原发性甲状腺功能减退所致认知功能损伤的可逆性分析

目的 探讨接受甲状腺激素替代治疗后激素水平恢复时患者认知功能损伤的可逆性.方法 进行纵向研究,入选甲状腺功能减退(甲减)患者20例,平均年龄(47.6±10.9)岁,进行6个月的甲状腺激素替代治疗,并选取与其相匹配的同年龄、同文化程度、同性别、甲状腺功能(甲功)正常对照者20名.对治疗前、后的甲功及认知功能损伤进行评估.结果 甲状腺激素替代治疗6个月后,甲减患者在神经心理学实验中的画钟表试验、图像记忆、摆积木、复杂图形复制、复杂图形回忆及图形延迟回忆、连线A、词表学习第1次、词表延迟回忆、词语再认、数字顺背、数字倒背、词语流畅性、数字符号实验均较治疗前有明显提高(P＜0.05),而词语学习第2次及第3次、连线B与治疗前相比无差异(P＞0.05).结论 经过甲状腺激素替代治疗,甲减所造成的认知功能损伤可恢复.     

老年人甲状腺功能低下的认知损害特点研究

目的探讨老年甲状腺功能低下患者的认知损害特点。方法选择原发性甲状腺功能减退患者60例,根据年龄分为老年组15例和年轻组45例,并2组患者进行神经心理学检测。结果老年组在图形延迟回忆、连线A、词表学习3、数字倒背、符号数字试验中较非老年组成绩差,差异有统计学意义(P<0.05)。而简易智能状态检查量表评分、立体图形、画钟表试验、图像记忆、摆积木、复杂图形描摹、复杂图形回忆,连线B、词表学习1、词表学习2、词表延迟回忆、词语再认、数字顺背、词语流畅性等方面差异无统计学意义(P>0.05)。结论老年原发性甲状腺功能低下患者的认知损害在一些认知易老化区域表现较年轻患者有更严重的损害。     

四个不同脑部位卒中后听觉词语学习能力比较研究

目的 分析左右丘脑和左右基底节卒中后听觉词语学习能力、记忆和保留能力的差异.方法 选择具有单一病灶的丘脑、基底节卒中患者63例与健康对照组34例、遗忘型轻度认知功能损害(aMCI)患者34例进行听觉词语学习测验评定. 结果 卒中组与健康对照组比较,听觉词语即刻与延迟自由回忆、听觉词语的保留率均有显著下降(P＜0.05)；听觉再认左丘脑卒中组受损(19.0±3.1)分,aMCI组受损(17.6±3.3)分,而另外3个卒中组保留.听觉词语学习能力左丘脑卒中组为(2.2±2.0)分,右丘脑卒中组为(2.1±1.9)分,与健康对照组(3.6±1.8)分比较,左右丘脑卒中组的听觉词语学习能力下降明显(P＜0.05)；听觉词语保留能力左丘脑卒中组(2.8±1.7)分,右基底节卒中组(2.7±1.9)分,与健康对照组(1.7±1.4)分比较显著下降(P＜0.05). 结论 卒中组患者的自由回忆、学习能力和保留能力下降,以左丘脑下降更明显；左丘脑卒中的听觉记忆损害模式与aMCI组相似,而不同于另外3个卒中组.     

老年亚临床甲状腺功能减退症患者认知功能障碍及相关因素分析

目的 了解亚临床甲状腺功能减退(亚甲减)患者的认知功能及损害的特点.方法 采用简易智力状态检查量表(MMSE)及韦氏记忆量表(WMS)测试亚甲减患者和甲状腺功能正常对照者(甲功正常)的认知功能,及亚甲减患者给予左旋-甲状腺素片(L-T4)治疗后认知功能的变化,并作相关性分析.结果 在两组的生化指标对比中,各项指标差异均无统计学意义(P＞0.05);亚甲减组治疗前后与甲功正常组,在MMSE评分中的差异无统计学意义;两组在WMS评分中,在图片回忆、联想学习、触摸、理解记忆及背数测试分值上,亚甲减组较甲功正常组差异有统计学意义(P＜0.05),提示亚甲减患者存在一定程度的认知功能障碍,主要表现在记忆力、注意力等方面.经过L-T4治疗3个月后,各项指标均有明显改善(P＜0.05).结论 亚甲减患者存在认知功能障碍,当促甲状腺素(TSH)恢复后,认知功能也有所提高.

