以神经型为主的地方性克汀病患者血清胆固醇分析刘玄，陈秋明，尹金明一般认为地方性克汀病（地克病）粘液水肿型血清胆固醇水平在高值［１－３］，神经型则正常或略低［３］。但后者见诸报道甚少。作者于１９８６～１９８８年对新晃县２８例以神经型为主的住院地克...     

19例神经型地方性克汀病患者免疫状态的初步测定

目前对地方性克汀病(以下简称地克病)临床类型的划分,世界各国都趋向于将其分为粘液性水肿型、神经型和混合型(或称中间型)三型。集贤地区地克病患者的临床特点与新几内亚、南美(厄瓜多尔、巴西)、瑞士等国所报导的神经型地克病相一致。现已有大量文献报导了神经型地克病的临床研究。而对地克病患者免疫研究的材料见之不多。本文将神经型地克病患者     

1980年新疆和田地区不同临床类型地方性克汀病比较分析

目的了解新疆和田地区不同临床类型地方性克汀病各类指标改变情况。方法对地甲病、不同临床类型地方性克汀病与正常人在尿碘、24h甲状腺吸^131I率、血清T4、T3及TSH等指标的改变情况进行比较分析。结果尿碘浓度均明显低于正常水平,24h甲状腺吸^131I率地甲病人与正常人都明显增高,神经型、混合型及粘肿型地克病人明显偏低,血清T4,正常人、地甲病人与神经型地克病均在正常范围。混合型与粘肿型明显低于神经型地克病、地甲病和正常人,血清T3见于粘肿型病例且明显偏低,血清TSH以粘肿型及混合型最高,神经型也明显偏高,地甲病人与正常人未见明显差异,但均在正常值范围,少数病例也有增高的现象。结论和田地区人群尿碘水平均处于严重缺碘状况,神经型、混合型及粘肿型地克病人与正常人24h甲状腺吸”。I率、血清T4、T3、TSH与正常人比较有明显差异。     

先天性碘缺乏对新生大鼠脑内 T_3T_4核 T_3受体与 T_45′-脱碘酶活性的影响

用地甲肿与地克病高发区粮食饲养大鼠复制地克病动物模型,观察和比较了先天性碘缺乏第一代和第五代仔鼠20日龄时脑内甲状腺激素及其受体与 T_45′-脱碘酶活性动态变化的实验结果。发现第一代仔鼠存在有限的代偿机制;而第五代仔鼠脑核 T_3减少极为显著,T_45′-脱碘酶活性降低非常显著,与核 T_3受体浓度明显下降,表明机体失代偿。在大脑 T_3含量不足时,推测受体的下行调节可能是地克病发病的始动环节。     

34例地方性克汀病甲状腺体积B超测定结果分析

３４例地方性克汀病甲状腺体积Ｂ超测定结果分析李东阳庞文静刘守军宋戈萍摘要观察了３４例未投碘治疗地克病患者甲状腺性质、体积。神经型、粘肿型地克病伴甲状腺肿大分别占５２．９４％和１７．６５％，提示无论神经型或粘肿型地克病虽可不必终生使用甲状腺激素替代疗法...     

34例地方性克汀病甲状腺体职B超测定结果分析

观察了３４例未凤碘治疗地克病患者甲状腺性质、体积、神经型、粘肿型地克病伴甲状腺肿大分别占５２．９４％和１７．６５％，提示无论神经型或粘肿型地方病虽可不必终生使用甲状腺激素替代疗法、但需补给足够生理需要量的碘。     

和田和洛浦粘肿型与神经型地方性克汀病对比观察

从1908年 Maccarrison 将地方性克汀病分为两型以来,近半个多世纪国内外主要研究了神经型地方性克汀病(以下称神克病):直到60年代初 Dumot 与 Thilly 等人在扎伊尔又重新对粘液水肿型克汀病(以下称粘克病)从临床表现和生物学特点进行了比较观察,来探讨地克病的分型和发病机制。根据研究Dumont 氏提出的假说“对神经型的甲状腺机     

