心理干预对腹膜透析患者焦虑、抑郁情绪和生活质量的影响

目的 探讨心理干预对腹膜透析患者焦虑、抑郁情绪和生活质量的影响.方法 采用健康状况问卷(SF-36)评估 164 例腹膜透析患者的生活质量;分别用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA) 评估患者的抑郁、焦虑症状,根据评分并将其分为抑郁、焦虑组与非抑郁、焦虑组,比较2组间生活质量及腹膜透析质量的差异.将抑郁、焦虑组患者以就诊先后顺序分为心理干预组和非心理干预组,比较2组间生活质量及腹膜透析质量的差异.结果 腹膜透析患者抑郁、焦虑情绪的发生率分别为21.95%和41.46%.抑郁、焦虑症状评分与生活质量8项指标中7项呈负相关;尤其在躯体疼痛、情感问题所导致的角色限制和情感健康中差异有显著性(r分别为-0.310,-0.367,-0.409;均P<0.01),抑郁、焦虑组SF-36总分[(46.23±16.25) 分,(73.69±19.17)分, P=0.000]、主观综合营养评估[(19.84±4.41)分,(57.34±6.14)分,P<0.01]、尿素清除指数[(2.00±0.43)分,(3.76±0.35)分,P＜0.01]明显低于非抑郁、焦虑组.心理干预治疗后心理干预组SF-36总分、主观综合营养评估、尿素清除指数明显高于非心理干预组.结论 腹膜透析患者抑郁、焦虑症状发生率较高,且与患者生活质量密切相关. 心理干预对腹膜透析患者焦虑、抑郁情绪和生活质量的影响     

Plasma CRP, apolipoprotein A-1, apolipoprotein B and Lpa levels according to thyroid function status

BACKGROUND: Altered lipid profile is a well-known manifestation of thyroid dysfunction. Recently, serum Lp(a) and C-reactive protein (CRP) have emerged as new cardiovascular risk factors, but studies on changes of these markers with respect to thyroid function status have produced variable results. To better understand the effects of thyroid dysfunction on the development of atherosclerosis, we investigated plasma CRP and lipid profiles such as apoA1, apoB, and Lp(a) in cases with differing severities of thyroid dysfunction. METHODS: Fifty four patients with hyperthyroidism, 35 patients with subclinical hyperthyroidism, 33 patients with overt hypothyroidism, 190 patients with subclinical hypothyroidism and 100 age- and sex-matched healthy control subjects were evaluated. Serum high sensitivity (hs)-CRP and Lp(a) were measured by immunonephelometry. RESULTS: No significant differences were found in serum hs-CRP, Lp(a), HDL-C or ApoA1 in different thyroid function groups. Serum total cholesterol and LDL-C levels were significantly lower in cases of hyperthyroidism than in cases of overt hypothyroidism, subclinical hypothyroidism or subclinical hyperthyroidism, or in healthy control subjects (p <0.01). Serum triglyceride levels were higher in overt hypothyroidism than in hyperthyroidism or healthy controls (p <0.05). Serum apoB levels were significantly lower in hyperthyroidism than in overt hypothyroidism, subclinical hypothyroidism or in healthy control subjects (p <0.01). These differences were consistently significant after adjustment for age and BMI. CONCLUSIONS: Serum CRP and Lp(a) levels, risk factors for atherosclerosis, were not found to be significantly affected by the degree of thyroid dysfunction. Increased risk of atherosclerosis in hypothyroidism does not appear to be associated with non-traditional cardiovascular risk factors, such as serum CRP, Lp(a) or apoA1 levels.     