Abstract：

Objective To understand the features of cognitive impairment in patients with subclinical hypothyroidism. Methods The cognitive function of the patients with subclinical hypothyroidism and the healthy controls was tested using Mini-Mental State Examination (MMSE) and Wechsler Memory Scale (WMS). The change in cognitive function was observed and analyzed before and after L-T4 treatment. Results Fifty-seven patients with subclinical hypothyroidism and the same number of healthy controls were enrolled in this study. There were no significant differences between two groups in biochemical indexes and MMSE score (all P＞0.05). But there were significant differences between two groups in WMS score, including pictures, memories, learning, touch, understanding memory and back several test scores (all P＜0.05). There existed certain degree of cognitive dysfunction mainly displayed in memory, attention, etc. After three months of L-T4 treatment, all had significant improvement (all P＜0.05). Conclusions Patients with subclinical hypothyroidism have cognitive dysfunction, when the thyroid stimulating hormone is restored to normal level, cognitive function is also improved.     

多奈哌齐和石杉碱甲对轻度认知功能损害的影响

目的 观察可逆性胆碱酯酶抑制剂对轻度认知功能损害(MCI)患者认知功能的影响.方法 MCI患者100例,随机分为治疗组和对照组(各50例),在既往用药的基础上,治疗组根据患者意向给予多奈哌齐(5mg/d)或石杉碱甲(300 μg,/d)治疗.采用简易精神状态量表、词语延迟回忆、本顿视觉保持、数字符号替换及数字广度倒数分、连线A、言语流畅性、画钟等测验评价用药3个月、6个月、1年时两组患者的认知功能,比较1年随访时两组患者进展为痴呆的病例数.结果 治疗组的词语延迟回忆测验、本顿视觉保持测验、数字符号替换及数字广度倒数分测验、连线A测验以及MMSE得分持续改善,1年后进展为痴呆的病例数较对照组显著降低(P＜0.05).结论 可逆性胆碱酯酶抑制剂可改善MCI患者的认知功能,延迟痴呆的发生.     

甲状腺功能减退症患者的左甲状腺素钠替代治疗剂量研究

目的探讨甲状腺功能减退症患者左甲状腺素钠替代治疗的合适剂量。方法甲状腺功能减退症患者1 368例,按照入选患者首次确诊时甲状腺激素测定结果进行分组:A组:单纯TSH升高(亚临床甲减);B组:TSH升高伴T4和(或)FT4降低;C组:TSH升高伴T3和(或)FT3降低;D组:TSH升高伴T4、T3、FT3、FT4降低。分析各组左甲状腺素钠替代治疗的剂量差别。结果 A、B、C、D组左甲状腺素钠替代治疗的合适剂量分别为(38±8.5)、(62±9.2)、(88±7.9)、(114±9.4)μg,各组间比较P均<0.05。结论对于甲状腺功能减退症患者可以根据治疗前的甲状腺激素测定结果,大致推断替代治疗的合适剂量,从小剂量开始逐渐增加剂量直到合适剂量,维持6周以上再测定甲状腺激素水平,从而减少甲状腺激素测定的次数,并能够使甲状腺功能减退症患者的甲状腺功能尽快恢复正常。     

亚临床甲状腺功能减退与糖尿病慢性并发症相关性研究

目的 探讨亚临床甲状腺功能减退(甲减)与2型糖尿病患者慢性并发症的相关性.方法 将临床资料相对完整的1062例2型糖尿病患者按照是否合并亚临床甲减分为2型糖尿病合并亚临床甲减组(糖尿病+甲减组)及2型糖尿病甲状腺功能正常组(糖尿病组),回顾性分析患者的一般资料,既往病史,合并糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变、糖尿病外周血管病变、糖尿病足情况,辅助检查结果及实验室检查指标,并进行多因素非条件Logistic回归分析. 结果 糖尿病+甲减组患者年龄、糖尿病病程、并存冠心病、代谢指标、超敏C反应蛋白、尿微量白蛋白排泄率及促甲状腺激素水平明显高于糖尿病组;糖尿病+甲减组慢性并发症发病率较糖尿病组明显升高,分别为肾病62.8％对46.0％(P＜0.01),视网膜病变40.0％对28.7％(P＜0.05).周围神经病变33.8％对24.0％ (P＜0.05),外周动脉病变50.7％对38.0％ (P＜0.05),糖尿病足22.3％对12.3％(P＜0.01);而踝臂指数、E峰/A峰值低于糖尿病组.经Logistic回归分析结果显示,高促甲状腺激素是糖尿病肾病(β=0.1273,OR=1.1361)、糖尿病足(β=0.1163,OR=1.1222)发生的独立危险因素. 结论 糖毒性可改变甲状腺自身免疫功能,亚临床甲减可促进糖尿病进程,是糖尿病肾病、糖尿病足发生的独立危险因素.老年2型糖尿病患者及病程较长者,应定期进行甲状腺功能检查,以便及早诊断和干预亚临床甲减,从而预防和延缓糖尿病慢性并发症的发生和发展.     

