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目的探讨弥漫性毒性甲状腺肿(Graves)病孕妇妊娠期间血清促甲状腺激素受体抗体fTRAb)水平对新生儿甲亢的影响。方法选取2002年6月至2008年6月在北京协和医院就诊的68例Graves病孕妇及其新生儿-应用放射性受体法(RRA)和电化学发光免疫法(ECLIA)分别检测孕妇妊娠期间血清、脐血及新生儿出生5~14d的血清T3、T4、FT3、FT4、促甲状腺激素(TSH)及TRAb水平。结果妊娠晚期孕妇血清TRAb与脐静脉血TRAb呈正相关(n=68,r=0.8494,P〈0.01),与新生儿血清TRAb也呈正相关(n=68,r=0.8286,P〈0.01)。新生儿甲亢的发生率为11.8%(8/68),8例甲亢新生儿出生后两周内血清TRAb均高于正常3倍以上;其中2例新生儿出生后(7~14d)血清TRAb水平高于正常15倍以上,出生6个月时,其甲状腺功能及血清TRAb水平仍未恢复正常状态。结论妊娠晚期血清TRAb水平增高是发生新生儿甲亢的一个危险因素。孕妇血清TRAb水平与新生儿甲亢的严重程度有一定的关系。 相似文献
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探讨Crave's病患者血清中促甲状腺激素受体抗体(thyrotropin receptor antibody, TRAb)与其病情的内在联系,自1996年8月至1998年6月对156例门诊Crave's病患者的血清TRAb进行检测并进行临床观察.结果: 初诊Crave's病患者90.1%血清TRAb升高; 经抗甲状腺药物治疗后的患者,当血清甲状腺激素水平正常时,血清TRAb恢复正常;经药物或手术及131I治疗后的复发病例,血清TRAb值升高.故血清TRAb水平与Crave's病病情有密切的相关性.结论: 血清TRAb水平的测定对于Crave's病患者的诊断、治疗及随访均有重要意义. 相似文献
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探讨 Crave′s 病患者血清中促甲状腺激素受体抗体(thyrotropin receptor antibody, T R Ab)与其病情的内在联系,自 1996 年 8 月至 1998 年 6 月对 156 例门诊 Crave′s 病患者的血清 T R Ab 进行检测并进行临床观察。结果: 初诊 Crave′s 病患者 90.1% 血清 T R Ab 升高; 经抗甲状腺药物治疗后的患者,当血清甲状腺激素水平正常时,血清 T R Ab 恢复正常;经药物或手术及1 31 I治疗后的复发病例,血清 T R Ab 值升高。故血清 T R Ab 水平与 Crave′s 病病情有密切的相关性。结论: 血清 T R Ab 水平的测定对于 Crave′s 病患者的诊断、治疗及随访均有重要意义。 相似文献
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用ABC-ELISA法对50例重症肌无力(MG)病人血清中抗乙酰胆碱受体抗体(AchRab)和抗突触前膜抗体(PrMab)进行检测。结果发现:①MG患者抗体总阳性37例(阳性率74%),其中AchRab阳性33例(66%),PrMab29例(58%),二者均显示重症患者阳性率高于轻症。②血清中两种抗体滴度重症患者均明显高于轻症,胸腺肿瘤AchRab滴度明显高于胸腺增生病例,抗体滴度与胸腺病理关系呈肿瘤>萎缩或正常>增生。③AchRab和PrMab高度相关。结果表明AchRab与MG病情轻重和胸腺病理有一定关系,可用于MG的病情监测,PrMab同样可以作为MG的一项免疫学诊断指标,有重要的临床应用价值。 相似文献
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目的探讨甲状腺动脉栓塞治疗Graves病对甲状腺自身抗体的影响。方法对临床确诊的41例Graves病进行甲状腺动脉栓塞治疗。术前测定甲状腺自身抗体水平,术后随访3~61个月,依据患者症状、体征、甲状腺功能等观察疗效,并定期检测甲状腺自身抗体的滴度/活性和阳性率。结果Graves病时TRAb、TGAb、TMAb滴度/活性和阳性率高于正常水平,以TRAb更为显著。介入治疗6个月后有效组TRAb活性和阳性率降至正常水平,而复发组则仍保持较高水平。TGAb、TMAb滴度和阳性率于治疗前、后无明显变化。结论栓塞治疗可以间接地纠正Graves病免疫功能的紊乱,降低某些自身抗体的产生。栓塞治疗有效者术后6个月TRAb多降至正常水平,高于正常水平者提示复发可能,TRAb可作为判断手术疗效的指标之一;TGAb和TMAb对于判断手术疗效意义不大。 相似文献
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目的探讨血25羟维生素D[25(OH)D]水平与Graves病的关系。方法选取2014年9月至2016年3月遵义医学院附属医院门诊及住院的Graves病患者及健康体检者共367例,将Graves病患者分为初发组、未控制组、控制组,以健康体检者作为对照组。采用电化学发光法(罗氏~(TM),601型)测促甲状腺素受体抗体(thyrotropin receptor antibody,TRAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)及25(OH)D水平,采用化学发光法(西门子~(TM),Centuar XP型)检测游离甲腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxin,FT_4)、三碘甲腺原氨酸(triiodothyronine,T_3)、甲状腺素(thyroxin,T_4)、促甲状腺素(thyroid stimulating hormone,TSH)等相关指标,探讨血清25(OH)D水平变化及其临床意义。结果未控制组血清25(OH)D水平低于初发组(P0.01),初发组血清25(OH)D水平低于控制组组(P0.01)。血清25(OH)D水平与TSH、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)呈正相关,与FT_3、FT_4、T_3、T_4呈负相关。结论血清25(OH)D水平降低可能与Graves病的发生及严重程度相关。 相似文献
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维生素D作为维持机体钙磷代谢平衡的重要激素,对机体骨与矿物质盐代谢起着重要的调节作用。近年来研究发现Graves病患者体内维生素D水平偏低,这可能预示着Graves病患者机体内将出现一系列骨代谢紊乱的发生,测量Graves病患者体内维生素D水平,有助于Graves病相关骨质疏松的治疗和预防。此外,还有研究者发现维生素D缺乏可能参与Graves病的发生发展,而补充维生素D可能有助于Graves病的预防和治疗。本文将对维生素D与Graves病相关性及其可能存在的机制的研究新进展进行综述。 相似文献