终末期肾衰患者的精神症状与生活质量的相关分析

目的:探讨终末期肾衰患者焦虑、抑郁症状与生活质量的关系。方法:采用健康相关生活质量量表(SF-36)调查57例终末期肾衰患者生活质量,SF-36包括8个纬度,体能(PCS)和精神(MCS)两方面总分;分别用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估患者抑郁、焦虑症状,并将其分为抑郁组与非抑郁组、焦虑组与非焦虑组,比较生活质量组间差异。结果:抑郁症状的发生率为38.6%,焦虑症状的发生率为54.4%。抑郁、焦虑评分与生活质量8个纬度中7项呈负相关,与PCS和MCS呈负相关(P<0.05)。抑郁组、焦虑组以及二者共存组的生活质量明显低于无相应精神症状组患者(P<0.05)。结论:终末期肾衰患者焦虑症状和抑郁症状发生率较高,与患者生活质量相关。有效改善患者精神症状可能是提高患者生活质量途径之一。     

颈椎病患者的生活质量及相关因素分析

目的探索颈椎病患者的生活质量及相关因素。方法对60例颈椎病患者进行一般情况调查,汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、健康情况调查问卷(SF-36)评定。结果除生理机能外,颈椎病患者SF-36各维度评分均显著低于常规(P<0.01)。病程影响患者的生活质量,病程大于4年的患者的生活质量除生理机能评分外均低于病程小于4年的患者(P<0.01),伴有抑郁或焦虑症状的颈椎病患者,其SF-36的躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康6个维度评分显著低于不伴抑郁或焦虑症状的患者(P<0.05或P<0.01)。结论颈椎病患者的生活质量低于一般正常人群,病程长,伴有抑郁或焦虑症状的生活质量受损更加严重。     

Depression and anxiety in hyperthyroidism

BACKGROUND: Our objective was to determine symptomatology of depression and anxiety in patients with untreated hyperthyroidism and compare with euthyroid patients. METHODS: Thirty-two patients with hyperthyroidism (high free T3 and free T4, and suppressed TSH) and 30 euthyroid (normal free T3, free T4, and TSH) controls attending the Endocrinology Out-Patient Department at Celal Bayar University Hospital in Manisa, Turkey were included in the study. Hormonal screening was performed by immunoassay and hemagglutination method. For psychiatric assessment, Hospital Anxiety and Depression Scale [HAD], Hamilton Depression Rating Scale [HAM-D], and Hamilton Anxiety Rating Scale [HAM-A] were used. There was no difference between the two groups in terms of demographic features. RESULTS: Total scores obtained both from HAM-D and HAM-A were significantly greater in the hyperthyroidism group than that of the euthyroid group (p <0.05); there was no difference in terms of HAD. When compared in terms of symptomatology, early insomnia (HAM-D#6), work and activities (HAM-D#7), psychic anxiety (HAM-D#10), weight loss (HAM-D#16), insomnia (HAM-A#4), and cardiovascular symptoms (HAM-A#8) were significantly more frequent in the hyperthyroidism group. By Wilks lambda discriminant analysis, psychomotor agitation (HAM-D#9), weight loss (HAM-D#16), and insomnia (HAM-A#4) were found as the discriminating symptoms for the hyperthyroidism group, whereas somatic anxiety (HAM-A#11) and loss of interest (HAD#14) were distinguishing symptoms of the euthyroidism group. CONCLUSIONS: Hyperthyroidism and syndromal depression-anxiety have overlapping features that can cause misdiagnosis during acute phase. For differential diagnosis, one should follow-up patients with hyperthyroidism with specific hormonal treatment and evaluate persisting symptoms thereafter. In addition to specific symptoms of hyperthyroidism, psychomotor retardation, guilt, muscle pain, energy loss, and fatigue seem to appear more frequently in patients with comorbid depression and hyperthyroidism; thus, presence of these symptoms should be a warning sign to nonpsychiatric professionals for the need for psychiatric consultation.     