2型糖尿病对老年人群认知功能的影响

目的 了解T2DM对老年人群认知功能的影响. 方法 选取T2DM患者（T2DM组）69 例与非糖尿病者（N-DM组）73例,分析蒙特利尔认知评估（MoCA）量表和简明智能精神状态检查（MMSE）量表的检测结果,比较认知功能障碍合并或未合并T2DM的认知检查差异. 结果 两组MoCA量表检查中,短时记忆[（2.8±1.6）vs（3.3±1.3）分,P＜0.05]和画钟试验[（3.1±1.2）vs（3.4±1.0）分,P=0.054]较差.认知功能障碍患者中T2DM组认知功能损害范围更广.MoCA量表的延迟记忆以3分为界时,诊断认知功能障碍Kappa值0.831. 结论 T2DM对老年人群认知功能的影响主要表现在记忆力上,并对认知能力造成广泛损害.MoCA量表的延迟记忆可作为简易筛查认知功能障碍的方法.     

正常甲状腺功能与老年人轻度认知功能损害的相关性

目的探讨正常甲状腺功能对老年人认知功能的影响,明确甲状腺功能是否为老年人轻度认知功能损害(MCI)的危险因素。方法MCI患者和认知功能正常人各80例,空腹抽血测血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、血糖、血脂、血尿酸(UA),测量身高、体重和血压。分析甲状腺功能与认知功能的相关性及老年人MCI的危险因素。结果 TSH与老年人MMSE评分负相关(B=-1.6,P=0.000),FT4则与其正相关(B=2.2,P=0.04),FT3与其无显著相关;正常高TSH组的MMSE评分明显低于TSH中间组(P<0.05);Logistic回归分析发现TSH和FT4是老年人MCI的影响因素。结论老年人正常范围内甲状腺功能轻度降低可以影响认知功能。     

亚临床甲状腺功能减退与原发性高血压患者动脉粥样硬化的相关性研究

目的探讨亚临床甲状腺功能减退(甲减)对原发性高血压患者动脉粥样硬化的影响。方法选择2016年在上海市徐汇区中心医院住院的原发性高血压患者218例,按照甲状腺功能分为甲状腺功能正常组(157例)和亚临床甲减组(61例)。所有患者均检测血清空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、甲状腺功能,同时测量收缩压和舒张压,彩色多普勒超声测量颈动脉内膜中层厚度。多元线性回归分析法和多元logistic回归分析法分析上述危险因素对原发性高血压患者动脉粥样硬化的影响。结果亚临床甲减组的颈动脉内膜中层厚度[(1. 2±0. 3) mm比(1. 1±0. 3) mm,P=0. 001]和颈动脉粥样斑块发生率(57. 4%比38. 9%,P=0. 015)明显高于甲状腺功能正常组。此外,多元线性回归分析结果显示随着促甲状腺激素、年龄、空腹血糖、舒张压的升高及高密度脂蛋白胆固醇的降低,颈动脉内膜中层厚度增厚;多元logistic回归分析结果显示年龄和促甲状腺激素与颈动脉粥样斑块发生率具有独立相关性。结论原发性高血压患者促甲状腺激素升高是颈动脉粥样斑块发生的独立危险因素,亚临床甲状腺功能减退可加速原发性高血压患者动脉粥样硬化的进展。     

