高碘地区妊娠晚期妇女与育龄妇女甲状腺功能的比较

探讨妊娠和高碘对妇女甲状腺功能及甲状腺自身免疫功能的影响.选择高碘地区(27.69±4.73)岁孕妇210例和(30.62±6.01)岁育龄妇女290例;采集空腹晨尿及静脉血,砷-铈催化分光光度法测定尿碘浓度,化学发光法测定血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)及灵敏促甲状腺激素(sTSH),放射免疫法测定血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb).孕妇和育龄妇女尿碘中位数分别为1 240.70μg/L和949.21μg/L,有94.3%的孕妇和81.0%的育龄妇女碘过量.孕妇和育龄妇女甲状腺疾病总患病率为22.9%和30.3%,孕妇甲状腺功能亢进症(甲亢)、亚临床甲亢、甲状腺功能减退症(甲减)、亚临床甲减的患病率分别为0.5%、1.9%、0.5%和20.0%.育龄妇女的甲亢、亚临床甲亢、甲减及亚临床甲减的患病率分别为2.8%、0.3%、0.3%和26.9%.孕妇的FT3、FT4水平低于育龄妇女[(4.03±0.59对4.71±1.04)pmol/L,(13.35±1.59对14.27±3.63)pmol/L,均P＜0.01],TGAb阳性率低于育龄妇女(7.1%对14.1%,P=0.014).高碘地区妇女甲状腺疾病患病率及甲状腺自身抗体阳性率较高,妊娠使孕妇甲状腺激素水平及TGAb阳性率较育龄妇女降低,建议育龄妇女及孕妇控制碘摄入,并加强甲状腺功能和甲状腺自身抗体的监测.

Abstract：

To explore the influences of pregnancy and iodine intake on thyroid function and immune functions, 210 pregnant women and 290 fertile women were chosen from iodine excess area, and the average ages of them were (27. 69±4. 73 )and (30. 62±6. 01 )years respectively. Fasting blood and urine were collected in the morning. The urinary iodine level was determined by arsenic-cerium catalytic contact. Serum free triiodothyronine ( FT3 ), free thyroxine ( FT4 ), and sensitive thyroid-stimulating hormone ( sTSH ) levels were measured by chemiluminescence.Thyroid peroxidase antibody (TPOAb)and thyroglobulin antibody (TGAb)were measured by radioimmunoassay. The median urinary iodine in the pregnant and fertile women were I 240. 70 and 949. 21 μg/L, respectively. There were 84. 3% pregnant women and 81.0% fertile women admitting excess iodine intake. The prevalence of overall thyroid diseases was 22. 9% in the pregnant women and 30. 3% in the fertile women. The prevalence of hyperthyroidism,subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism was0. 5%, 1.9%, 0. 5%, and 20. 0% in the former group, and 2. 8%, 0. 3%, 0. 3%, and 26. 9% in the latter. Both FT3 and FT4 levels of the pregnant women were lower than those of fertile women [(4. 03±0. 59 vs 4. 71 ± 1.04)pmol/L, ( 13. 35 ± 1.59 vs 14. 27 ±3.63 )pmol/L,both P＜0. 01], and the positive rate of TGAb of pregnant women was also lower than that of fertile women (7. 1% vs14. 1%, P=0. 014). The prevalence of thyroid diseases and positive rate of thyroid autoantibodies is high in women with excess iodine intake. Compared with fertile women, pregnancy may lead to decreas~s in level of thyroid hormones and positive rate of TGAb. Their iodine intake should be controlled, and the thyroid function and autoimmunity antibodies should be monitored.     

Significant association of insulin and proinsulin with clustering of cardiovascular risk factors

AIM: To investigate the association between true insulin and proinsulin and clustering of cardiovascular risk factors. METHODS: Based on the random stratified sampling principles, 1196 Chinese people (533 males and 663 females, aged 35-59 years with an average age of 46.69 years) were recruited. Biotin-avidin based double monoclonal antibody ELISA method was used to detect the true insulin and proinsulin, and a risk factor score was set to evaluate individuals according to the number of risk factors. RESULTS: The median (quartile range) of true insulin and proinsulin was 4.91 mIu/L (3.01-7.09 mIu/L) and 3.49 pmol/L (2.14-5.68 pmol/L) respectively, and the true insulin level of female subjects was significantly higher than that of male subjects (P=0.000), but the level of proinsulin displayed no significant difference between males and females (P = 0.566). The results of covariate ANOVA after age and sex were controlled showed that subjects with any of the risk factors had a significantly higher true insulin level (P=0.002 for hypercholesterolemia, P=0.021 for high low-density lipoprotein cholesterol, P= 0.003 for low high-density lipoprotein cholesterol, and P=0.000 for other risk factors) and proinsulin level (P=0.001 for low high-density lipoprotein cholesterol, and P=0.000 for other risk factors) than those with no risk factors. Furthermore, subjects with higher risk factor scores had a higher true insulin and proinsulin level than those with lower risk factor scores (P=0.000). The multiple linear regression models showed that true insulin and proinsulin were significantly related to cardiovascular risk factor scores respectively (P=0.000). CONCLUSION: True insulin and proinsulin are significantly associated with the clustering of cardiovascular risk factors.     