自身免疫性甲状腺疾病患者血浆丙二醛与炎症因子的检测及临床意义

对初诊为自身免疫性甲状腺疾病甲状腺功能亢进症（甲亢）33例、亚临床甲亢21例、甲状腺功能减退症（甲减）25例、亚临床甲减23例、甲状腺功能正常15例,正常对照30例,进行血浆丙二醛（MDA）、超氧化物歧化酶（SOD）和炎症因子检测。甲状腺功能异常各组MDA水平显著高于正常对照组（P〈0．01或P〈0．05）,SOD／MDA比值显著低于正常对照组（P〈0．01或P〈0．05）;超敏C反应蛋白、肿瘤坏死因子足MDA重要影响因素。     

综合医院神经内科住院患者焦虑/抑郁状况的多中心研究

目的探讨综合医院神经内科住院患者焦虑／抑郁状况的发生率及健康相关的生活质量。方法使用医院焦虑抑郁量表（HADS）、汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）和简明健康状况调查表（SF-36）对综合医院神经内科住院患者在入院时（48h之内）和出院时（48h之内）分别进行评估,以了解这些患者的情感状况和健康状况相关的生活质量。结果共有610例患者完成了入院时的评估,入院时具有临床意义的抑郁症状（HAMD≥18分）和焦虑症状（HAMA≥14分）的患者分别为123例（20．2％）和161例（26．4％）,此284例中有96例同时达到具有临床意义的抑郁和焦虑状态。405例患者完成了出院时的评估,出院时有具有临床意义的抑郁症状（HAMD≥18分）和焦虑症状（HAMA≥14分）的患者分别为68例（16．8％）和93例（23％）,此161例中有52例同时达到有临床意义的抑郁和焦虑状态。以入院时SF-36量表总分作为因变量的多元回归分析显示：性别、焦虑、抑郁与健康状况相关的生活质量相关。住院期间对有临床意义的患者进行药物治疗的为59例（20．8％）。药物治疗组和非治疗组比较在出院时HAMA和HAMD总分下降;活力,情感职能和精神健康等分数反映健康相关的生活质量增加。结论神经内科住院患者的焦虑抑郁发生率较高,焦虑和抑郁情感对患者的健康相关的生活质量有影响,单纯治疗躯体疾病并不能缓解焦虑和抑郁情感,且患者的焦虑抑郁从负面影响患者对于躯体疾病治疗结局的评价,应该对合并焦虑、抑郁情感的神经内科住院患者给予抗抑郁和抗焦虑的治疗。     

Effects of depression and anxiety on quality of life of patients with rheumatoid arthritis, knee osteoarthritis and fibromyalgia syndrome

OBJECTIVE: To measure the effects of depression and anxiety on quality of life (QoL) in patients with rheumatoid arthritis (RA), knee osteoarthritis (OA) and fibromyalgia syndrome (FMS). METHODS: One hundred and fifty-four patients with RA, knee OA, and FMS who presented to the physical medicine and rehabilitation department were studied. For evaluation of the patients, Beck depression scale, Beck anxiety scale, and Short Form-36 were used. RESULTS: Twenty-two per cent of patients (n = 34) were diagnosed with of RA, 52.6% (n = 81) knee OA and 25.3% (n = 39) FMS. Except for the subscales, of physical and emotional role, there were statistically significant differences among diagnostic groups in the rest of the SF-36 subscales. In the physical functioning subscale, the highest score was obtained in the fibromyalgia group and the lowest in the RA group (p < 0.001). However, in the bodily pain subscale, the lowest score was recorded in the fibromyalgia group (p = 0.019). In all diagnostic groups, the scores of SF-36 subscales were significantly low in patients who scored above the threshold value of Beck depression scale (p < 0. 001). A strong negative correlation was detected between scores of Beck anxiety scale and the scores of all SF36 subscales in patients with RA and knee OA. On the other hand, in patients with FMS, anxiety scores correlated negatively with only physical and somatic function scores of SF-36. CONCLUSION: Quality of life is significantly low in patients with RA, knee OA and FMS, whose depression and/or anxiety scores are high. Therefore, these patients should be managed using a multidisciplinary approach including psychiatric support.     