老年人不同甲状腺功能状态下脂代谢特征与氧化应激的关系

目的 探讨老年人不同甲状腺功能状态下脂代谢特征与氧化应激的关系.方法 初诊老年甲状腺疾病患者86例[甲状腺功能亢进(甲亢)47例,甲状腺功能减退(甲减)39例]、非老年甲状腺疾病患者83例(甲亢43例,甲减40例)和老年健康对照组20例.检测空腹血浆丙二醛(MDA)和超氧化物歧化酶(SOD),氧化型低密度脂蛋白(OX-LDL)水平,同时测定血脂指标及甲状腺功能,计算SOD/MDA比值.结果 老年甲亢组血脂各组分均高于非老年甲亢组、低于老年对照组(P＜0.05或P＜0.01);老年甲亢组与非老年甲亢组、老年对照组比较,丙二醛[分别为(10.23±6.29)、(7.37±4.58)μmol/L和(3.66±2.53)μmol/L]、游离脂肪酸(FFA)[分别为(0.86±0.58)、(0.61±0.46)mmol/L和(0.45士0.12)mmol/L]和SOD显著升高(P＜0.01或P＜0.05).老年甲减组与非老年甲减组和老年对照组比较,MDA[(9.03±5.98)、(6.59±3.18)μmol/L和(3.66±2.53)μmol/L]、OX-LDL[(387.36±71.04)、(355.22±45.01)μg/L和(324.53±56.19)μg/L]及部分血脂组分均显著增高(P＜0.05或P＜O.01).老年甲亢组、甲减组SOD/MDA比值均低于老年对照组和非老年组(均为P＜0.01).多元回归分析,甲亢组游离甲状腺素(FT4)和FFA是影响MDA的因素,甲减组非HDL-C和LDL-C与MDA独立相关.结论 初诊老年甲亢和甲减患者氧化应激增强,氧化损伤程度与脂代谢紊乱有关.     

不同甲状腺功能状态对人体血清瘦素水平的影响

目的　研究不同甲状腺功能状态(甲亢、甲减及正常)对人体血清瘦素水平的影响。方法　选取甲亢患者53例(男15,女38),甲减患者48例(男15,女33)和正常对照51例(男15,女36),抽取静脉血测瘦素水平。结果　各组瘦素水平皆与BMI呈强的正相关(P＜0.01),且女性瘦素水平显著比男性高。甲亢患者无论性别,其瘦素水平〔男性(1.2±0.8)μg/L;女性(4.0±2.2)μg/L〕都较正常人〔男性(3.7±2.0)μg/L;女性(7.3±3.0)μg/L〕低(男性P＜0.01,女性P＜0.001);而甲减患者女性瘦素水平〔(5.1±4.1)μg/L〕较正常女性〔(7.3±3.0)μg/L〕低(P＜0.001),男性瘦素水平〔(3.8±2.7)μg/L〕与正常男性〔(3.7±2.0)μg/L〕相比差异无显著性(P=0.09)。结论　生理浓度的甲状腺激素水平可能是人体产生足够的瘦素、从而维持人体正常能量代谢平衡的一个重要因素。     

2型糖尿病患者甲状腺功能与纤维蛋白原关系的研究

目的 探讨T2DM患者甲状腺功能与纤维蛋白原（FIB）的相关性. 方法 选取T2DM患者502例,测定FIB、游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）和临床生化指标,采用方差分析、Spearman相关分析及多元逐步回归分析甲状腺功能与FIB的相关性. 结果 （1）FT3与FIB呈负相关（r=-0.331,P＜0.01）.（2）甲减组FIB高于甲亢组[（3.765±1.089）vs（3.346±0.879）pmol/L,P＜0.01],与正常组[（3.232±0.985） pmol/L]比较差异无统计学意义;按FIB由低到高四分位间距分组,FT3依次为（4.54±0.96）,（4.47±0.81）,（3.94±1.13）及（3.67±0.95）pmol/L,P0～组与P25～组均高于P75～组（P＜0.01）.（3）年龄、[脂蛋白LP-（a）]、C-RP、HbA1c是FIB的独立影响因素（β=0.382,0.272,0.552,0.221;P＜0.05或P＜0.01）;FT3与FIB呈负相关（β=--0.289,P＜0.01）,且与C-RP呈依赖性. 结论 T2DM患者年龄、LP-（a）、C-RP、HbA1 c及FT3均与FIB相关,甲状腺激素可能通过炎症机制影响FIB.     

