甲状腺机能亢进性肌病的临床和肌电图研究

目的：探讨肌电图在甲状腺机能亢进(甲亢性肌病)性肌病中的临床应用价值及其与甲状腺素、病程和性别的关系。方法：对38例甲状腺功能亢进患者进行神经传导速度测定及肌电图检查。结果：38例甲亢患者运动神经及感觉神经传导速度正常，9例肌力减退者运动单位电位(MUP)时限缩短，29例肌力正常者中，MUP时限缩短者16例。男性患者MUP时限缩短的发生率高于女性，T3、T4增高者MUP时限缩短的发生率高于T3、T4正常者。病程短于4个月者MUP时限缩短的发生率较高。结论：EMG检测可发现亚I临床甲亢性肌病，MUP时限为较敏感和客观的指标，并与性别、甲状腺素水平及病程有关。     

甲亢患者血清骨钙素与甲状腺激素的关系探讨

甲亢患者血清骨钙素与甲状腺激素的关系探讨赵世礼，王宾甲状腺机能亢进（甲亢）导致的骨代谢紊乱曾有报告，为评价甲亢时骨细胞的活性及骨钙素（ＢＧＰ）与甲状腺激素的关系，我们对部分未治疗和治疗后的甲亢患者进行了血清ＢＧＰ，Ｔ３，Ｔ４，ＴＳＨ含量测定和分析，现...     

甲亢病人心理干预的临床观察

甲状腺机能亢进症（简称甲亢）致病因素除自身免疫调节紊乱等原因外，心理社会因素对其发生、发展及其转归具有一定的影响。本文对４２例甲亢病人进行药物及药物加心理干预的临床观察。资料与方法将４２例甲状腺机能亢进的病人随机分成常规治疗组与心理干预组各２１例。常...     

甲状腺自身抗体与甲状腺相关性眼病的关系

目的：探讨甲状腺自身抗体与甲状腺相关性眼病（Thyroid-associated ophthalmopathy,TAO）、甲状腺机能亢进症突眼（甲亢突眼）及甲状腺机能亢进（甲亢）的关系。方法：甲状腺相关性眼病35例,甲亢突眼37例,甲亢83例,正常对照90例,分别检测其甲状腺球蛋白抗体（TGA）、甲状腺微粒体抗体（TMA）、促甲状腺受体抗体（TRAb）。结果：四组的TGA阳性数（率）分别为3（8.6%）、6（16.2%）、16（19.3%）、6（6.7%）,TMA阳性数（率）分别为6（17.2%）、7（18.9%）、32（38.6%）、12（13.3%）,TGA、TMA双阳性数（率）分别为1（2.6%）、4（10.8%）、11（13.8%）、0（0.0%）,TRAb阳性数（率）分别为22（62.9%）、31（83.8%）、70（84.3%）、6（6.7%）。结论：TGA、TMA与TAO的相关性不大,诊断意义很小,TRAb与TAO有较好的相关性,对其早期诊断、治疗和随访有很大价值。     

甲状腺功能亢进患者血清甘胆酸变化的观察

对甲状腺功能亢进（甲亢）患者219例，健康对照组98人测定其空腹血清甘胆酸（CG）含量。结果甲亢患者血清CG为764．5土999．spg／dL，正常对照组CG为92．6上72．spg／dL，甲亢组CG明显高于对照组（P＜0．001）。说明部分甲亢患者肝脏功能有较明显损害。材料与方法1受试对象甲亢患者219例（男50例，女169例），年龄9～58岁，平均年龄33．1岁。全部均为初发甲亢，病程两月至八年不等，均未经抗甲药物治疗。所有甲亢患者均经临床和有关甲状腺系列检查而确诊。健康对照组98名（男47名，女sl名），年龄6～27岁。甲亢组及健康对照组所有受试…     

肌萎缩侧索硬化症患者临床与肌电图特点分析

目的：探讨肌萎缩侧索硬化症（ALS）患者的临床特点、肌电图（EMG）和神经传导速度（NCV）对ALS的诊断价值。方法：对42例ALS患者回顾性分析其临床特点、NCV及其胸锁乳突肌、胸段脊旁肌及肢体肌EMG资料。结果：42例患者均呈广泛神经原性损害,胸锁乳突肌EMG异常率为90％,胸椎旁肌EMG异常率为88％,两者异常率均低于上、下肢肌EMG的异常率（100％,98％）,而胸椎旁肌自发电位异常率又高于胸锁乳突肌。结论：早期EMG及NCV检查有助于ALS的早期确诊,行胸锁乳突肌及胸椎脊旁肌EMG检测对ALS的诊断及鉴别诊断有重要价值。     