阻塞性睡眠呼吸暂停综合征合并高血压患者血浆神经肽Y水平变化

Objective To explore the potential role of neuropeptide Y (NPY) in the pathphysiological process of hypertension caused by obstructive sleep apnea sydrome (OSAS). Methods The concentration of serum NPY were measured with radioimmunoassay (RIA) in 417 subjects (97 normotensive controls without OSAS, 113 cases of normotensive with OSAS, 73 cases of hypertensive without OSAS and 134 cases of hypertensive with OSAS. Futher, the mean NPY level were compared in four groups and the possible effective factors on NPY were discussed. Results ( 1 ) The concentration of NPY in four groups were (50. 5 ±37. 2) pmol/L in normal controls, (76. 0 ±39. 9) pmol/L in normotensive with OSAS group, (66. 9 ± 36. 2 ) pmol/L in hypertensive without OSAS group and (86. 8 ± 36. 8 ) pmol/L in hypertensive with OSAS group. Whether the patients with OSAS combined with hypertension or not, the concentration of NPY in the serum raised remarkably compared with those without OSAS and hypertension,the highest level of serum NPY was detected in OSAS combined with hypertension group. (2) Pearson corelation analysis indicated that both SBP and DBP related to the serum NPY significantly in non-OSAS group (AHI < 10), while the BMI, abdominal circumference, AHI as well as the lowest level of SaO_2 correlated to NPY besides SBP in OSAS group with ( AHI ≥ 10). (3) Multiple linear regression model showed that the abdominal circumference and AHI were contributing factors to SBP, while neck circumference and BMI were contributing factors to DBP. The level of NPY in the serum were significantly affected by AHI and BMI, in which the former one had greater influnce. Conclusion The increased level of serum NPY may play weakly potential roles in the pathphysiological process of hypertension caused by OSAS.     

阻塞性睡眠呼吸暂停综合征合并高血压患者血浆神经肽Y水平变化

Objective To explore the potential role of neuropeptide Y (NPY) in the pathphysiological process of hypertension caused by obstructive sleep apnea sydrome (OSAS). Methods The concentration of serum NPY were measured with radioimmunoassay (RIA) in 417 subjects (97 normotensive controls without OSAS, 113 cases of normotensive with OSAS, 73 cases of hypertensive without OSAS and 134 cases of hypertensive with OSAS. Futher, the mean NPY level were compared in four groups and the possible effective factors on NPY were discussed. Results ( 1 ) The concentration of NPY in four groups were (50. 5 ±37. 2) pmol/L in normal controls, (76. 0 ±39. 9) pmol/L in normotensive with OSAS group, (66. 9 ± 36. 2 ) pmol/L in hypertensive without OSAS group and (86. 8 ± 36. 8 ) pmol/L in hypertensive with OSAS group. Whether the patients with OSAS combined with hypertension or not, the concentration of NPY in the serum raised remarkably compared with those without OSAS and hypertension,the highest level of serum NPY was detected in OSAS combined with hypertension group. (2) Pearson corelation analysis indicated that both SBP and DBP related to the serum NPY significantly in non-OSAS group (AHI < 10), while the BMI, abdominal circumference, AHI as well as the lowest level of SaO_2 correlated to NPY besides SBP in OSAS group with ( AHI ≥ 10). (3) Multiple linear regression model showed that the abdominal circumference and AHI were contributing factors to SBP, while neck circumference and BMI were contributing factors to DBP. The level of NPY in the serum were significantly affected by AHI and BMI, in which the former one had greater influnce. Conclusion The increased level of serum NPY may play weakly potential roles in the pathphysiological process of hypertension caused by OSAS.     