地方性克汀病人甲状腺功能的临床研究及对分型的探讨

对新疆阿克苏地区４０名地方性克汀病患者及１５名当地正常人进行了Ｂ超法甲状腺体积测量，血清激素（ＴＳＨ，Ｔ４，Ｔ３）测定及皮肤组织粘液物质检查，以期了解该区地克病人的甲状腺功能水平。结果表明，４０名克汀病人的平均ＴＳＨ水平（３０．８５ｍＵ／Ｌ）明显高于当地正常人（３．２５ｍＵ／Ｌ）按ＴＳＨ不同水平将地克病人分为３组，则发现血清Ｔ４，Ｔ３水平随着ＴＳＨ升高而逐渐下降，甲状腺体积逐渐减小，皮肤粘液物质检     

克汀病患者垂体甲状腺轴功能的研究

本文测定了两个病区共53名克汀病患者的血清中促甲状腺激素、甲状腺激素及甲状腺球蛋白浓度。同时选非病区53名正常人做对照。两病区患者所测指标水平大部分在正常范围内。表明缺碘原因所致的克汀病经补碘后,缺碘状态可以改善,垂体甲状腺激素可恢复正常水平。     

EFFECTS OF IODIDES ON THE HYPOTHALAMIC-PITUITARY-THYROID AXIS IN NEUROLOGICAL ENDEMIC CRETINISM: EVIDENCE FOR COMPENSATED THYROIDAL FAILURE IN ADULT LIFE

Thyroid function studies, performed after iodide administration to five patients with neurological endemic cretinism, were indicative of hypothyroidism. All five subjects had either a low serum thyroxine (T4) or a high basal thyrotrophin (TSH) level and a clearly exaggerated TSH response to thyrotrophin releasing hormone (TRH). These findings are in sharp contrast with those we have previously described in goitrous patients without cretinism from the same geographical area. One interpretation of our observations is that there is an underlying mild defect in thyroid hormone synthesis in endemic cretinism predisposing to iodine induced hypothyroidism.     

THE EFFECT OF THYROTROPHIN-RELEASING HORMONE ON PLASMA PROLACTIN AND THYROTROPHIN LEVELS IN PRIMARY HYPOTHYROIDISM

Plasma prolactin and thyrotrophin (TSH) were measured by radioimmunoassay before, at 20 min and 60 min after the intravenous administration of 200 μg thyrotrophin-releasing hormone (TRH) in thirty-two patients with untreated primary hypothyroidism and in sixteen normal volunteers. Whereas basal plasma TSH was markedly elevated in all the patients with hypothyroidism, a slight, but significant increase (P<0.05) in basal plasma prolactin in primary hypothyroidism could only be demonstrated by matching for age, sex and circulating gonadotrophin levels, ten patients with hypothyroidism with ten normal volunteers. There was, however, no significant difference between the two groups, matched or unmatched, in the plasma prolactin levels, in contrast to the plasma TSH levels, following TRH administration. No apparent relationship was found between basal prolactin and follicle-stimulating hormone (FSH), luteinizing hormone (LH) or TSH. Assuming the release of prolactin by TRH to be of physiological significance, the results suggest that TRH secretion by the hypothalamus may be increased in untreated hypothyroidism and that low levels of circulating thyroid hormone increase the sensitivity of the pituitary thyrotrophs, but not the prolactin secreting cells, to TRH. Markedly elevated plasma prolactin levels associated with galactorrhoea were not seen in primary hypothyroidism in the absence of the puerperium or oestrogen therapy.     

