甲状腺自身免疫与流产关联性的meta分析

目的 综合评价甲状腺自身免疫(TAI)与流产的关联性.方法 通过文献检索收集2009年3月以前发表的有关甲状腺自身免疫与流产相关性的病例对照研究以及队列研究,剔除不符合要求的文献,以漏斗图检验入选文献的发表偏倚,并根据各入选文献的同质性检验结果进行数据合并,分别计算合并OR值与RR值,应用meta分析软件包RevMan 4.3.1进行计算.结果 经检索得到23篇文献,剔除综述4篇,余19项临床研究均符合本次meta分析的纳入标准.纳入的19项研究中,7项为病例对照研究,12项为队列研究.7项病例对照研究得到的合并OR值为2.72(95% CI 1.27～5.80,P=0.01);12项队列研究得到的合并RR值为2.41(95% CI 1.96～2.96,P＜0.01).甲状腺自身抗体(TA)阳性妇女较TA阴性者平均年长1.29岁(95% CI 0.43～2.16,P=0.003),TA阳性妇女的TSH较TA阴性者平均高0.61 mIU/L(95% CI 0.51～0.71,P＜0.01).结论 TAI与流产显著关联.除了TA的直接效应以外,TA阳性孕妇轻度的增龄与甲状腺功能不足亦可能是导致流产风险增加的潜在原因.     

α—干扰素致甲状腺自身免疫机制的研究

为阐明α－干扰素（ＩＦＮ－α）致甲状腺自身免疫的机制，应用ＩＦＮ－α与自身免疫性甲状腺疾病（ＡＩＴＤ）患者的外周血单个核细胞（ＰＢＭＣ）的体外培养系统，观察在不同浓度的ＩＦＮ－α作用下，６例正常人和９例ＡＩＴＤ患者的Ｔ细胞、Ｔ细胞亚群、Ｂ细胞、巨噬细胞和自然杀伤细胞的变化以及甲状腺自身抗体的产生，发现ＩＦＮ－α对体外的Ｔ淋巴细胞呈普遍的抑制作用。这种抑制作用在抑制性Ｔ细胞（ＣＤ８／ＣＤ１１ｂ）亚群表现的尤为显著。ＩＦＮ－α的这种抑制和刺激作用同样表现在ＡＩＴＤ患者和正常对照组，不具有选择性。根据免疫系统Ｔ细胞亚群调节平衡学说，临床应用ＩＦＮ－α诱致的甲状腺自身免疫作用可能与抑制性Ｔ细胞功能低下有关。ＩＦＮ－α有刺激Ｂ细胞和巨噬细胞增生作用，而Ｂ细胞、巨噬细胞功能的亢进可能也是导致甲状腺自身免疫的原因之一。     

药物流产后致继发不孕118例临床分析

近年来，药物流产广泛应用于临床，药物流产后继发不孕病例亦明显增多。现将我院收治的因药物流产后继发不孕的118例临床资料分析报告如下。     

自身免疫性甲状腺损害与甲状腺功能减退症

自身免疫性甲状腺损害与甲状腺功能减退症高妍甲状腺功能减退症（甲减）是较常见的内分泌疾病，由各种原因引起甲状腺激素分泌不足，血中甲状腺激素水平减低或靶器官对其拮抗而引起。绝大多数是因甲状腺本身损害所致原发性甲减，少数是由垂体或下丘脑疾病引起的继发性甲减...     

自身免疫性甲状腺疾病与细胞凋亡

自身免疫性甲状腺疾病(autoimmune thyroid disease．AITD)是人类常见的自身免疫性疾病，主要包括Graves’病(GD)和桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)。AITD的病变部位主要发生在甲状腺，属于器官特异性自身免疫性疾病。多数学者研究认为，AITD发病是自身抗体的免疫应答或特异性T细胞介导的细胞免疫引起甲状腺组织的免疫损     

低分子肝素治疗自身免疫型复发性流产的作用机制及安全性

复发性流产（RSA）是指与同一配偶连续发生2次或2次以上流产，约1／3的病例与自身免疫性过强或血栓前状态有关。自身抗体导致的流产为免疫高反应型，目前的治疗方法有抗凝、免疫抑制、血浆置换及静脉丙种球蛋白。免疫抑制治疗副作用较大，对胎儿有潜在的致畸作用；静脉用丙种球蛋白价格昂贵。低分子肝素（LMWH）联合小剂量阿司匹林抗凝治疗在RSA中的作用越来越受到重视。现将LMWH在RSA中的应用及其治疗机制综述如下。     

自身免疫性甲状腺疾病的遗传学发病机制进展

自身免疫疾病是遗传和环境相互影响的结果.免疫调节基因和甲状腺特异基因在自身免疫性甲状腺疾病的发病过程中起重要作用.     