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<正>Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody (TRAb) levels and the antithyroid drug(ATDs) use in pregnant women with Graves' disease in their neonatal thyroid function. Methods:The serum TRAb and T3,T4,FT3,FT4,TSH levels in 68 pregnant women with Graves' disease and their newborns were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay (ECLIA),respectively.Based on the maternal serum TRAb levels and the use of antithyroid drugs during pregancy, the newborns were divided into different groups.The incidence of neonatal thyroid dysfunction and its risk factors were analyzed. Results:The results showed the incidence of abnormal thyroid function of newborns was 29.4%(20/68).The proportion of neonatal thyroid dysfunction in women with high TRAb levels in the third trimester of pregnancy were significantly higher than these with normal TRAb(P0.01).In 23 newborns whose mothers were normal in serum TRAb levels and took no ATDs during pregnancy,only one case had thyroid dysfunction within two weeks after birth,while in other 45 newborns whose mothers had a high level of serum TRAb and/or took ATDs during pregnancy, 19 developed thyroid dysfunction within two weeks after birth. Conclusion:Neonatal thyroid function depends on the balance between the transplacental TRAb and ATDs. TRAb measurement in pregnant women with Graves' disease is of significance in evaluation of neonatal thyroid function. Elevated level of serum TRAb in the third trimester of pregnancy is a risk factor for neonatal thyroid dysfunction. 相似文献
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Clinical significance of risedronate for osteoporosis in the initial treatment of male patients with Graves' disease 总被引:1,自引:1,他引:0
Majima T Komatsu Y Doi K Takagi C Shigemoto M Fukao A Morimoto T Corners J Nakao K 《Journal of bone and mineral metabolism》2006,24(2):105-113
It has been well established that hyperthyroidism leads to diminished bone mineral density (BMD), and that a previous history
of hyperthyroidism remains a risk factor for fractures. However, little is known about how to manage the reduction in BMD
caused by hyperthyroidism. The purpose of this study was to evaluate the efficacy of risedronate for the treatment of osteoporosis/osteopenia
in patients with Graves' disease (GD). Of 34 Japanese male patients with newly diagnosed GD, 27 with osteoporosis/osteopenia
were included in this study. They were randomly divided into two groups by therapeutic regimen. Group A consisted of 14 patients
treated with an antithyroid drug and risedronate. Group B consisted of 13 patients treated with the same antithyroid drug
only. We used dual-energy X-ray absorptiometry to measure BMD at the lumber spine, femoral neck, and distal radius at baseline,
and at 6 and 12 months after the trial. Bone-specific alkaline phosphatase and urinary N-terminal telopeptide of type I collagen
normalized by creatinine were significantly more reduced in group A than in group B after both 6 and 12 months. The percentage
increases in BMD at the lumbar spine and distal radius were significantly greater in group A than in group B. These beneficial
effects of risedronate for patients with osteoporosis/osteopenia caused by GD may lead to a reduced risk of future fractures.