碘/钠摄入量对小鼠血脂代谢影响的实验研究

Objective The present study has been designed to investigate the impact of dietary iodine/sodium intake on blood lipid metabolism in mice. Methods According to body weight and gender, two hundred and sixty Balb/c mice were randomly divided into 2 groups including normal sodium group(Na) and low sodium group(LNa), with 130 animals per group. Each group were then randomly further divided into 5 sub-groups according to the amount of iodine intake: ① severe iodine deficiency(SID); ② mild iodine deficiency(MID); (③normal iodine (NI); ④ 10-fold high iodine ( 10HI ); (⑤ 50-fold high iodine (50HI), 10 groups in total, 26 per group.Eight months later, the body weight and the levels of urinary iodine, thyroid hormones and total cholesterol (TC),Results In Na group, the levels of TG and TC in male mice of SID group[ (1.64 ± 0.35), (3.88 ± 0.35 )mmol/L]and MID group[ ( 1.67 ± 0.31 ), (3.41 ± 0.66)mmol/L] were significantly higher than that of NI group[ ( 1.49 ± 0.42), (3.25 ± 0.47)mmol/L] and the levels of TG in female mice of SID group[(1.52 ± 0.22)mmol/L] were significantly higher than that of NI group[ (1.23 ± 0.22)mmol/L]. In addition, the levels of TG in male mice of 10HI and 50HI groups [ ( 1.16 ± 0.23 ), ( 1.21 ± 0.27 ) mmol/L ] were significantly lower than that of NI group [ ( 1.49 ± 0.42)mmol/L, all P ＜ 0.05], the levels of TC in female mice of 10HI and 50HI groups[(2.37 ± 0.49), (2.48 ± 0.37)mmol/L] were significantly lower than that of NI group[ (2.84 ± 0.37) mmol/L, all P ＜ 0.05 ]. In LNa group,the levels of TG and TC in male mice of SID group[ (1.39 ± 0.40), (3.33 ± 0.46 )mmol/L] were significantly lower than that of NI group [(1.30 ± 0.28), (3.00 ± 0.53) mmol/L, all P ＜ 0.05], the levels of TG, TC and LDL in female mice of SID group[ (1.48 ± 0.26), (2.76 ± 0.43), (0.62 ± 0.22)mmol/L], the levels of LDL in female mice of MID group[ (0.60 ± 0.17 )mmol/L] were significantly lower than that of NI group[(l.22 ± 0.36), (2.51 ± 0.38),(0.48 ± 0.08), (0.48 ± 0.08)mmol/L, all P ＜ 0.05], the levels of TG in male mice of 10HI and 50HI group [ (1.12 ± 0.22), (0.90 ± 0.11 )mmol/L] were significantly lower than that of NI group (all P ＜ 0.05 ), the levels of TC in female mice of 10HI and 50HI groups[ (2.35 ± 0.34), (2.37 ± 0.37)mmol/L], the levels of LDL in female mice of 50HI group[(0.65 ± 0.18)mmol/L], were significantly lower than that of NI group(all P ＜ 0.05). In Na group, the levels of thyroid hormones were distinctively decreased in SID group[TT4(0.00 ± 0.00)nmol/L, FT4 (0.93 ± 0.42)pmol/L, TT3(0.49 ± 0.07)nmol/L, FT3(2.86 ± 0.37)pmol/L] and MID group [TT4 (17.15 ± 15.26)nmol/L, FT4( 18.46 ± 4.31 )pmol/L, TT3(0.67 ± 0. 10)nmol/L, FT3(3.18 ± 0.24)pmol/L] compared with that of the NI group [TT4 (37.15 ± 15.26)nmol/L, FT4(28.46 ± 4.31)pmol/L, TT3(0.85 ± 0.10)pmol/L, FT3(3.87 ± 0.24)pmol/L, all P ＜ 0.05 ]. In LNa group, the levels of thyroid hormones were distinctively decreased in SID group [TT4 (0.00 ± 0.00) nmol/L,FT4(1.03 ± 0.78)pmol/L, TT3(0.51 ± 0.05)nmol/L, FT3(3.01 ± 0.17)pmol/L] and MID group[TT4(19.76 ± 12.22)nmol/L, FT4(21.46 ± 5.37)pmol/L, TT3(0.71 ± 0.21)nmol/L, FT3(3.56 ± 0.23)pmol/L] compared with that of the NI group[TT4(36.23 ± 14.72)nmol/L, FT4(30.96 ± 6.33)pmol/L, TT3(0.89 ± 0.20)nmol/L, FT3(4.05 ± 0.24)pmol/L, all P ＜ 0.05]. Conclusions Dietary iodine intake plays an important role in the blood lipid metabolism. Iodine deficiency could increase while iodine excess could decrease the levels of serum TG, TC or LDL in mice. Monitoring the amount of iodine intake during sodium restriction should have an important role in effective prevention and treatment of cardiovascular disease.     

Association of urotensin Ⅱ with angiographic severity of coronary artery disease

Objective The goal of this study was to examine the association between urotensin Ⅱ (U Ⅱ) concentration and the severity of coronary artery disease (CAD). Methods We studied U Ⅱ concentrations in 100 patients with known or suspected CAD referred for cardiac catheterization. Based on coronary angiograms, subjects were classified as having no or mild CAD (stenosis ＜50%) and significant CAD (stenosis=50%). Micheal score system was used to estimate the severity of CAD. Result U Ⅱ concentration in the significant CAD group had no difference compared with the no or mild CAD group (1.95±1.18 pmol/L vs 2.04±1.47 pmol/L, P＞0.05),but higher in the severe group (score =9) than in the normal or nearly normal group (score＜3)( 2.50±1.62 pmol/L vs 1.61±1.05 pmol/L,P=0.03). U Ⅱ concentration had no relationship with other known risk factors, but it correlated with CAD severity (r=0.213, P=0.034).In multiple regression analysis, U Ⅱ is one of the determinants of the severity of CAD, other than age, abnormal glucose, hypertension and gender. Conclusios U Ⅱ is elevated in severe CAD and there is a significant relationship between U Ⅱ concentration and CAD severity.     

Risk factors for hepatocellular carcinoma in patients with drug-resistant chronic hepatitis B

AIM:To investigate the risk factors and characteristics of hepatocellular carcinoma(HCC) in the patients with drug-resistant chronic hepatitis B(CHB).METHODS:A total of 432 patients with drug-resistant CHB were analyzed retrospectively from January 2004to December 2012. The patients were divided into two groups:the HCC group(n = 57) and the non-HCC group(n = 375). Two groups compared using logistic regression for various patients and viral characteristics in order to identify associated risk factors for HCC.Secondarily,patient and tumor characteristics of HCC patients with na ve CHB(N group,n = 117) were compared to the HCC group(R group,n = 57) to identify any difference in HCC characteristics between them.RESULTS:A significant difference was found for age,platelet count,alpha-fetoprotein(AFP),positivity of HBeAg,seroconversion rate of HBeAg,virologic response,the Child-Pugh score,presence of rtM204I,and the duration of antiviral treatment in non-HCC and HCC group. Cirrhosis,age(> 50 years),HBeAg(+),virologic non-responder status,and rtM204I mutants were independent risk factors for the development of HCC. The R group had lower serum C-reactive protein(CRP) and AFP levels,earlier stage tumors,and a shorter mean tumor surveillance period than the N group. However,the total follow-up duration was not significantly different between the two groups.CONCLUSION:13.2% of patients with drug-resistant CHB developed HCC. Age,cirrhosis,YIDD status,HBeAg status,and virologic response are associated with risk of HCC. Patients with drug-resistant CHB and these clinical factors may benefit from closer HCC surveillance.     