自身免疫性甲状腺疾病

本文对自身免疫性甲状腺疾病的发病机制作了详细介绍,着重讨论体液免疫的作用。     

成人隐匿性自身免疫糖尿病与甲状腺自身免疫的关系

目的探讨成人隐匿性自身免疫糖尿病(LADA)与甲状腺自身免疫的关系.方法对90例LADA患者、104例1型糖尿病(T1DM)患者、100例2型糖尿病(T2DM)患者和100例健康对照进行甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体(TG-Ab)检测.糖尿病患者还进行谷氨酸脱羧酶抗体(GAD-Ab)检测.TPO-Ab、TG-Ab采用放免法检测,GAD-Ab采用放射配体法检测.结果(1) LADA患者TPO-Ab的检出率为16.7%(15/90)高于T2DM患者(7.0%, 7/100; P<0.05).LADA患者中任一甲状腺自身抗体(TPO-Ab或 TG-Ab阳性)的检出率与T1DM差异无显著性(18.9%,17/90比25.0%,26/104,P>0.05),且均高于正常对照的8.0%(8/100, P<0.05).(2)携高滴度GAD-Ab(GAD-Ab指数≥0.5)的LADA患者中任一甲状腺自身抗体的检出率为50.0%(9/18),高于低滴度GAD-Ab 的LADA患者(12.5%, 8/64; P<0.05).(3) 甲状腺自身抗体阳性的LADA患者甲状腺功能异常率高于抗体阴性者(47.1 %, 8/17比17.1%, 6/34, P<0.05).结论 (1)LADA患者, 尤其是携高滴度GAD-Ab的 LADA患者,与经典的T1DM相似,易合并甲状腺自身免疫紊乱.(2)LADA患者甲状腺自身抗体的存在预示甲状腺功能异常的风险增高.(3)LADA可作为自身免疫多内分泌腺病综合征(APS)的一个重要组成成分,且常以APS-Ⅲ型存在.     

Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics

Abstract Diabetes mellitus and thyroid disease are common endocrine disorders in the general population. To investigate the association between thyroid dysfunction, thyroid autoimmunity and Saudi type 2 diabetics, a random sample of 100 Saudi type 2 diabetics and 100 age- and sex-matched controls were studied. The mean age was 54 years for diabetics and 55 years for controls while the male:female ratios were 1:1.6 and 1:14 respectively. GAD65ab were found in 26% diabetics and 2% controls (p=0.001). Thyroid autoimmunity were detected in 10% diabetics vs. 5% controls (p=0.05), while thyroid dysfunction was found in 16% and 7% respectively (p=0.03). In GAD65ab-positive diabetics, thyroid autoimmunity was observed in 27% vs. 4% GAD65ab-negative diabetics (p=0.02) and thyroid dysfunction was reported in 42% and 7% respectively. We conclude that thyroid dysfunction and autoimmunity are common in Saudi type 2 diabetics. Further studies are needed on the cost effectiveness of thyroid screening in diabetics.     

Endocrine autoimmunity in families with type 1 diabetes: frequent appearance of thyroid autoimmunity during late childhood and adolescence

Aims/hypothesis  Thyroid autoimmunity clusters with other endocrine and non-endocrine forms of autoimmunity. The aim of this study was to determine the chronological appearance of thyroid autoantibodies in relation to other forms of autoimmunity in at-risk children. Methods  The BABYDIAB study follows children of parents with type 1 diabetes. Children born in Germany between 1989 and 2000 were recruited at birth and followed up at 9 months and at 2, 5, 8, 11, 14 and 17 years. Antibodies to thyroid peroxidase were measured in samples taken at the last study visit in 1,489 children and in all previous samples in children who tested positive. Islet antibodies and antibodies to 21-hydroxylase and transglutaminase were also measured in all children. Median follow-up was 8 years. Results  The cumulative risk for developing antibodies to thyroid peroxidase was 20.3% (95% CI 12.3–28.3) by age 14 years. The risk was increased in girls (adjusted HR 2.0; 95% CI 1.2–3.4; p = 0.008), in children who had multiple first-degree family history of type 1 diabetes (adjusted HR 3.3; 95% CI 1.4–8.0; p = 0.006) and in children who also had antibodies to GAD (adjusted HR 3.0; 95% CI 1.5–5.9; p = 0.001). Thyroid peroxidase antibody appearance was most common from age 8 years and was often the last autoantibody to develop in children with other autoantibodies. Conclusions/interpretation  Among children of patients with type 1 diabetes, the appearance of thyroid autoantibodies is frequent, is not synchronous to the appearance of other autoantibodies and is most common in late childhood and adolescence.     

硒与自身免疫性甲状腺疾病

硒是人体必需的一种微量元素,以硒蛋白的形式发挥其生物学功能.自身免疫性甲状腺疾病(AITD)患者中,血清硒及硒蛋白水平存在异常.研究表明,硒缺乏可能通过降低多种硒蛋白酶的抗氧化活性、影响辅助性T细胞(Th) 1/Th2平衡、减弱巨噬细胞抗原识别和提呈作用等途径参与AITD的发生.补硒治疗对AITD患者病情缓解可能有一定的作用,但其安全性有待进一步的临床研究提供证据.     