We thus conclude that risedronate should be considered for the treatment of decreased bone mass associated with GD. 相似文献
13.
Pregnancy results in dramatic changes in the cardiovascular system. Maternal heart disease complicates 0.2%-3% of pregnancies. Valvular heart disease in women of reproductive age is most commonly due to rheumatic heart disease, endocarditis, or congenital abnormalities. In general, regurgitant lesions are well tolerated during pregnancy because the increased plasma volume and lowered systemic vascular resistance result in increased cardiac output. In contrast, stenotic valvular disease is poorly tolerated with advancing pregnancy, owing to the inability to increase cardiac output in relation to the increased plasma volume preload. The choice of anesthesia depends on the lesion and its severity. Usually, regional anesthesia provides the least amount of alteration in hemodynamics, although general anesthesia for cesarean section can be equally safe when the abrupt changes associated with laryngoscopy, intubation, and extubation are blunted by the appropriate choice of pharmacological agents and anesthetic techniques. 相似文献
14.
Incidental thyroid carcinoma in patients with Graves' disease 总被引:1,自引:0,他引:1
BACKGROUND: The clinical significance of incidental thyroid carcinoma in patients with Graves' disease is uncertain. METHODS: The prevalence of incidental thyroid carcinoma was determined in patients with Graves' disease who underwent surgery from 1990 to 2007 and was compared with patients with nontoxic nodular goiter or toxic multinodular goiter who underwent surgery during the same time period. RESULTS: Of the 93 patients who underwent thyroidectomy for Graves' disease, 2 patients (2.2%) had an incidental papillary carcinoma: .4 and .5 cm in size. Neither patient developed recurrent disease after 3 and 13 years of follow-up evaluation. The prevalence of incidental thyroid cancer was 3.6% and 6.2% in patients with nontoxic nodular goiter and toxic multinodular goiter, respectively (P = not significant). CONCLUSIONS: The prevalence of incidental thyroid carcinoma in patients with Graves' disease is comparable with patients with nontoxic or toxic goiter. Incidental thyroid carcinomas in patients with Graves' disease were papillary microcarcinomas of no clinical consequence. 相似文献
15.
Yoshio Kasuga MD Akira Sugenoya Shinya Kobayashi Gengo Kaneko Hiroyuki Masuda Minoru Fujimori Shozo Takahashi Futoshi Iida 《Surgery today》1990,20(3):283-289
The purpose of this study was to evaluate the acute effects of corticosteroid and iodide preoperative therapy in patients
with Graves' disease in terms of thyroid function and immunological parameters. The above combination was prescribed for 4
patients who had experienced severe side effects from antithyroid drugs (ATD) in order to reduce the possibility of post-thyroidectomy
thyroid storm. Corticosteroids were employed daily for four days, and iodides were given daily for two weeks prior to thyroidectomy.
The free T3 values decreased rapidly to euthyroid levels following the administration of both drugs, although the free T4 values were still much higher than normal in 3 of the 4 patients at the time of surgery. By comparison, 3 of 8 patients treated
with ATD also had thyroid hormone levels above normal. Studies of lymphocyte subsets revealed that the percentage of helper
T cells was significantly less in the corticosteroidiodide treatment group than in the control and ATD groups. It is thus
possible that postoperative thyroid storm might be prevented through corticosteroid-iodide therapy by virtue of the reduction
of free T3 values to within the normal range by the time of surgery. The acute suppression of helper T cells was another result of this
form of therapy observed. 相似文献
16.
K.M. Woo N.N. Imasogie I. Bruni S.I. Singh 《International Journal of Obstetric Anesthesia》2009,18(3):272-275
Carcinoid tumours are neuroendocrine in origin and release vasoactive substances. Carcinoid tumours may be associated with carcinoid syndrome in 2–5% of patients and result in haemodynamic instability, bronchospasm, volume and electrolyte imbalance, and hyperglycaemia. We present the anaesthetic management of a 29-year-old parturient with metastatic carcinoid tumour. Although our patient did not ultimately develop carcinoid syndrome during the peripartum period, it was important that we used a multidisciplinary team approach, with close monitoring of her antenatal progress, and planned epidural analgesia for labour and delivery. 相似文献
17.