131I治疗Graves'甲亢630例的临床分析

近年来，受多种因素影响，甲状腺机能亢进（甲亢）的发病率逐年上升，尤以毒性弥漫性甲状腺肿（Graves’病）最为常见。Graves’病属于自身免疫性疾病，是甲状腺刺激免疫球蛋白（TSI或TSAb）与甲状腺滤泡细胞上的TSH受体相结合，刺激有应答能力的所有甲状腺组织弥漫性增生和高功能所致的甲亢，我科2003年5月～2007年5月对630例Graves’甲亢患者进行131I治疗，取得了较好的效果，现将结果报告如下。     

108例甲亢患者的糖耐量观察

甲状腺机能亢进（甲亢）患者与糖耐量之间的关系,虽有多方研究,但结论尚不一致,我们根据甲亢病人的空腹、餐后1h、2h（75g葡萄糖）血糖的检测结果与正常人、糖尿病组进行分析,探讨其间关系。     

妊娠合并甲状腺机能亢进255例临床分析

目的探讨妊娠合并甲状腺机能亢进患者的围产期发病率,药物治疗剂量及规范治疗后的母婴结局。方法收集我院1995年1月～2007年12月的妊娠合并甲亢患者的临床资料255例,分为控制组153例,未控制组102例,选择同期正常妊娠315例作为对照组,控制组均在我院产科高危门诊定期产前保健,每1～1.5月监测FT4,FT3,调整抗甲状腺药物（ATD）的剂量。对妊娠合并甲亢的发生率,控制组的抗甲状腺药物剂量以及3组母儿结局进行回顾性分析。结果（1）发病率：我院近13年来妊娠合并甲亢的发病率0.26%,呈逐年上升的趋势（0.17%～0.32%）。（2）抗甲状腺药物剂量（ATD）：控制组（116例）ATD的平均剂量孕前、孕早期、孕中晚期分别为：126.27±109.92,174.58±121.42,125.21±110.77,孕前与孕早期比较,差异有统计学意义（P〈0.05=;孕早期与孕中、晚期比较,差异有统计学意义（P〈0.05）;孕前与孕中、晚期比较,差异无统计学意义（P〉0.05）。（3）母婴结局：未控制组的子痫前期、早产、胎儿生长不良、胎儿窘迫发生率与控制组比较,差异有统计学意义,控制组与正常妊娠比较,差异无统计学意义。结论妊娠合并甲亢的发病率逐年升高,孕期需及时调整抗甲状腺药物治疗量,规律治疗能明显改善母儿结局。     

甲状腺机能亢进及减退实验诊断进展(文献综述)

甲状腺机能亢进（甲亢）及减退（甲减）是临床上一种常见的内分泌疾病,男女各年龄均可发病,就甲亢而言,尤以女性多发,男女之比为1：4～6。     

A comparative study of single fiber electromyography and repetitive nerve stimulation in consecutive patients with myasthenia gravis

AIM: To compare the diagnostic yield of single fiber electromyography (SFEMG) and repetitive nerve stimulation (RNS) in consecutive patients with myasthenia gravis (MG). METHODS: Consecutive 33 patients with MG diagnosed on the basis of clinical features, positive neostigmine test and/or acetylcholine receptor antibody assay were categorized into stage 1 (3), 2A (10), 2B (12) and 2C (8 patients). Low rate repetitive nerve stimulation (3Hz) was performed in distal muscles (abductor digiti minimi, anconeus, flexor carpi ulnaris, tibialis anterior) and proximal muscles (deltoid, serratus anterior, trapezius and nasalis). Decrement exceeding 10% was considered abnormal. Single fiber EMG was performed in extensor digitorum communis (EDC), recording 20 potential pairs. The abnormality was defined as mean jitter exceeding 40 micros or 10% of potential pairs having block or jitter exceeding 54 micros. The abnormality in RNS and SFEMG was compared and correlated with severity of MG. RESULTS: RNS study was carried out in 33 and SFEMG in 30 patients. In 2 patients SFEMG was not possible due to lack of cooperation and in one due to severe weakness. The RNS study was normal in 6 (2 in stage 1, 3 in 2A and 1 in 2B) patients and in all of them SFEMG was abnormal. The abnormality in RNS and SFEMG correlated with severity of MG. CONCLUSION: SFEMG is indicated in the patients with MG in whom RNS test is negative.     