Multi-factor analysis of initial poor graft function after orthotopic liver transplantation

BACKGROUND: In the early period of orthotopic liver transplantation (OLT), initial poor graft function (IPGF) is one of the complications which leads to primary graft non-function (PGNF) in serious cases. This study set out to establish the clinical risk factors resulting in IPGF after OLT. METHODS: Eighty cases of OLT were analyzed. The IPGF group consisted of patients with alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) above 1500 IU/L within 72 hours after OLT, while those in the non-IPGF group had values below 1500 IU/L. Recipient-associated factors before OLT analyzed were age, sex, primary liver disease and Child-Pugh classification; factors analyzed within the peri-operative period were non-heart beating time (NHBT), cold ischemia time (CIT), rewarming ischemic time (RWIT), liver biopsy at the end of cold ischemia; and factors analyzed within 72 hours after OLT were ALT and/or AST values. A logistic regression model was applied to filter the possible factors resulting in IPGF. RESULTS: Donor NHBT, CIT and RWIT were significantly longer in the IPGF group than in the non-IPGF group; in the logistic regression model, NHBT was the risk factor leading to IPGF (P<0.05), while CIT and RWIT were possible risk factors. In one case in the IPGF group, PGNF appeared with moderate hepatic steatosis. CONCLUSIONS: Longer NHBT is an important risk factor leading to IPGF, while serious steatosis in the donor liver, CIT and RWIT are potential risk factors.     

Predicting factors and adverse effect of non-infectious fever in patient with aortic dissection after endovascular aortic repair

Background Non-infectious fever in patients with aortic dissection after endovascular aortic repair (EVAR) is very common and can cause a series of adverse effects. However,the etiology and pathophysiology of non-infectious postoperative fever is seldom studied. Methods According to predefined criteria,148 patients underwent EVAR were divided into two groups:non-infectious fever group and non-fever group. Clinical data were compared between groups and multiple logistic regressions were performed to detect the risk factors of noninfectious fever. Results A total of 54.1% (80/148) EVAR patients suffered non-infectious fever. Fever (37.3-38 ℃) was almost universally presented in 57.5% patients. And 37.5% of the patients had fever ranging from38.1 to 39 ℃ and 5% of the patients had fever above 39℃. Increased levels of D-dimer,white blood cell count (WBC),procalcitonin (PCT),C-reactive protein (CRP),operation time duration and the length of stents and decreased levels of hemoglobin were presented in the non-infectious fever group as compared to non-fever group (P0.005) . Multiple logistic regression analysis revealed that D-dimer (OR=2.533,P=0.031),PCT (OR= 3.307,P=0.009),operation time duration (OR=2.631,P=0.021) and the length of stents (OR=2.851,P=0.015) were independently associated with non-infective fever EVAR. Furthermore,we also found that the duration of stay in CCU (3.2±2.2 vs. 2.5±2.0),hospital time (8.6±2.2 vs. 7.5±2.3) and hospitalization expense (131.2 ± 30.8 vs.120.6 ± 25.9 thousand yuan) were significant different between the two groups. Conclusions Increased levels of D-dimer,procalcitonin concentration,operation duration and the length of stents are risk factors for non-infectious fever of EVAR,which may prolong the duration of stay in CCU and hospital,and increase the hospitalization expense.     

福建省人群胃食管反流病流行病学调查

Objective To assess the prevalence of gastroesophageal reflux disease(GERD) in the population of Fujian province, and to analyze the risk factors in relation to the disease. Methods A survey on GERD symptoms and its related factors was carried out in the population of Fuzhou city in Fujian province using a stratified random sampling method. According to reflux disease questionnaire (RDQ) score, the subjects were divided to GERD group with Sc≥ 12 and control group with Sc＜ 12.The risk factors related to GERD were compared between two groups. Results A total of 1347residents were investigated. The prevalence of GERD was 8.76 %, and male to female ratio wasincreased in population above 40 years of age (P＜0.05). The incidence of GERD in subjects with different occupations was as follows: the businessmen [17.91%(12/67)], retirees [13.48%(12/89)]and soldiers [2.94%(2/68)]. Symptoms including abdominal distension, belching, nausea, vomiting,dyspepsia were common in GERD group compared to control group (P ＜ 0.01). Besides, the laryngitis, pharyngitis and mouth ulcer were common in GERD group compared to control group ( P＜0.05). The risk factors of GERD were eating greasy (OR= 1.589) and sweetmeat (OR= 2.413),overeating (OR = 2.053), constipation (OR = 1.650), acridity food (OR = 1.366 ), coffee (OR =1.295), strong tea (OR= 1.362). Conclusions The prevalence of GERD is high in the population of Fujian province, and many factors are closely related to reflux.     