Osamu Ozaki Kunihiko Ito Takashi Mimura Kiminori Sugino Yutaka Kitamura Hiroshi Iwabuchi Michikazu Kawano 《Surgery today》1994,24(2):164-169
We recently treated three additional patients with hemiaplasia of the thyroid associated with Graves' disease, making a total
of eight such cases. All eight of these patients were women and their chief complaints were goiter in five cases, whereas
exophthalmos or palpebral edema were noted in six cases. All eight patients underwent surgery for Graves' disease. The left
lobe was absent in six cases and the right lobe in two, whereas the isthmus was absent in six cases and the pyramidal lobe
in four. A total of 102 cases of hemiaplasia of the thyroid, including our present three cases, have been reported in the
world literature since 1970, with 32 of them consisting of hemiaplasia associated with hyperthyroidism. Of these, the cause
of hyperthyroidism was Graves' disease in 22 cases, an autonomously functioning thyroid nodule in 7, and thyrotoxic multinodular
goiter in 3. The left lobe was absent in 19 cases while the right lobe was missing in 12, and laterality was unknown in 1
case. 相似文献
18.
Gambling DR Catanzarite V Fisher J Harms L 《International Journal of Obstetric Anesthesia》2011,20(1):85-88
Gorham-Stout disease is a rare disorder of bone loss and proliferation of lymphatic and vascular tissue (lymphangiomatosis). A 30-year-old nulliparous woman with Gorham-Stout disease presented at 8 weeks of gestation with a fused cervical spine. At 31 weeks she developed basilar invagination and neurological symptoms that were managed with a neck brace. Anesthetic considerations were those of airway compromise, development of severe preeclampsia and Kasabach-Merritt coagulopathy. Elective tracheostomy was declined. She presented two days before a planned cesarean delivery at 35 weeks in preterm labor. A semi-urgent cesarean delivery under spinal anesthetic proceeded uneventfully, with an otolaryngologist present in case a surgical airway was required. Mother and baby were discharged home after three days. Maternal postpartum recovery was complicated by episodes of respiratory compromise and critical bone loss in the cervical spine, necessitating further surgical reinforcement. 相似文献
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目的:观察放射性131Ⅰ治疗男性Graves甲亢患者早期血清性激素和性功能的变化。方法:男性Graves甲亢患者34例,年龄21~40(32.3±6.7)岁,给予131Ⅰ治疗剂量为111~407(237.8±51.8)MBq,在131Ⅰ治疗前及治疗后3、6个月分别检测血清甲状腺激素及性激素,同时对患者进行勃起功能问卷评分(IIEF-5)调查。用同期体检的健康男性20例作为对照,年龄25~37(31±3.1)岁。结果:男性Graves甲亢患者雌激素、睾酮、促黄体生成素水平分别为(132.5±40.4)pmol/L、(21.6±4.6)nmol/L、(10.1±4.4)IU/L,明显高于健康对照组的(80.4±31.2)pmol/L、(14.5±4.2)nmol/L、(6.2±1.9)IU/L(P<0.05)。131Ⅰ治疗3个月后血清雌激素、睾酮水平为(110.2±20.6)pmol/L、(17.7±5.5)nmol/L,较治疗前明显下降(P<0.05)。治疗6个月后雌激素、睾酮、促黄体生成素水平为(82.6±30.1)pmol/L、(13.8±3.4)nmol/L、(6.6±1.5)IU/L,与健康对照组相比无差别(P>0.05)。男性Graves甲亢患者IIEF-5评分为5~25(15.5±3.5)分,明显低于对照组的19~25(24.5±0.5)分(P<0.05)。131Ⅰ治疗后6个月组为10~25(23.5±1.5)分,明显高于3个月组的8~25(19.5±1.0)分(P<0.05)。结论:男性Graves甲亢患者雌激素、睾酮、促黄体生成素水平明显增高,性功能评分(IIEF-5)明显降低。使用131Ⅰ治疗6个月后,患者血清睾酮、促黄体生成素,雌激素水平以及IIEF-5评分基本恢复正常。Graves甲亢患者使用131Ⅰ治疗可明显改善其性功能。 相似文献