THE ASSESSMENT OF 125I TREATMENT OF THYROTOXICOSIS

257 patients have been reviewed 1-5 years (mean 3 years 2 months) after receiving one of five dose regimes of ¹²⁵I for thyrotoxicosis. The cumulative incidence of hypothyroidism was 34% and of persistent thyrotoxicosis 17%. The group receiving doses between 351 and 500 μCi/g had the highest proportion of euthyroid patients (65%) with the lowest requirement for repeat therapy (46%). In the euthyroid patients, increasing dose of ¹²⁵I was associated with progressive decline in mean thyroxine (T4) level and free thyroxine index (FTI) within the respective normal ranges, and increase in mean thyroid stimulating hormone (TSH) level to above the normal range. Euthyroid patients with elevated TSH levels had significantly lower T4 and FTI values compared with those with normal TSH, and showed a 3-4-fold increased rate of development of hypothyroidism over 1 year. Euthyroid patients with elevated T3 levels remained euthyroid during the subsequent year and mean T3 levels declined significantly, suggesting that abnormally elevated T3 levels after ¹²⁵I do not generally indicate impending relapse of thyrotoxicosis. It is concluded that the potential advantages of ¹²⁵I therapy for thyrotoxicosis in reducing the incidence of hypothyroidism have not been realized in practice.     

甘肃省成县黄渚乡地方性克汀病的临床研究

本文报道对地方性克汀病患者进行了临床神经病学检查,包括传统的椎体神经系统检查,而且注意检查了椎体外系统,特别对智力功能做了比较精细的研究。同时观察了垂体甲状腺功能,结果表明克汀病组血清T_4值较正常对照组低而TSH值高(P<0.05)。血清hGH空腹值两组无差别,但用左旋多巴兴奋后60分钟及90分钟值克汀病组低于正常对照组(P<0.05)。运用左旋多巴刺激试验证实地方性克汀病人垂体人类生长激素储备功能差,是一个新发现,有利于对碘缺乏病史深入地研究。     

先天性脑发育不全患儿的甲状腺功能研究

为了解先天性脑发育不全(CMB)患儿的甲状腺功能,测定60例CMB患儿腕部骨龄及血三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、促甲状腺素(TSH),对其中T_4降低者采用甲状腺片治疗,同时与41例先天性甲状腺功能低下患儿对比。结果显示,60例CMB患儿中腕骨骨龄发育迟缓者30例(占50％),T_4降低者32例(占53.3％),T_3降低者12例(占20％),TSH增高者18例(占30％)。对T_4降低的32例用甲状腺片治疗,26例有一定疗效。表明部分CMB患儿有甲状腺功能低下,甲状腺片治疗有一定效果。     

AN ASSESSMENT OF PLASMA TSH RADIOIMMUNOASSAY AND OF THE TSH STIMULATION TEST IN THE DIAGNOSIS OF 100 CONSECUTIVE PATIENTS WITH SUSPECTED HYPOTHYROIDISM

A plasma TSH estimation and a TSH stimulation test were performed on each of 100 consecutive patients seen at a thyroid clinic in whom it was necessary to exclude a diagnosis of hypothyroidism. None of the patients had received replacement therapy. The normal response to 10 i.u. bovine TSH administered intramuscularly on three consecutive days was shown to be an absolute increment in the 4 hr uptake of ¹³²I by the thyroid gland of at least 13%. The mean plasma TSH in twenty-five untreated euthyroid patients, who had neither goitres nor thyroid antibodies, whose TSH stimulation tests were normal and in whom there was no evidence of hypopituitarism, was 3.8 μU/ml+3.6 (2 S.D.). All forty-nine patients with primary hypothyroidism had plasma TSH levels in excess of 25 μU/ml. In eighty-nine of the 100 patients, the radioimmunoassay of plasma TSH and the TSH stimulation test gave similar information about the reserve of thyroid function and in five euthyroid patients the plasma TSH was > 7.4 μU/ml while the TSH stimulation test was normal. The remaining six subjects (including one patient with hypopituitarism and three who had been treated with radioiodine for thyrotoxicosis) were euthyroid with an abnormal TSH stimulation test and a plasma TSH of <7.4 μU ml. For clinical purposes a plasma TSH of <7.4 μU/ml indicates a normal reserve of thyroid function, a plasma TSH between 7.4 and 25 μU/ml is equivocal, and a plasma TSH >25 μU/ml indicates an impaired or absent reserve of thyroid function with or without hypothyroidism. It is concluded that a single plasma TSH estimation should replace the time-consuming TSH stimulation test in the assessment of thyroid reserve.     