重症肌无力的重复神经刺激检查研究

目的：研究重复神经刺激（ＲＮＳ）检查对重症肌无力（ＭＧ）疾病的诊断价值。方法：对４４例ＭＧ患者进行重复神经刺激检查,共检查１３２条神经。结果：ＭＧ患者１３２条神经ＲＮＳ诱发的波幅衰减阳性率６５２％。受检的三组肌肉中三角肌阳性率最高（８４１％）,测量波面积对ＭＧ的诊断价值优于测量波幅,两种测量方法阳性率比较有显著性差异（Ｐ＜００５）。ＲＮＳ阳性的ＭＧ患者１００％的在低频刺激时即可获得阳性结果,波幅衰减最明显的刺激频率为５Ｈｚ。结论：ＲＮＳ检查在ＭＧ疾病诊断中具有重要价值     

单纤维肌电图中多电位对颤抖值的影响

目的：确定单纤维肌电图（SFEMG）中最佳的颤抖（jitter）值数目。方法：选择39例重症肌无力患者进行眼轮匝肌SFEMG检测,重新计算多电位的颤抖值并比较差异性。结果：来自异常终板的多电位可以增大颤抖值,该值在不同的Ossermann分型之间无差异。结论：在SFEMG操作中,应采用一个颤抖值的描记,以防止假阳性的结果。     

A study of diagnostic yield, technical ease and patient discomfort of low rate repetitive nerve stimulation test in patients with myasthenia gravis

AIM: The diagnostic yield of repetitive nerve stimulation (RNS) study in different muscles has been evaluated in myasthenia gravis (MG) but there is paucity of comprehensive study on technical ease and patient comfort. In this study we evaluate diagnostic yield of RNS test, technical ease and patient discomfort in 8 different muscles in patients with MG. METHODS: Consecutive patients with MG diagnosed on the basis of clinical evaluation, neostigmine test and/or acetylcholine receptor antibody (AchRAb) assay were subjected to 3 Hz RNS study in abductor digiti minimi (ADM), flexor carpi ulnaris (FCU), anconeus, deltoid, trapezius, serratus anterior (SA), nasalis and tibialis anterior (TA) at rest and 3 min after 30 s exercise. Decrement exceeding 10% was considered abnormal. Patient's discomfort was assessed on a 0-5 scale and technical difficulty by the number of repetitions needed to complete the test or abandonment of test. RESULTS: Thirty-three patients with MG whose age ranged between 16-81 y were evaluated. At the time of RNS study the predominant weakness was ocular in 3, oculobulbar in 13 and limb in 17 patients. The highest diagnostic yield of RNS test was with deltoid and nasalis (78.8% each), followed by trapezius (65.5%). The highest mean patient discomfort score was with deltoid (2.4), followed by nasalis (1.3). The technical difficulty was maximal in deltoid needing 36.4% repetitions followed by SA (33.3%). In oculobulbar group the best yield was in nasalis (92.3%) followed by deltoid (84.6%), and in limb variety deltoid (82.4%) followed by SA (80%) and trapezius (75%). Combining the diagnostic yield, patient comfort and technical ease; the choice of muscle for RNS should be ADM followed by trapezius for patient with predominant limb weakness, nasalis and trapezius in oculobulbar and nasalis in ocular.     

Thyroid disorders in patients with myasthenia gravis: A systematic review and meta-analysis

BackgroundOur purpose was to determine the prevalence of thyroid disorders in myasthenia gravis (MG) or whether MG was associated with an increased risk of thyroid disorders.MethodsPubmed, Embase, Web of Science, Cochrane database, Google Scholar and the Chinese Biomedical Databases were searched about the relationship between thyroid disorders and myasthenia gravis up to November 30, 2018, without language restrictions. The prevalence and relative risk (RR) for thyroid disorders were pooled by the R and STATA software.Results39 papers with 24,927 MG patients were ultimately included for analysis in this meta-analysis. The pooled estimate of thyroid autoimmunity prevalence in MG patients was 10.1% (95%CI 6.7%–15.1%). Subgroups in patients with thyroid autoimmunity showed the prevalence of positive TGAb was the highest in MG patients (12.6%, 95%CI 8.1%–19.1%), followed by GD (6.0%, 95%CI 4.2%–8.5%), HT (4.6%, 95%CI 1.9%–10.5%). Moreover, the pooled estimated prevalence of thyroid dysfunction in MG patients was 6.8% (95%CI 4.6%–9.8%). After stratification, the results showed the prevalence of hyperthyroidism and hypothyroidism in MG cases were 5.6% (95%CI 3.9%–8.0%) and 2.6% (95%CI 1.7%–4.1%), respectively. In addition, meta-analysis of 2 studies showed that MG was significantly associated with the increased risk of thyroid autoimmunity (OR = 2.86; 95%CI 1.54–5.28, P = .001).ConclusionsThis systemic review and meta-analysis provides reliable evidence that thyroid disorders are prevalent in MG, especially TGAb positivity, GD, hyperthyroidism, and HT, and MG is associated with increased risk for thyroid autoimmunity.     