自身免疫性甲状腺疾病患者血清瘦素水平观察

目的 观察自身免疫性甲状腺疾病(AITD)中Graves病(GD)和桥本氏甲状腺炎(HT)患者血清瘦素水平,探讨瘦素在AITD发病机制中的免疫学作用.方法 102例体质量指数(BMI)和年龄等因素相匹配的女性AITD初诊患者,根据临床表现及实验室检查结果分为3组:GD甲亢组,HT甲低组,亚甲低组,另设性别、年龄、BMI匹配的对照组.免疫化学发光法检测血清FT3、FT4、sTSH,ELISA法检测血清瘦素水平.结果 GD甲亢组血清FT3、FT4水平[(19.74±15.39)、(78.25±58.68)pmol/L]明显高于对照组[(4.87±0.25)、(15.96±3.15)pmol/L],而sTSH[(0.15±0.08)mU/L]和瘦素水平[(8.73±1.92)μg/L]明显低于对照组[(3.81±0.19)mU/L、(12.38±3.51)μg/L].组间比较差异均有统计学意义(P＜0.01或＜0.05).而HT甲低组兀FT3、FT4水平[(3.36±0.26)、(6.95±3.29)pmol/L]均明显低于对照组(P＜0.05),而sTSH[45.48±35.83)mU/L]和瘦素水平[(17.17±3.82)μg/L]明显高于对照组(P＜0.01或＜0.05).亚甲低组FT3、FT4水平[(4.67±0.60)、(14.87±2.14)pmol/L]与对照组比较差异无统计学意义(P＞0.05),而sTSH[(13.67土8.66)mU/L]和瘦素水平[(16.25±3.67)μg/L]均明显高于对照组(P＜0.01或＜0.05).结论 瘦素在AITD发病机制中可能具有一定的免疫调节作用,而AITD患者瘦素水平也可能受sTSH影响.     

自身免疫性甲状腺疾病患者血清纤维化指标观察

目的 观察自身免疫性甲状腺疾病(AITD)患者血清Ⅲ型前胶原(PCⅢ)和透明质酸(HA)水平.探讨其临床意义.方法 按甲状腺功能将114例AITD患者分为3组:①Graves病甲状腺功能亢进(简称甲亢)组(38例),②桥本甲状腺炎甲状腺功能低下(简称甲低)组(35例),③桥本甲状腺炎亚临床甲状腺功能低下(简称哑甲低)组(41例),另设40例健康人作为对照组.用免疫化学发光法检测以上各组人群血清游离三碘甲腺原氨酸(FT3),游离甲状腺素(FT4),超敏促甲状腺激素(sTSH)水平.用酶联免疫吸附试验(ELISA)检测血清PCⅢ水平,用放射免疫分析法(RIA)检测血清HA水平.结果 甲亢组血清FT3,FT4水平[(18.35±6.19),(76.28±23.49)pmol/L]明显高于对照组[(4.75±0.31),(16.12±3.27)pmol/L],sTSH水平[(0.15±0.07)mU/L]明显低于对照组[(3.78±0.15)mU/L],差异均有统计学意义(P＜0.01),甲低组FT3,FT4水平[(3.36±0.26),(6.37±2.19)pmol/L]均低于对照组(P＜0.05),sTSH[(44.58±13.29)mU/L]明显高于对照组(P＜0.01),亚甲低组FT3,FT4水平[(4.86±0.45),(15.26±2.78)pmol/L]与对照组比较,差异无统计学意义(P＞0.05),sTSH[(14.26±4.73)mU/L]明显高丁对照组(P＜0.01).甲亢组血清PCⅢ水平[(4.63±1.22)μg/L]明显高于甲低组[(3.64±1.12)μg/L],亚甲低组[(3.54±1.17)μg/L],对照组[(3.56±1.07)μg/L],组问两两比较差异有统计学意义(P＜0.05),而甲低组,哑甲低组,对照组PCⅢ水平任意两组间比较,差异均无统计学意义(P＞0.05),甲低组血清HA水平[(31.13±10.28)μg/L]高于甲亢组[(22.24±7.22)μg/L],亚甲低组[(22.43 4-7.99)μg/L]和对照组[(23.09±9.19)μg/L],组间两两比较差异均有统计学意义(P＜0.05),而甲低组,亚甲低组,对照组HA水平任意两组比较,差异均无统计学意义(P＞0.05).结论 在排除肝纤维化等病变的情况下,检测甲亢患者血清PCⅢ,对了解早期的心肌纤维化有重要意义,对病程较长的甲亢患者,血清HA,PCⅢ的榆测可作为早期发现肝损伤和纤维化的参考依据.     