左旋甲状腺素钠治疗先天性甲状腺功能减退症的初始剂量研究

目的 探讨先天性甲状腺功能减退症(CH)左旋甲状腺素钠(L-T_4)替代治疗的初始剂量.方法对筛查确诊的CH患儿分为A(n=36)、B(n=51)、C(n=40)3组,分别采用L-T_4 10、8和6 μg·kg~(-1)·d~(-1) 3种不同的初始剂量治疗,分别在治疗后第2周、4-6周、8～12周复查血清TSH、T_4和FT_4水平,根据结果进行L-T_4剂量的个体化调整.12周后每3个月复查1次,随访2年.期间定期进行患儿体格发育评价,甲状腺超声检查、骨龄检测和智能发育测定.结果127例患儿治疗2周,(1)TSH水平,A、B组迅速下降至正常范围[(1.3±1.5)mU/L和(3.7±5.6)mU/L],两组间差异无统计学意义(P=0.28),A组中8例(22.2%)TSH下降到0.5 mU/L以下;C组TSH均未降至正常[(11.4±16.5)mU/L],与A、B组比较有显著性差异(P<0.01),其中10例(25.0%)TSH>10 mU/L,平均值为(34.0±19.2)mU/L.(2)T_4、FT_4水平迅速提高,A组有9例(25.O%)T_4>250 nmol/L;11例(30.6%)FT_4>45 pmol/L,达到正常值高限的1.5倍,并出现高甲状腺素血症,13例(36.1%)患儿分别表现腹泻、烦躁、多汗、哭吵不安等甲状腺功能亢进的临床症状.治疗12周后3组间TSH、T_4和FT_4水平无显著差异,L-T_4剂量也无显著差异.治疗随访2年,127例身高、体重均达到相应年龄的正常范围(x±s);腕部骨龄成熟程度达到相应年龄,3组无显著性差异;智力发育达到正常水平,3组间差异无统计学意义(均P>0.05).结论L-T_4初始剂量(8.0±0.5)μg·kg~(-1)·d~(-1)是我国先天性甲状腺功能减退症初始治疗比较安全、合理、有效的剂量.CH替代治疗时,L-T_4剂量必须个体化,保持甲状腺功能与其年龄相匹配的水平,应能保证其体格和智能的正常发育.     

重组人生长激素治疗对生长激素缺乏症患者甲状腺功能的影响

为探讨生长激素治疗对甲状腺功能的影响及其机制，给１９例特发性生长激素缺乏症患者每日皮下注射重组人生长激素（ｒｈＧＨ）Ｇｅｎｏｔｒｏｐｉｎ０．１ＩＵ／ｋｇ体重，治疗１年，观察治疗前后甲状腺功能及血促甲状腺激素（ＴＳＨ）对静脉推注促甲状腺素释放激素（ＴＲＨ）的反应。经Ｇｅｎｏｔｒｏｐｉｎ治疗后，患者血清Ｔ４及ＦＴ４水平较治疗前明显下降（Ｐ＜０．０１）；治疗半年后，血清ＦＴ３水平亦较治疗前下降（Ｐ＜０．０５）；而血清Ｔ３、３，３′，５′－三碘甲状腺原氨酸及ＴＳＨ水平无明显变化（０．２＜Ｐ＜０．３）。治疗１年后，８例患者血清ＦＴ４水平降至正常范围以下，依此将患者分为治疗后甲状腺功能正常组及降低组，结果证实甲状腺功能降低组在治疗前或治疗后ＴＳＨ对ＴＲＨ兴奋的反应均较甲状腺功能正常组高（Ｐ＜０．０５）。血清ＴＳＨ对ＴＲＨ的反应增强提示患者治疗前就已有潜在的ＴＲＨ缺乏，后者可能是ｒｈＧＨ治疗过程中ＦＴ４及Ｔ４水平下降的潜在基础。因此在ｒｈＧＨ治疗过程中需监测特发性生长激素缺乏症患者的甲状腺功能，以及时给予替代治疗。