三维能量多普勒血管成像在甲亢和亚临床甲减鉴别诊断中的应用

目的探讨三维能量多普勒血管成像及其定量参数在甲状腺功能亢进(甲亢)与亚临床甲状腺功能减退(亚临床甲减)鉴别诊断中的应用。方法选择甲亢组、亚临床甲减组和正常对照组各40例作为研究对象,对各组研究对象的甲状腺进行检查,获得直方图及定量指标,包括平均灰阶(MG)、血管指数(VI)、血流指数(FI)和血管血流指数(VFI),并进行对比分析。结果甲亢组各项参数均较对照组明显增高(P<0.05);亚临床甲减组MG与对照组比较差异无统计学意义(P>0.05),VI、FI、VFI均较对照组明显增高(P<0.05);亚临床甲减组的MG、FI、VFI明显低于甲亢组(P<0.05),VI与甲亢组比较差异无统计学意义(P>0.05)。结论三维能量多普勒血管成像可以定性定量判定甲状腺的腺体回声水平和血流情况,为甲亢和亚临床甲减的诊断及鉴别诊断提供更多客观依据。     

Hypothyroidism and obesity. Cause or effect?

OBJECTIVE: To establish relationship between obesity and hypothyroidism and to analyze the frequency the frequency of primary hypothyroidism in obese patients and frequency of obesity in primary hypothyroidism patients. METHODS: We conducted this retrospective, observational study in the Department of Endocrinology and Obesity Clinic, Medwin Hospital, Hyderabad, India in Mar 2008. In the last 18 months (between September 2006 to February 2008), data on 625 consecutive primary hypothyroidism patients (Group I) and 450 patients from obesity clinic (Group II) were analyzed. Frequency difference between the 2 groups was assessed by Chi-square test. RESULTS: In Group I, 278/625 (44%) had body mass index (BMI) >25 kg/m2. Obesity was higher (46% versus 34%) in overt hypothyroidism than in subclinical hypothyroidism (p=0.21). More patients were overweight in overt hypothyroidism group than in subclinical hypothyroidism group (p=0.02). In obesity patients, overt hypothyroidism was present in 33% and subclinical hypothyroidism in 11% patients. CONCLUSION: Overall thyroid dysfunction was found more in obese individuals with varying degree of significance. Detailed studies are required to assess the cause and effect relation between obesity and hypothyroidism.     

Depression and anxiety in hypothyroidism

The aim of the study was to determine the prevalence and severity of depression and anxiety in patients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, for psychiatric assessment, Hospital Anxiety and Depression Scale (HAD), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used. There was no difference between the two groups in terms of demographic features. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyrodism. However, depression was more significant in the hypothyroid than euthyroid group.     

慢性丙型肝炎患者抗病毒治疗后甲状腺功能动态变化和转归及其影响因素

目的：探讨慢性丙型肝炎（CHC）患者抗病毒治疗后甲状腺功能动态变化和转归,阐明基线因素对甲状腺功能改变的影响。方法:取基线甲状腺功能正常的CHC患者243例,均给予干扰素-α2b联合利巴韦林抗病毒治疗48周,分别在12、24、36、48、60和72周时对甲状腺功能和HCV RNA定量等进行检测,根据治疗后甲状腺功能变化情况分为持续正常组、亚临床甲状腺功能减退(亚甲减)组、甲状腺功能减退(甲减)组和甲状腺功能亢进(甲亢)组,观察各组患者甲状腺功能变化的规律。结果:82例（33.7%）患者发生甲状腺功能改变,其中亚甲减51例（20.9%）,甲减13例（5.3%）,甲亢18例（7.4%）。随访至72周时,亚甲减、甲减
、甲亢患者恢复正常的分别为32例（39.0%）、12例（14.6%）和7例（8.5%）,甲减转变为亚甲减的为6例（7.3%）,甲亢转变为亚甲减的为3例（3.7%）;19例（23.2%）患者病情无明显改善,1例（1.2%）表现为持续亚甲减,13例（15.9%）持续甲减,5例（6.1%）持续甲亢;3例（3.7%）患者由甲亢转变为甲减。女性甲减发生率高于男性（P<0.05）;发生甲亢患者平均年龄低于甲减、亚甲减及持续正常患者（P<0.05）;发生甲亢和甲减患者基线γ-谷氨酰转肽酶水平低于亚甲减和持续正常者（P <0.05）;发生甲亢患者中HCV2a型患者所占比例明显高于发生甲减、亚甲减及持续正常者（P <0.05）。结论:CHC患者抗病毒治疗可使甲状腺功能发生改变,性别、年龄、肝功能和基因型对甲状腺功能改变具有预测意义。     