Graves病患者药物治疗复发的相关因素分析

目的 回顾抗甲状腺药物(ATD)治疗的初发Graves病(GD)患者的临床资料,观察各临床特征对ATD治疗转归的影响,以评价GD复发的影响因素.方法 收集204例初发GD甲亢患者的临床资料.根据ATD治疗结果分为有效组和失败组,失败组包括停药复发和未能停药两个亚组,比较各因素对ATD治疗转归的影响.结果 204例初发GD患者中94例(46.1%)治疗有效,110例(53.9%)治疗失败.与有效组比较,失败组发病年龄小[(31.0±12.2)岁比(36.3±14.0)岁,P=0.004],发病初游离T3水平高[(25.60±9.52)pmol/L比(19.16±6.38)pmol/L,P=0.001],FT3/FT4比值大[(4.87±1.21)比(3.86±0.98),P=0.001],促甲状腺素受体抗体(TRAb)水平高[(57.3±18.4)%比(29.6±14.9)%,P=0.001].logistic分析显示,发病初甲状腺大小、FT3/FT4比值、TRAb水平是药物治疗失败的独立影响因素.复发亚组停药时,甲状腺明显肿大、伴有眼征的患者比率高.治疗过程中甲状腺激素正常3、6、9、12个月时,复发亚组中超敏促甲状腺素(TSH)受抑制患者的比率均明显多于有效组(P=0.001).结论 (1)治疗前甲状腺明显肿大、TRAb水平高、FT3/FT4比值大的患者,药物治疗反应差;(2)停药时甲状腺明显肿大、伴有眼病者,停药后复发率高;(3)经治疗甲状腺激素正常、TSH延迟恢复或仍受抑制者复发率高.     

血清游离三碘甲状腺原氨酸游离甲状腺素及两者比值在甲状腺毒症病因鉴别诊断中的价值

目的 探讨游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及FT3/FT4值在甲状腺毒症病因鉴别诊断中的价值,为甲状腺毒症病因鉴别提供一项简单实用的临床参考指标.方法 回顾性分析2017年10月至2019年11月在中南大学湘雅医院新诊断的326例甲状腺毒症患者的临床资料,根据病因分为Graves病组(203例)和...     

Graves病患者甲状腺激素水平正常后sTSH长期抑制机制的探讨

目的 探讨临床上部分Graves病(GD)患者经抗甲状腺药物(ATD)治疗后甲状腺激素水平达到正常,但促甲状腺素(TSH)仍长期处于被抑制状态的机制.方法 入选初发122例GD甲亢患者,予以初始等效剂量的ATD治疗,每月随访时根据甲状腺功能测定的结果酌情减量,并适时添加左旋甲状腺素(L-T4).当甲状腺激素(FT3、FT4)水平持续正常3个月即达随访标准,复查FT3、FT4、sTSH、TSH受体抗体(TRAb),并根据TRAb是否阳性分组比较.结果 122例GD甲亢患者经(7.1±1.1)个月的ATD治疗后,甲状腺激素水平均已经达到正常3个月.随访时,58例TRAb转为阴性,64例TRAb持续阳性.两组甲状腺激素水平无差异, TRAb阳性组的sTSH水平明显低于阴性组[0.044 mIU/L(0.001～4.163 mIU/L) vs 1.749 mIU/L(0.079～4.646 mIU/L),P＜0.01];血清sTSH水平与TRAb呈明显负相关(r=-0.539,P＜0.01),与FT3、FT4、年龄、病程、治疗时间、L-T4剂量、L-T4添加时间等均无相关性.结论 药物治疗过程中,甲状腺激素水平正常的GD患者,其TSH水平长期受抑制的原因与高水平TRAb相关,可能由于TRAb直接与垂体内TSH受体结合,通过超短环反馈抑制TSH的分泌所致.     

Graves病患者甲状腺功能改变与细胞免疫相关分析

目的探讨Graves病患者甲状腺功能与机体的细胞免疫间的关系。方法（1）采用流式细胞仪检测20例高功能Graves病患者和20例健康对照组的T淋巴细胞亚群和CD8-／IFN-γT（Th1）细胞和CD8-／IL-4＋T（Th2）细胞的百分含量。（2）化学发光法检测FT3、FT4、s-TSH,放射免疫法检测TRAb、TGAb、TMAb。（3）应用逐步回归分析,以FT3、FT4、8-TSH为因变量,CD4T细胞、CD8T细胞、CD4＋／CD8＋T细胞比值、Th2细胞百分含量、Th1细胞百分含量、Th1／Th2比值、TRAb、TGAb、TMAb滴度为自变量进行分析。结果（1）Graves病患者的FT3,s—TSH、TRAb、TGAb、TMAb滴度均较正常对照组明显增高（P〈0．01）。（2）Graves病患者较正常人群CD4＋T细胞和CD4＋／CD8＋T细胞比值增高;Th2百分含量增高;而CD8＋T细胞、Th1细胞及Th1／Th2细胞比值下降（P均〈0．05）。（3）CD4／CD8＋T细胞比值、Th1／Th2细胞比值以及TRAb、TGAb、TMAb成为影响FT3、FT4、TSH变化的重要因素。结论Graves病患者机体的T细胞免疫调节失衡不仅参与疾病的发生和发展,还影响了甲状腺激素功能。CD4＋／CD8＋T细胞比值、Th1／Th2比值可作为临床治疗的监测高功能Graves病活动及疗效的指标。     