Osteoporosis and fractures in Turner syndrome-importance of growth promoting and oestrogen therapy

OBJECTIVE: Previous studies have suggested that hypothyroidism affects both systolic and diastolic cardiac function. We have applied equilibrium radionuclide angiography to the study of heart function at rest in hypothyroidism. DESIGN: A prospective study, evaluating cardiac function at rest in primary hypothyroidism. METHODS: Cardiac function was studied by means of equilibrium radionuclide angiography. Screening echo-Doppler examinations were performed on each patient. PATIENTS: Twenty-six consecutive untreated hypothyroid patients without clinical or echocardiographic cardiac disease and 20 healthy matched controls. RESULTS: Between patients and controls, the time to peak emptying rate (161 +/- 6 msec vs. 144 +/- 6 msec, P < 0.05) and the time to peak filling rate (188 +/- 6 msec vs. 170 +/- 5 msec, P < 0.05), were the only discriminatory parameters. In hypothyroid patients, a trend towards a decrease in diastolic cardiac function, expressed as peak filling rate, was observed: 2.6 +/- 0.1 End Diastolic Volume (EDV)/s vs. 3.0 +/- 0.1 EDV/s, P = 0.06. Within the hypothyroid patient group, the time to peak emptying rate was more prolonged in patients with lower free thyroxine levels (R = -0.60, F = 13.5, P < 0.001). Peak filling rate was decreased in patients with lower free thyroxine levels (R = 0.51, F = 8.4, P < 0.01) whereas the time to peak filling rate was more prolonged (R = -0.62, F = 15, P < 0.001). CONCLUSION: In a large group of consecutive patients presenting with primary hypothyroidism, even in the absence of clinical cardiac disease and echocardiographic abnormalities, clear changes in myocardial performance at rest were observed. The most obvious effect of thyroid hormone deficiency on the heart was a lengthening of both systolic and early diastolic time characteristics. Diastolic rather than systolic cardiac function was influenced by hypothyroidism.     

大鼠钙结合蛋白-3基因与关节炎严重程度相关性研究

目的 进一步精细定位Oia2区域,以期发现除C型凝集素超家族成员(CLECSFs)以外的其他关节炎易感基因.方法 在DA大鼠及其同源异基因品系R16大鼠中建立矿物油诱导性关节炎(OIA)模型并记录各临床表型.另取DA和R16大鼠,不完全弗氏佐剂(IFA)免疫后第10天,处死并采集腹股沟淋巴结以获取单个细胞,在mRNA水平检测各R16同源异基因及各炎性细胞因子的表达.两两比较采用Mann-Whitney U检验.结果 OIA模型中,和雄性DA大鼠比较,雄性R16大鼠的关节炎严重程度明显减轻(5.9±3.8与9.3±2.3,P＜0.05),同时其促炎性细胞因子白细胞介素(IL)-17(1.4±2.2与2.7±2.9,P＜0.05)和IL-1β(1.5±2.1与2.3±2.5,P＜0.05)的表达水平明显下降;雄性R16大鼠钙结合蛋白-3(Clstn3)基因的表达明显减低(0.7±0.4与2.2±1.6,P＜0.01).结论 Clstn3基因与雄性大鼠关节炎严重程度密切相关,Clstn3可能为雄性大鼠所特有的关节炎易感基因,同时也表明Clstn3基因变异对雄性大鼠OIA严重程度的影响可能通过辅助T细胞(Th)17型免疫反应而发挥作用.     

The paraventricular nucleus of the hypothalamus has a major role in thyroid hormone feedback regulation of thyrotropin synthesis and secretion