精索静脉曲张不育症的研究进展

精索静脉曲张（VC）是男性不育症常见病因之一。目前对其机制已进行了不少研究,但仍未完全阐明。该文结合近年的文献资料,对VC男性不育症的发病机理、诊疗进展进行阐述,以期能提高临床诊疗水平和统一诊疗规范。     

妊娠糖尿病与甲状腺自身免疫的相关性研究

目的 研究妊娠糖尿病与甲状腺功能异常及甲状腺自身抗体阳性的相关性.方法 选取妊娠糖尿病患者共80例作为妊娠糖尿病组,另外选择糖耐量正常孕妇36名作为正常对照组.同时选择产后18 ～ 120个月曾诊断为妊娠糖尿病者作为曾患妊娠糖尿病组(36例),并以产后18～96个月的正常妊娠者28名作为随访对照组.检测4组受试者空腹血糖、餐后2h血糖、游离T4、促甲状腺激素(TSH)、血脂水平,以及谷氨酸脱羧酶65(GAD65)抗体、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb).曾患妊娠糖尿病组根据甲状腺自身抗体情况分为甲状腺自身抗体阳性组与阴性组,统计两个亚组糖代谢异常的发生情况.结果 妊娠糖尿病组空腹血糖、餐后2h血糖高于其他组(P均’＜0.05),4组间血脂水平差异没有统计学意义(P均＞0.05).与正常对照组相比,妊娠糖尿病组游离T4、TSH水平差异均没有统计学意义(P均＞0.05).妊娠糖尿病组GAD65抗体阳性者有4例,曾患妊娠糖尿病组有3例.分别与正常对照组及随访对照组相比,妊娠糖尿病组及曾患妊娠糖尿病组TPOAb、TgAb阳性发生率均增加(x2=7.459,P＜0.05).曾患妊娠糖尿病组总体TSH水平异常的发生率、同时存在TSH水平异常及甲状腺自身抗体阳性的发生率显著高于其他3组(x2=5.925,8.766,P均＜0.05).曾患妊娠糖尿病组47.2％(17/36)在随访时发生高血糖,甲状腺抗体阳性组60.0％(6/10)出现糖代谢异常,而甲状腺抗体阴性组42.3％(11/26)有糖代谢异常,但两组间差异没有统计学意义(P＞0.05).结论 产后甲状腺自身免疫与糖代谢受损无关.妊娠糖尿病可能是发生甲状腺自身免疫异常的危险因素.     

The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms

We determined the frequency of thyroid autoantibodies in fibromyalgia (FM) patients and the relationship between FM symptoms and these antibodies. Euthyroid 128 FM patients, 64 rheumatoid arthritis (RA) patients, and 64 healthy control subjects were included in the study. The sociodemographic features and the clinical features of FM patients were determined. By using a visual analog scale, patients were questioned about the severity of FM-related symptoms. All patients were administered with Duke-Anxiety Depression (Duke-AD) scale, the physical function items of the fibromyalgia impact questionnaire scale. Thyroid autoimmunity was defined as the presence of detectable antithyroglobulin (TgAb) and/or antithyroid peroxidase (TPOAb) antibodies by the immunometric methods. Patients with a connective tissue disorder, hypo- or hyperthyroidism, and patients who had psychiatric treatment within the last 6 months were not included into the study. The frequencies of thyroid autoimmunity in FM (34.4%) and RA (29.7%) patients were significantly higher than controls (18.8%) (p<0.05). Twenty-six (20.3%) FM patients had positive TgAb and 31 (24.2%) had positive TPOAb. When patients with thyroid autoimmunity were compared to others, it was seen that the mean age, the percentage of postmenopausal patients, the frequency of dryness of the mouth, and the percentage of patients with a previous psychiatric treatment were higher in this group (p<0.05). FM patients had thyroid autoimmunity similar to the frequency in RA and higher than controls. Age and postmenopausal status seemed to be associated with thyroid autoimmunity in FM patients. The presence of thyroid autoimmunity had no relationship with the depression scores of FM patients.     

甲状腺结核的诊断和治疗

目的　探讨甲状腺结核的诊断与治疗。方法 对48例经手术和病理证实的甲状腺结核进行回顾性分析。结果 术前大多数误诊为甲状腺腺瘤,少数诊断为甲状腺癌、甲状腺炎,偶有怀疑本病者。病灶切除32例,腺叶切除6例,双侧次切4例,颈清3例,峡部切除3例,切排引流3例。抗痨治疗9～12个月治愈。随访1～22年,未见复发。结论 针刺细胞学检查有助于甲状腺结核的诊断。治疗首选药物抗痨。对弥漫性肿大性质未定者可行峡部切除,干酪型周围已形成脓肿者,可行脓肿切排引流,术后用抗结核药局部灌洗。     

甲状腺结节和肿瘤的诊断、治疗与展望

简要讨论甲状腺结节和甲状腺肿瘤的定义和分类，及细针抽吸细胞学检查、核素扫描和超声等检查在其诊断及指导治疗中的价值。评述甲状腺结节和甲状腺肿瘤的治疗原则及最新进展。