妊娠合并Graves病对后代的影响

目的 了解妊娠合并Graves病孕妇围产儿并发症以及与甲状腺功能和抗甲状腺药物（antithyroid drugs,ATDs）的关系,并观察对后代的长远影响.方法 回顾性分析2003年1月至2009年2月在我院分娩的既往或妊娠期有Graves病的93例孕妇（病例组）围产儿并发症情况,与无Graves病对照组孕妇进行比较,分析妊娠期间甲状腺功能状态及ATDs对围产儿的影响,比较两组后代甲状腺功能、甲状腺自身抗体及生长的差异.结果 病例组孕妇死胎、低出生体重儿、先天畸形的发生率均高于对照组孕妇（P＜0.05）.FT4高于正常参考范围上限是病例组孕妇发生死胎（P =0.04,OR =9.33,95％ CI=1.11～78.8）、低出生体重儿（P=0.04,OR =9.33,95％ CI=I.11 ～78.79）、先天畸形（P =0.02,OR=7.29,95％ CI=1.48 ～35.92）的危险因素;服ATDs孕妇其围产儿死胎、先天畸形的发生率与对照组孕妇均无统计学差异.病例组后代FT3、FT4、TGAb、TPOAb水平明显高于对照组后代.结论 妊娠合并Graves病围产儿死胎、低出生体重儿、先天畸形的风险明显增加,Graves病孕妇合理使用ATDs有利于减少围产儿并发症.妊娠合并Graves病孕妇的后代甲状腺自身免疫异常风险增加.     

妊娠合并Graves病T淋巴细胞亚群及甲状腺抗体检测的临床研究

目的 观察妊娠合并Graves病患者T淋巴细胞亚群及甲状腺抗体变化,探讨其免疫紊乱特征。方法 采用流式细胞仪测定32例初诊Graves病人、31例妊娠合并初诊Graves病人及28例正常对照者的T淋巴细胞亚群CD3＋、CD4＋、CD8＋、CD4＋／CD8＋,并用放射免疫法测定三组的TSAb、TGAb和TMAb。结果 妊娠合并初诊Graves病组的CD3＋为（62．72±6,13）％,CD4＋为（34．24±4．16）％,CD8＋为（33．26±3．71）％,CD4＋／CD8＋为（1、22±0．34）％。妊娠合并初诊Graves病组的TSAb20％,TGAb38％,TMAb32％.初诊Graves病组及妊娠合并初诊Graves病组与正常对照组比较,CD3＋、CD4＋、CD4＋／CD8＋下降,差异均有统计学意义（t分别=2．02、2．40、3,59、1,82、1．91、1．96,P均〈0．05）;CD8＋升高,差异均无统计学意义（t分别=1．35、1．45,P均〉0．05）;TSAb、TGAb、TMAb升高,差异均有统计学意义（χ^2分别=9．57、8．35、8．25、9,21、7．79、8．01,P均〈0．05）。妊娠合并初诊Graves病组与初诊Graves病组比较,CD3＋、CD4＋、CD4＋／CD8＋较高,差异均有统计学意义（t分别=1．83、2．02、2．95,P均〈0．05）;CD8＋较低,差异无统计学意义（t=0．73,P〉0．05）;TSAb、TGAb、TMAb较低,差异均有统计学意义（χ^2分别=6．59、5．24、4．87,P均〈0.05）。结论 妊娠合并Graves病人的T淋巴细胞亚群紊乱不如非妊娠状态明显,甲状腺抗体阳性率也较低．与妊娠期机体处于一种免疫抑制状态有关。     

Graves病合并混合性结缔组织病一例

1　临床资料患者女性 ,35岁 ,主因怕热、多汗、大便次数增多伴明显消瘦 2年 ,面部红斑 4月 ,加重半月余于 2 0 0 1年 6月收住我院。外院曾诊断甲亢 ,不规则服药 ,疗效欠佳。查体 :消瘦、营养差 ,毛发干燥、稀少 ,易断、易脱落 ,面部红斑样色素沉着 ,眼睑略苍白 ,双目炯炯有神 ,     

妊娠晚期合并细菌性阴道病对妊娠结局的影响

目的确定晚期妊娠合并细菌性阴道病（BV）的发病情况和对妊娠结局的影响。方法对南阳市卧龙区妇幼保健院3a来妊娠晚期32-37周孕妇4000例采用妇炎知（细菌性阴道病联合测定试剂盒）进行BV筛查的临床资料进行回顾性分析。结果晚期妊娠32～37周后合并BV者1092例发病率为27．3％。甲硝唑治疗组546例437例有效控制BV,甲硝唑片治疗BV有效率为80．0％,早产胎膜早破57例发病率为10．4％;未治疗对照组546例,早产胎膜早破138例发病率为25．3％。结论对晚期妊娠妇女进行BV的筛查和甲硝唑治疗可降低早产胎膜早破发生（P〈0．05）,减少不良妊娠结局提高产科质量。     