The role of the hypothalamic paraventricular nucleus (PVN) in thyroid hormone regulation of TSH synthesis during hypothyroidism was studied in adult male rats that were normal (n = 10), had primary hypothyroidism with sham lesions in the hypothalamus (n = 17), and had primary hypothyroidism with PVN lesions (n = 14). Two and 4 weeks after initiation of treatment, plasma levels of thyroid hormones (TSH, corticosterone and PRL) and pituitary content of TSH beta and alpha-subunit mRNA were measured. TRH mRNA levels in the PVN were determined by in situ hybridization histochemistry. At 2 weeks, despite a decrease in plasma free T4 in both hypothyroid groups, plasma TSH levels increased, but to a lesser degree, in the hypothyroid PVN lesioned compared to hypothyroid sham-lesioned group (7.8 +/- 1.3 vs. 20.5 +/- 1.1 ng/dl; P less than 0.05). Similarly, at 4 weeks, the hypothyroid PVN-lesioned group demonstrated a blunted TSH response compared to the hypothyroid sham-lesioned group (6.8 +/- 0.7 vs. 24.0 +/- 1.3 ng/dl; P less than 0.05). Plasma corticosterone and PRL did not significantly differ between sham-lesioned and PVN-lesioned groups. TSH beta mRNA levels markedly increased in hypothyroid sham-lesioned rats compared to those in euthyroid controls at 2 weeks (476 +/- 21% vs. 100 +/- 39%; P less than 0.05) and 4 weeks (1680 +/- 270% vs. 100 +/- 35%; P less than 0.05). In contrast, TSH beta mRNA levels did not increase with hypothyroidism in the PVN-lesioned group compared to those in euthyroid controls at 2 weeks (140 +/- 16%, P = NS) and only partially increased at 4 weeks (507 +/- 135; P less than 0.05). alpha mRNA levels at 4 weeks markedly increased in hypothyroid sham-lesioned rats compared to those in euthyroid controls (1121 +/- 226% vs. 100 +/- 48%; P less than 0.05), but did not increase in the hypothyroid PVN-lesioned rats (61 +/- 15%; P = NS). TRH mRNA in the PVN increased in the hypothyroid sham-lesioned rats compared to those in euthyroid controls (16.6 +/- 1.3 vs. 4.8 +/- 1.2 arbitrary densitometric units; P less than 0.05), and TRH mRNA was not detectable in the PVN of hypothyroid-lesioned rats at 2 weeks. In summary, lesions in rat PVN prevented the full increase in plasma TSH, pituitary TSH beta mRNA, and alpha mRNA levels in response to hypothyroidism. Thus, factors in the PVN are important in thyroid hormone feedback regulation of both TSH synthesis and secretion.     

Changes in circulating thyroid hormone levels and systolic time intervals in acute hypothyroidism

OBJECTIVE: We have previously reported that, in thyrotoxic patients treated with carbimazole, serum T4 and T3 levels are the first parameters to return to normal, followed by the systolic time interval (STI, a marker of thyroid function at tissue level) and then the serum TSH. The aim of this study was to compare the rate of change of thyroid hormones, TSH and STI in treated hypothyroid patients after the sudden withdrawal of thyroxine. DESIGN AND PATIENTS: Serum T4, T3 (free and total) and TSH were measured in 12 patients taking thyroxine for primary hypothyroidism; seven were biochemically euthyroid and five were over-replaced, as defined by an elevated free T4 and a sub-normal TSH. Thyroxine was withdrawn and the measurements repeated three times a week until the STI rose above the euthyroid range (0.26-0.32). RESULTS: After stopping thyroxine, the serum TSH and STI left the normal range, in advance of the free T4 and T3, after 9.5 +/- 0.95 and 12.2 +/- 1.5 days respectively (mean +/- SEM). The TSH was the first parameter to leave the euthyroid range in all subjects except one in whom the serum TSH was fully suppressed (less than 0.05 mU/l) initially. In the euthyroid group the TSH and STI increased rapidly after stopping thyroxine (time to leave euthyroid range 7.4 +/- 0.8 and 9.4 +/- 0.7 days respectively). In contrast, in the over-replaced group serum TSH and STI became elevated after 12.4 +/- 1.0 days (P less than 0.005 vs euthyroid group) and 16.0 +/- 2.7 days (P less than 0.05 vs euthyroid group) respectively. There was no delay in the fall in serum T4 or T3 in the over-replaced group when compared with the euthyroid group. CONCLUSIONS: In the evolution of primary hypothyroidism, markers of thyroid function at a tissue level (TSH and STI) become abnormal in advance of thyroid hormones. After stopping thyroxine therapy in treated hypothyroid patients, there is a delayed rise in STI and serum TSH levels in subjects with a subnormal TSH level, as compared with those with a normal TSH on treatment. This suggests mild tissue thyrotoxicosis in these individuals.     