重复频率电刺激对儿童重症肌无力的诊断价值

目的：研究重复频率电刺激（RNS）在儿童重症肌无力（MG）诊断中的价值。方法：对67例儿童MG患儿分别进行面、腋、尺神经的低频RNS，并对结果进行分析。结果：67例MG患儿中属眼肌型（Ⅰ型，最轻型）50例RNS检测结果阳性率为58％～75％；属于全身型（Ⅱ型）17例RNS检测结果阳性率达100％。结论：MG患儿RNS检测结果与临床病情的严重程度呈正相关。     

重症肌无力患者胸腺内microRNA-29表达水平的探究

目的 检测重症肌无力(myasthenia gravis,MG)患者胸腺组织中microRNA-29的表达水平并探讨其与MG发病的相关性.方法 22例经手术治疗的MG患者胸腺组织作为实验组,22例经手术治疗的非MG伴胸腺异常患者胸腺组织作为对照组.通过实时荧光定量PCR(quantitative real-time PCR,qRT-PCR)的方法检测实验组及对照组胸腺组织中microRNA-29表达水平,采用秩和检验(Mann-Whitney U test)分析实验组与对照组中microRNA-29表达水平.采用Spearman秩相关分析实验组胸腺中microRNA-29表达水平与定量重症肌无力(quantitative myasthenia gravis score,QMG)之间的相关性.结果 MG患者胸腺组织中microRNA-29表达水平较对照组显著增高(P=0.032);依据MG患者性别、年龄、临床特点、胸腺病理结果将实验组分成不同临床亚组,microRNA-29在各组间表达差异无统计学意义(P值分别为0.614、0.471、0.267、0.329);microRNA-29表达水平与QMG呈显著正相关性(r=0.689,P=0.000a).结论 microRNA-29在MG患者胸腺组织中表达增高,其表达水平与肌无力严重程度呈正相关,而与患者性别、年龄、临床类型、胸腺病理结果无明显关联.     

Clinicopathological study of thymomas--correlation of histologic subtype to myasthenia gravis and prognosis

Thymoma is the most common primary tumor of anterior superior mediastinum. Sixty cases of thymomas over a 12 year period were analysed and the histologic subtype, according to Marino and Muller-Hermilink, classification was correlated with presence or absence of myasthenia gravis (MG) and capsular invasion. Thirty four patients had myasthenia gravis associated with thymoma and there was one case of pure red cell aplasia. There were 3 (1) predominantly cortical, 28 (20) cortical, 12 (9) mixed, 16 (4) medullary thymomas and 1 (0) thymic carcinoma (Figures in parenthesis indicate number of cases associated with MG). Capsular invasion was seen in 25 cases. Association with myasthenia gravis and capsular invasion were seen predominantly in cortical and mixed thymomas which were also associated with aggressive behaviour.     

重症肌无力患者AchR-Ab、Titin-Ab的检测及其临床意义

目的 对重症肌无力患者血清乙酰胆碱受体抗体(AchR-Ab)、连接素抗体(Titin-Ab)进行检测,探讨其临床意义,为临床提供诊断、治疗的依据.方法 选取本院2013年1月至2014年12月收治的重症肌无力患者80例.依据胸部CT检查结果将患者分为伴胸腺瘤(MGT)组与不伴胸腺瘤(NTMG)组.测定各组患者外周血AchR-Ab与Titin-Ab的含量并统计阳性例数,探讨其用于诊断重症肌无力的价值及意义.结果 MG组AchR-Ab与Titin-Ab阳性率明显高于HC组,MGT组AchR-Ab与Titin-Ab阳性率明显高于NTMG组,全身型(Ⅱ～Ⅳ型)AchR-Ab与Titin-Ab阳性率明显高于眼睑型(Ⅰ型)组,差异具有统计学意义(P＜0.05).结论 AChR抗体作为临床使用最广泛的重症肌无力患者检测指标具有一定价值,Titin抗体是应用于重症肌无力患者合并胸腺瘤时敏感而特异的血清学指标,在重症肌无力患者中开展血清Titin抗体的测定对于胸腺瘤的诊断及判断预后具有重要的临床指导意义.     

Misdiagnosis of myasthenia gravis

Patients with myasthenia gravis (MG) are too often misdiagnosed as having another disorder. Three patients are presented who were thought to have amyotrophic lateral sclerosis, velopharyngeal incompetence, and no diagnosis of MG, but actually each had myasthenia gravis. Their histories illustrate how the diagnosis of myasthenia gravis can be easily missed.