碘摄入量与甲状腺功能障碍关系的多因素分析

目的探讨碘摄入量和甲状腺功能障碍之间的关系.方法对轻度碘缺乏、碘超足量、碘过量三个碘摄入水平地区14岁以上成年人的流行病学调查资料进行多因素分析.结果Logistic回归显示,碘超足量、碘过量是亚临床甲减和临床甲减的独立危险因素(P＜0.05).碘过量时亚临床甲亢的患病危险减少,OR值为0.218(P＜0.05).引入碘摄入量与甲状腺自身抗体的交互作用后,碘过量仍然是亚临床甲减和临床甲减的独立危险因素(P＜0.01);碘超足量对临床甲减无显著影响,但使亚临床甲减的患病危险性显著升高(P＜0.01),并且其与TgAb的联合作用显著升高亚临床甲减和临床甲减的患病危险性(P＜0.05).结论碘摄入量增加有抑制甲状腺功能的趋势,碘超足量和碘过量使甲状腺功能减退症患病危险增加.     

综合性医院内科门诊焦虑障碍患者生命质量研究

目的研究综合性医院内科门诊焦虑障碍患者的生命质量及其相关影响因素。方法对107例综合性医院内科门诊焦虑障碍患者进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)24项和SF-36健康调查量表评估;将焦虑障碍患者SF-36健康调查量表各维度评分与杭州市区居民生命质量常模进行比较;采用线性逐步回归法分析焦虑障碍患者生命质量的影响因素。结果除生理功能外,综合性医院内科门诊焦虑障碍患者SF-36健康调查量表各维度评分均明显低于常模(P<0.001)。焦虑障碍患者生命质量的受影响程度与HAMD、HAMA评分呈负相关(P<0.001和P<0.01),与病程呈正相关(P<0.05)。结论综合性医院内科门诊焦虑障碍患者的生命质量低于正常人,并受焦虑、抑郁症状和病程的影响。     

综合性医院内科门诊焦虑障碍患者生命质量研究

目的 研究综合性医院内科门诊焦虑障碍患者的生命质量及其相关影响因素。方法 对107例综合性医院内科门诊焦虑障碍患者进行汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）24项和SF-36健康调查量表评估;将焦虑障碍患者SF-36健康调查量表各维度评分与杭州市区居民生命质量常模进行比较;采用线性逐步回归法分析焦虑障碍患者生命质量的影响因素。结果 除生理功能外,综合性医院内科门诊焦虑障碍患者SF-36健康调查量表各维度评分均明显低于常模（P<0.001）。焦虑障碍患者生命质量的受影响程度与HAMD、HAMA评分呈负相关（P<0.001和P<0.01）,与病程呈正相关（P<0.05）。结论 综合性医院内科门诊焦虑障碍患者的生命质量低于正常人,并受焦虑、抑郁症状和病程的影响。     