Graves病合并其他自身免疫性疾病30例

Gravis病(GD)是一种自身免疫性疾病,可同时或先后与多种其他自身免疫性疾病发生于同一患者。当二者并存时,可因一种疾病掩盖另一种疾病,给诊断与处理带来一定困难。我院自1975～1991年间,共收治30例,占同期成人住院甲亢1021例的3％。现报道如下。     

硒对甲巯咪唑治疗Graves病合并甲状腺功能亢进短期控制的影响

目的:探讨血清硒水平对甲巯咪唑(methimazole,MMI)治疗的Graves病(Graves’disease,GD)合并甲状腺功能亢进的短期控制的影响。方法:选择2015年12月至2017年6月期间在我院内分泌科住院部及门诊就诊的初发GD患者99例,根据硒摄入量不同将99例GD患者分为3组,高剂量补硒组34例,补硒剂量200μg/d,低剂量补硒组34例,补硒剂量100μg/d,正常对照组(未服用补硒药物)31例,3组患者均给予MMI治疗,比较3组患者治疗前和治疗12周后的甲状腺结节大小、超敏促甲状腺激素(hypersensitive thyroid stimulating hormone,sTSH),FT3,FT4及甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb),甲状腺球蛋白抗体(TGAb),促甲状腺激素受体抗体(thyroid stimulating hormone receptor antibody,TRAb),AST,ALT,γ-谷酰胺转肽酶(gamma glutamine transpeptidase,γ-GGT),碱性磷酸酶(alkaline phosphatase,ALP)水平。结果:正常对照组的总有效率为74.19%,低剂量补硒组的总有效率为91.18%,高剂量补硒组的总有效率为85.29%,低剂量补硒组的总有效率明显高于对照组,而低硒组和高硒组差异不明显;治疗后补硒组的甲状腺结节大小较对照组呈不同程度缩小,差异有统计学意义(均P<0.05);3组患者抗甲治疗后FT3,FT4水平较治疗前均有不同程度降低,sTSH明显升高(P<0.01),而补硒组FT3,FT4降低水平较正常对照组更加明显(P<0.01);3组患者治疗前TPOAb,TGAb,TRAb水平差异无统计学意义(P>0.05),治疗后TPOAb,TGAb,TRAb水平与治疗前比较有统计学意义(P<0.01),而补硒组降低更为明显(P<0.01)。补硒对GD甲状腺功能亢进患者肝功能无明显影响。结论:补硒治疗对GD患者甲状腺功能、甲状腺结节及自身抗体水平临床获益,而对患者肝功能无明显影响。     

细菌性阴道病对妊娠结局影响的研究

细菌性阴道病(BV)系因多种微生物所致的无阴道粘膜炎症表现的临床综合征。作为育龄期妇女最常见的阴道感染性疾病,其发病率远远高于阴道滴虫和霉菌感染者。妊娠合并细菌性阴道病对妊娠过程及其转归的影响尚不完全清楚,但有资料显示,在早产、胎膜早破、绒毛膜羊膜炎等并发症发生     

细菌性阴道病对妊娠结局影响的研究

细菌性阴道病（BV）系因多种微生物所致的无阴道粘膜炎症表现的临床综合征。作为育龄期妇女最常见的阴道感染性疾病，其发病率远远高于阴道滴虫和霉菌感染者。妊娠合并细菌性阴道病对妊娠过程及其转归的影响尚不完全清楚，但有资料显示，在早产、胎膜早破、     

妊娠合并细菌性阴道病与不良妊娠结局的关系

细菌性阴道病（BV）是育龄妇女最常见的一种下生殖道感染性疾病。研究资料表明，早产、胎膜早破、宫内感染和产后感染的患中BV发病率较高，推测BV可能与不良妊娠结局有关。     

Graves病合并肝功能异常临床研究

目的：了解Graves病合并肝功能异常的发生率、临床表现及相关因素。方法：1990～2001年复旦大学附属华山医院收治Graves病住院患者312例，分析其临床表现，肝功能指标，血清甲状腺激素水平以及甲状腺自身抗体水平。结果：312例患者中，Graves病合并肝功能异常的发生率为50．3％。这些患者的甲状腺激素水平、TsAb水平显著高于无肝功能异常患者；同时，他们合并甲亢性心脏病的比例更高。抗甲状腺药物治疗后，肝功能的恢复与甲状腺激素水平的回落一致。结论：Graves病合并肝功能异常的发生率较高，与患者的甲状腺激素水平、TsAb水平关系密切。     