甲状腺功能亢进症患者血清抵抗素水平与血糖、血脂及甲状腺激素的关系

目的 探讨甲状腺功能亢进症（简称甲亢）患者血清抵抗素水平与血糖、血脂、甲状腺激素(TH)的关系。方法 甲亢组50例,来源于2008、2009年就诊于哈医大二院内分泌科患者,均为新确诊尚未服药病例;以同时间到医院体检的40例健康者为对照组,两组均排除糖尿病、肥胖、高血压、高血脂。ELISA法测定血清抵抗素水平;化学发光法测定空腹胰岛素、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素(FT4)、促甲状腺激素(TSH);葡萄糖氧化酶-过氧化物酶(GOD-PAP)法测定空腹血糖;胆固醇氧化酶法测定总胆固醇(T-CH);磷酸甘油氧化酶(GPO)法测定甘油三酯(TG);均相酶比色法测定高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。同时测定身高、体重、腰围、臀围,计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)。组间比较采用t检验,相关分析采用Pearson相关检验,用多元逐步回归方法比较抵抗素与血糖、血脂、TH的关系。结果 甲亢组血糖[(5.2±0.7)mmol/L]、抵抗素[(132.1±41.3)μg/L]、FT3[(19.8±8.7) pmol/L]、FT4[(54.1±29.6)pmol/L]、胰岛素[(7.9±2.8)mU/L]、胰岛素抵抗指数[(2.3±1.0)]明显高于对照组[(4.7±0.5)mmol/L,(65.1±5.9)μg/L、(4.1±0.6)pmol/L、( 14.3±2.2)pmol/L、(6.4±2.7)mU/L、(1.5±1.2);t值分别为4.64、10.17、11.42、8.49、4.48、9.42,P＜ 0.01或＜0.05]。甲亢组T-CH[(3.7±0.8)mol/L]、LDL-C[( 1.8±0.6)mol/L]、TSH[(0.01±0.01 )mU/L]明显低于对照组[(4.6±0.7) mol/L、(2.3±0.7)mol/L、( 1.80±0.90)mU/L;t值分别为5.30、3.33、14.48,P均＜0.01）]。相关分析显示,甲亢组抵抗素与FT3、FT4、HOMA-IR呈正相关(r=0.719、0.790、0.396,P＜0.01或＜0.05),与T-CH、LDL负相关(r=-0.364、- 0.519,P＜0.05或＜0.01)。多元逐步回归显示,甲亢组抵抗素与FT3、FT4、HOMA-IR正相关（r=0.756,P均＜0.01）。结论 抵抗素水平的调节受甲状腺激素影响,甲亢患者血抵抗素可能与胰岛素抵抗及糖脂代谢紊乱有关。     

甲状腺功能亢进性肝损害与甲巯咪唑继发性肝损害的临床比较研究

目的分析甲状腺功能亢进症(简称甲亢)性肝损害患者的肝功能与甲状腺功能的相关性,探讨抗甲亢药物甲巯咪唑所致肝损害患者的临床特征及其引起肝损害的相关因素。方法纳入甲亢性肝病患者54例(甲亢性肝损害组)和初诊未治的无肝损害甲亢患者33例(甲亢无肝损害组),收集两组患者用药前的一般资料和临床资料(甲状腺功能和肝功能),分析甲亢性肝损害的相关因素;将同期抗甲亢药物甲巯咪唑致肝损害患者(27例)根据肝功能指标分为肝细胞型组(7例)、胆汁淤积型组(12例)和混合型组(8例),收集其一般资料和临床资料(甲状腺功能和肝功能)并比较。结果甲亢性肝损害组患者治疗前的ALT、AST、碱性磷酸酶(ALP)、谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)、游离三碘甲腺原氨酸(FT 3)、游离甲状腺激素(FT 4)和促甲状腺激素受体抗体(TRAb)水平明显高于甲亢无肝损害组(P<0.05),两组患者ALT、ALP、γ-GT水平均与FT 3、FT 4、TRAb水平呈明显正相关(P<0.05)。肝细胞型组、胆汁淤积型组和混合型组患者的年龄、用药时间、ALT、ALP比较差异均有统计学意义(P<0.05)。结论甲亢患者甲状腺功能异常的严重程度可能与其肝损害相关;抗甲亢药物甲巯咪唑引起的肝损害类型可能与患者年龄、病程及用药时间有关。     