MULTIVARIATE ANALYSIS OF RELATIONSHIPS BETWEEN IODINE BIOLOGICAL EXPOSURE AND SUBCLINICAL THYROID DYSFUNCTIONS

Objective To assess the relationships between iodine biological exposure and subclinical thyroid dysfunctions. Methods The cross-sectional survey was performed to obtain the epidemiologic data of population in three communities with different iodine biological exposure： mild iodine deficiency [median urinary iodine concentration （MUI） of 50-99 μg/L], more than adequate iodine intake （MUI of 200-299 μg/L）, and excessive iodine intake （MUI over 300 μg/L）. Univariate and multivariate analysis （logistic regression analysis） were used to analyze the risk factors of subclinical hypothyroidism and subclinical hyperthyroidism. Logistic regression analysis with sex and age controlled suggested that more than adequate iodine intake （OR = 3.172, P = 0.0004） and excessive iodine intake （OR = 6.391, P = 0.0001） increased the risk of subclinical hypothyroidism, while excessive iodine intake decreased the risk of subclinical hyperthyroidism （OR = 0.218, P= 0.0001）. Logistic regression analysis including interaction of iodine intake and antibodies [tryroid peroxidase antibody （TPOAb） and thyroglobulin antibody （TgAb）] suggested that excessive iodine intake was an independent risk factor of subclinical hypothyroidism （OR = 6.360, P= 0.0001）, but independent protect factor of subclinical hyperthyroidism （OR = 0.193, P= 0.0001）. More than adequate iodine intake and it＇s interaction with TgAb increased the risk of subclinical hypothyroidism independently, in addition, it decreased the risk of subclinical hyperthyroidism at the present of TPOAb. Conclusion Both excessive iodine intake and more than adequate iodine intake could increase risk of subclinical hypothyroidism, supplement of iodine should be controlled to ensure MUI within the safe range.     

Effect of different iodine intake on schoolchildren’s thyroid diseases and intelligence in rural areas

Background Reports are increasingly appearing on the side effects caused by excessive iodine intake. Our objective was to find out whether iodine excess would impair the thyroid function and intelligence of schoolchildren in rural areas of China.Methods A comparative epidemiological study was made on thyroid function and intelligence of the schoolchildren in the areas of low, moderate or excessive intake of iodine. In the area of low intake of iodine ( Panshan, Liaoning province, median urinary iodine (MUI) was 99 μg/L), of moderate intake of iodine (Zhangwu, Liaoning Province, MUI was 338 μg/L) and of excessive intake of iodine (Huanghua, Hebei Province, MUI was 631 μg/L). The numbers of schoolchildren from each area selected to take part in a Chinese version of Raven‘ s Test were 190,236 and 313, respectively, and then 116, 110 and 112 of them were tested for thyroid function, thyroid autoantibody (TAA) and urinary iodine (Ul).Results There were no significant differences in the incidences of overt hyperthyroidism, subclinicalhyperthyroidism and overt hypothyroidism in Panshan, Zhangwu and Huanghua. But significantdifferences were found in the incidences of subclinical hypothyroidism (P=0.001 ) in these three areas. The incidences of subclinical hypothyroidism in Huanghua and Zhangwu were 4. 76 and 3.37 times higher than that in Panshan. TAP, were negative in all the schoolchildren with subclinicalhypot hyroidism except for one. No significant difference was found among the rates of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in these three areas. Mean serumthyroglobulin (TG) value of Huanghua was markedly higher than those of the other two (P=0.02).Mean serum TG value of Zhangwu was higher than that of Panshan but the difference was not significant. Mean IQ value of the schoolchildren in Huanghua was markedly higher than that for Zhangwu (P=0.001). Mean IQ value of the schoolchildren in Panshan was lower than that of Huanghua and higher than that of Zhangwu but, again, the differences were not significant.Conclusions The increase of iodine intake may increase the risk for schoolchildren of subclinical hypothyroidism. In the area of iodine excess, most of the subclinical hypothyroidism cases are not of autoimmune origin. No obvious effect of excess iodine was found on mental development of schoolchildren.     