妊娠早期甲状腺功能筛查策略的有效性分析

目的 获得妊娠早期甲状腺功能异常的患病率,进行妊娠早期甲状腺功能筛查策略的有效性分析.方法调查中国沈阳2 899名妊娠早期妇女(4～12周).通过问卷调查方法收集所有孕妇的背景资料,将孕妇分为高风险组与非高风险组.应用妊娠早期特异性甲状腺功能正常参考范围,获得妊娠早期甲状腺功能异常患病率.结果高风险组甲状腺功能减退症患病率明显高于非高风险组(16.3%对5.3%,RR=3.1,95%CI 2.4～4.0,P＜0.01).甲状腺过氧化物酶抗体(TPOAb)阳性(RR=4.7,95%CI3.6～6.0,P＜0.01),甲状腺疾病个人史(RR=3.2,95%CI 1.9～5.4,P＜0.01)均可显著增加甲状腺疾病患病的风险.高风险组甲状腺功能亢进症的患病率明显高于非高风险组(3.1%对1.4%,RR=2.2,95%CI 1.2～3.9,P=0.006).TPOAb阳性(RR=2.6,95%CI 1.3～5.0,P=0.007),甲状腺疾病个人史(RR=4.7,95%CI 1.7～12.5,P=0.006)均可显著增加甲状腺功能亢进发生的风险.高风险组与非高风险组间相比低T4血症患病率差异无统计学意义(0.9%对0.9%,x2=0.008,P=0.928).仅在高危孕妇中筛查甲状腺功能会漏掉56.7%甲状腺功能减退症(临床和亚临床)患者及64.7%甲状腺功能亢进症(临床和亚临床)患者.结论推荐对妊娠早期所有孕妇进行甲状腺功能的筛查.筛查指标应当包括TSH、FT4和TPOAb.     

二甲双胍对促甲状腺素影响的初步研究

目的 观察二甲双胍对血清促甲状腺素(TSH)的影响.方法从2型糖尿病患者中,入选原发性甲状腺功能减退症(甲减)患者48例,组1单用二甲双胍而未予左旋甲状腺素(L-T4)替代治疗(n=17),组2给予L-T4稳定替代量的同时加用二甲双胍(n=19),组3用L-T4稳定替代量和非二甲双胍的其他降糖药(n=12).另外20例甲状腺功能正常的其他甲状腺疾病患者(组4)和30例无甲状腺疾病的患者(组5)作为对照.各组患者均定期检测血清TSH、FT3、FT4、TT3、TT4及血糖等主要指标的变化.结果 治疗12个月与基线时比较,组1为(5.05±1.07)对(2.61±0.91)mU/L(P＜0.01),组2为(2.67±1.03)对(1.35±0.74)mU/L(P＜0.01),两组的FT3及FT4均无明显变化.15例TSH显著降低的患者中有13例(87%)在停用二甲双胍后8～12周内TSH由(1.30±0.71)回升至(2.58±1.02)mU/L(P＜0.01).组3、组4及组5的血清TSH和甲状腺激素的水平均无明显改变.结论 服用二甲双胍可使TSH下降.

Abstract：

Objective To evaluate the effects of metformin on thyrotropin(TSH)levels. Methods From the patients with type 2 diabetes mellitus or metabolic syndrome, 48 patients with primary hypothyroidism were enrolled and grouped. 17 patients were treated only with metformin(group A), 19 patients with metformin and stable L-T4substitution(group B), and the remaining 12 patients with antidiabetic drugs(other than metformin)and L-T4(group C). Meanwhile, 20 euthyroid patients with other thyroid abnormalities(group D)and 30 patients without thyroid diseases(group E)served as control. TSH, FT3, FT4, TT3, TT4, and blood glucose were determined regularly in all these subjects. Results After administration of metformin for 12 months, serum TSH were decreased in group A [(5.05±1.07 vs 2.61±0.91)mU/L, P＜0.01] and group B [(2.67±1.03 vs 1.35±0.74)mU/L, P＜0.01]. No difference was found in FT3and FT4in both groups. TSH levels were raised from(1.30±0.71)to(2.58±1.02)mU/L(P＜0.01)within 8～12 weeks in 13 out of 15 patients after metformin withdrawal. Serum TSH and thyroid hormones in the other 3 groups were not significantly changed. Conclusion Administration of metformin may lead to reduction of serum TSH level.