碘/钠摄入量对小鼠血脂代谢影响的实验研究

目的 探讨膳食碘摄入量对适钠和低钠饮食小鼠血脂代谢影响,为揭示碘与心血管疾病发病的相关性进行初步研究.方法 Balb/c小鼠260只,按体质量、性别随机分为适钠组(Na)和低钠组(Lna),每组130只;此两大组又分别按照碘摄入量分为①重度低碘组(SID);②轻度低碘组(MID);③适碘组(NI);④10倍碘过量组(10HI);⑤50倍碘过量组(50HI),总计为10组,每组26只.各组小鼠在饲养8个月时收集尿液和小鼠外周血,分离血清.测定小鼠尿碘、体质量、血脂[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白醇(HDL)]及甲状腺激素水平[总甲状腺素(TT4),总三碘甲腺原氨酸(TT3)、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)].结果适钠组中,SID组、MID组雄性小鼠TG水平[(1.64±0.35)、(1.67±0.31)mmol/L]和SID组TC水平[(3.88±0.35)mmol/L]明显高于NI组[(1.49±0.42)、(3.25±0.47)mmol/L,P均＜0.05],SID组中雌性小鼠TG水平[(1.52±0.22)mmol/L]高于NI组[(1.23±0.22)mmol/L,P＜0.05].10HI和50HI组雄性小鼠外周血TG水平[(1.16±0.23)、(1.21±0.27)mmol/L]低于NI组(P均＜0.05),雌性小鼠TC水平[(2.37±0.49)、(2.48±0.37)mmol/L)低于NI组[(2.84±0.37)mmol/L,P均＜0.05].在低钠组,SID组雄性小鼠TG、TC水平[(1.39±0.40)、(3.33±0.46)mmol/L]均高于NI组[(1.30±0.28)、(3.00±0.53)mmol/L,P均＜0.05],SID组雌性小鼠TG、TC、LDL水平[(1.48±0.26)、(276±0.43)、(0.62±0.22)mmol/L]、MID组雌性小鼠LDL水平[(0.60±0.17)mmol/L]均高于NI组[(1.22±0.36)、(2.51±0.38)、(0.48±0.08)mmol/L,P均＜0.05].10HI和50HI组雄性小鼠TG水平[(1.12±0.22)、(0.90±0.11)mmol/L]均低于NI组(P均＜0.05),10HI和50HI组雌性小鼠TC水平[(2.35±0.34)、(2.37±0.37)mmol/L]、50HI组雌性小鼠LDL水平[(0.65±0.18)mmol/L]均低于NI组(P均＜0.05).适钠组中的SID和MID组血清TT4[(0.00±0.00)、(17.15±15.26)nmol/L]、FT4[(0.93±0.42)、(18.46±4.31)pmol/L]和TT3[(0.49±0.07)、(0.67±0.10)nmol/L]、FT3[(2.86±0.37)、(3.18±0.24)pmol/L]水平均低于NI组[(37.15±15.26)、(28.46±4.31)、(0.85±0.10)、(3.87±0.24)pmol/L,P＜0.01或P＜0.05].在低钠组,SID和MID组血清TT4、FT4和TT3、FT3水平[(0.00±0.00)nmol/L、(1.03±0.78)pmol/L、(0.51±0.05)nmol/L,(3.01±0.17)pmol/L,(19.76±12.22)nmol/L、(21.46±5.37)pmol/L、(0.71±0.21)nmol/L、(3.56±0.23)pmol/L]均低于NI组[(36.23±14.72)nmol/L、(30.96±6.33)pmol/L、(0.89±0.20)nmol/L、(4.05±0.24)pmol/L,P均＜0.05],10HI组的TT3水平[(1.06±0.23)nmol/L]高于NI组(P＜0.05).结论碘缺乏可致TG、TC和LDL升高,过量碘可致TG/TC水平降低.碘摄入量是影响血脂代谢的重要因素.限盐饮食的同时,严密监控碘的摄入量对当前有效防治心血管疾病应具有重要作用.     

桥本甲状腺功能亢进与Graves病鉴别诊断的临床观察

目的 探讨细针穿刺细胞学(FNAC)检查和甲状腺自身抗体检测在桥本甲状腺功能亢进(甲亢)与Graves病(GD)鉴别诊断中的临床应用价值.方法 本组资料362例中有3例因样本细胞数量少而未能诊断,根据FNAC分型将359例甲亢患者分为桥本甲亢组119例、GD-Ⅰ组(间质淋巴细胞浸润<10%)162例、GD-Ⅱ组(淋巴细胞浸润10%～20%)49例、GD-Ⅲ组(淋巴细胞浸润20%～40%)29例,观察4组甲状腺自身抗体及甲状腺激素水平的差异.结果 FNAC发现淋巴细胞破坏上皮细胞以及退行性变和(或)嗜酸性变的滤泡上皮细胞时仅见于桥本甲亢组,为其特征性表现.GD-Ⅰ、Ⅱ、Ⅲ3组FNAC检查可见淋巴细胞数量依次呈增加趋势,而滤泡上皮细胞增生呈降低趋势;3组平均血清甲状腺球蛋白抗体(TGAb)分别为(43.5±29.0)%、(61.3±24.4)%、(68.9±22.3)%,而平均甲状腺微粒体抗体(TMAb)分别为(38.0±26.1)%、(54.7±23.0)%、(60.8±22.7)%,与GD-Ⅰ组相比,GD-Ⅱ、GD-Ⅲ组升高均有显著性差异(P<0.05);3组的促甲状腺激素受体抗体(TRAb)水平分别为(57.7±71.0)U/L、(31.5±62.1)U/L、(21.2±47.0)U/L,与GD-Ⅰ组相比,GD-Ⅱ、GD-Ⅲ组显著降低(P<0.01).桥本甲亢组TGAb、TMAb均值显著高于GD-Ⅰ组(P<0.01),而TRAb、游离T_3(FT_3)、游离T_4(FT_4)均值显著低于GD-Ⅰ组(P<0.01);桥本甲亢组与GD-Ⅱ、Ⅲ组相比,各抗体均值差异均无统计学意义(P>0.05).GD-Ⅲ组病史均值显著长于其他3组(P<0.01),而其他3组间差异无显著性(P>0.05).结论 FNAC对鉴别桥本甲亢与GD各型具有重要的临床价值.血清TRAb、TGAb、TMAb水平对鉴别桥本甲亢与GD-Ⅰ型有一定临床价值,而对鉴别桥本甲亢与GD-Ⅱ型、Ⅲ型临床意义不大.