超声剪切波弹性成像在桥本甲状腺炎临床诊断中的价值

目的 探讨剪切波弹性成像技术(SWE)对桥本甲状腺炎(HT)不同分期的诊断价值.方法 104例经临床确诊的HT患者,根据甲状腺功能状态分为HT甲亢组(26例)、HT甲功正常组(29例)、HT亚临床甲减组(27例)和HT临床甲减组(22例).同期选择健康志愿者作为健康对照组(50例).利用SWE技术测量所有受检者甲状腺组织的杨氏模量值.采用Spearman相关分析法分析甲状腺组织杨氏模量值与甲状腺峡部厚度、甲状腺微粒体抗体(TMAb)、甲状腺球蛋白抗体(TGAb)滴度的相关性.结果 健康对照组、HT甲亢组、HT甲功正常组、HT亚临床甲减组、HT临床甲减组甲状腺组织杨氏模量值呈递增趋势(P＜0.01).HT甲亢组剪切波弹性模量值低于HT甲功正常组、HT亚临床甲减组、HT临床甲减组,差异均有统计学意义(P均＜0.05).HT甲功正常组剪切波弹性模量值低于HT亚临床甲减组、HT临床甲减组,差异有统计学意义(P均＜0.05).结论 剪切波弹性成像杨氏模量值与桥本甲状腺炎不同分期患者临床表现有一定相关性,提示超声弹性成像对桥本甲状腺炎病程分期有一定的诊断价值.     

Comparison of fluoxetine and paroxetine in type II diabetes mellitus patients

BACKGROUND: This study aims to investigate the efficacy of fluoxetine and paroxetine on the levels of depression-anxiety, quality of life, disability, and metabolic control in type II diabetes mellitus (DM) patients. METHODS: The patients were first applied the Hospital Anxiety-Depression Scale (HADS). After a psychiatric interview with patients who had scores above the cut-off point, those who were diagnosed as having a major depressive disorder according to DSM-IV criteria were applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Twenty three patients who scored 16 or above on the HDRS were included in the study and given the Short Form-36 (SF-36), and the Brief Disability Questionnaire (BDQ) and HbA1c levels were measured. Patients were randomized on 20 mg/day fluoxetine or 20 mg/day paroxetine treatment. The patients were evaluated with the same scales at the 2(nd), 4(th), 6(th), and the 12(th) weeks. RESULTS: Both groups showed a statistically significant decrease in HDRS, HARS, and BDQ scores with comparison to the index assessment. At the end of treatment, though not statistically significant, a decrease was observed in HbA1c values of the fluoxetine-administered group. CONCLUSIONS: Fluoxetine and paroxetine effectively reduce the severity of major depressive disorder in type II DM patients. There is need for further and longer-lasting monitoring studies with more patients in order to determine whether there is any difference in terms of their effects on glycemic control.     

阿仑膦酸钠联合侧方椎体间融合术在腰椎退行性疾病中的效果

目的 探讨阿仑膦酸钠联合侧方椎体间融合术(LLIF)在腰椎退行性疾病中的应用效果。方法 选取本院2018年2月至2020年2月收治的80例腰椎退行性疾病患者作为研究对象,根据随机数字表法分为对照组和观察组,每组各40例,两组均行LLIF治疗,对照组术后采用常规药物治疗,观察组在对照组基础上服用阿仑膦酸钠。比较两组术前、术后3个月的腰椎功能[(腰椎功能障碍评估表(ODI)]、疼痛程度[视觉模拟评分法(VAS)];术后连续随访6个月,比较两组康复质量、生活质量[生活质量评估量表(SF-36)],比较两组术后1个月的并发症发生率(脊髓炎、腰椎不稳、腰椎松动、椎间隙感染)。结果 随访6个月,观察组康复优良率95.00%,高于对照组80.00%,差异有统计学意义(P0.05)。两组术后ODI、VAS评分均较术前降低,SF-36评分较术前上升,观察组ODI、VAS评分较对照组低,SF-36评分较对照组高,差异有统计学意义(P0.05)。术后观察组并发症总发生率5.00%,低于对照组20.00%,差异有统计学意义(P0.05)。结论 阿仑膦酸钠联合LLIF用于腰椎退行性疾病中可降低并发症发生率,改善腰椎功能,减轻疼痛症状,还可促进术后康复,改善患者生活质量。