Use of an artificial neural network to predict Graves' disease outcome within 2 years of drug withdrawal

BACKGROUND: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism, which can relapse in many patients after antithyroid drug treatment withdrawal. Several studies have been performed to predict the clinical course of GD in patients treated with antithyroid drugs, without conclusive results. The aim of this study was to define a set of easily achievable variables able to predict, as early as possible, the clinical outcome of GD after antithyroid therapy. METHODS: We studied 71 patients with GD treated with methimazole for 18 months: 27 of them achieved stable remission for at least 2 years after methimazole therapy withdrawal, whereas 44 patients relapsed. We used for the first time a perceptron-like artificial neural network (ANN) approach to predict remission or relapse after methimazole withdrawal. Twenty-seven variables obtained at diagnosis or during treatment were considered. RESULTS: Among different combinations, we identified an optimal set of seven variables available at the time of diagnosis, whose combination was useful to efficiently predict the outcome of the disease following therapy withdrawal in approximately 80% of cases. This set consists of the following variables: heart rate, presence of thyroid bruits, psycological symptoms requiring psychotropic drugs, serum TGAb and fT4 levels at presentation, thyroid-ultrasonography findings and cigarette smoking. CONCLUSIONS: This study reveals that perceptron-like ANN is potentially a useful approach for GD-management in choosing the most appropriate therapy schedule at the time of diagnosis.     

Serum laminin in Graves' disease

Abstract. We determined serum levels of laminin in 23 patients with Graves' disease (GD) and in 24 patients with toxic nodular goiter (TNG). Elevated levels of soluble laminin were observed in patients with GD prior to treatment (median concentration 1376 ng mL^-1 [range 712–2402]), compared to patients with TNG (median 442 ng mL^-1 [284–891]), and normal controls (median 492 ng mL^-1 [range 235–675], n = 26) respectively. In GD patients serum laminin levels decreased during thiamazole treatment and normalized within 8 weeks of therapy. There was no correlation between serum laminin levels and serum levels of thyroid hormones and/or auto-antibodies, respectively. Whether serum laminin is a marker for alterations of extracellular matrix during GD and release of basement membrane components in the circulation and/or reflects an impaired clearance remains to be elucidated.     

彩色多普勒超声显像对Craves病的诊断疗效观察分析

目的:探讨彩色多普勒超声诊断Graves病的意义以及治疗后疗效观察。材料和方法:全部45例分3组其中初发组14例,复发组9例,治疗后稳定组22例,并与12例正常人对照。应用彩色多普勒超声显像观察甲状腺腺体血流分布,甲状腺上动脉多普勒血流参数分析,并与血FT3、FT4值比较。结果:初发组和复发组甲状腺肿大,回声不均匀,血流丰富是“大海征”。甲状腺上动脉血流频谱,收缩期最大流速(Vmax)坎高(x95.80±14.62;88.53±17.65)与治疗后稳定组及对照组比有明显差异(P<0.01);治疗后稳定组血T3T4正常,腺体内血流减少。甲状腺上动脉Vmax下降(x23.01±6.53)。部分病例(2例)经短期治疗,血FT3FT4正常,但“大海征”仍存在,Vmax稍高,提示仍有复发可能。结论:本文认为CDFI可作为graves病诊断及治疗后疗效及预后观察的一个重要指标之一。     

~(131)I活度与甲状腺质量比值在治疗Graves'病中的价值

目的探讨131Ⅰ活度与甲状腺质量比值(MBq/g)在治疗Graves'病中的疗效和意义。方法选取门诊131Ⅰ治愈Graves'病患者442例并随访1年以上,根据131Ⅰ活度与MBq/g分为低比值组(MBq/g3.7)和高比值组(MBq/g≥3.7),比较2组疗效。结果低比值组和高比值组分别有196例(44.3%)和246例(55.7%),MBq/g比值分别为(3.0±0.4)和(4.4±1.2)(t=-16.0679,P0.01),首次治愈率分别为74.5%(146/196)和85.0%(209/246)(χ2=6.9157,P0.01),治疗次数分别为(1.4±0.8)次和(1.2±0.5)次(t=2.8726,P0.01),晚发甲减例数分别为104例(53.1%)和120例(48.8%)。结论与MBq/g低比值相比,限值在3.7~5.6 MBq/g可提高一次治愈率,减少重复治疗,且不增加晚发甲减概率。     

预测抗甲状腺药物治疗Graves病复发的分子标志物

抗甲状腺药物(ATD)治疗Graves病(GD)有较高的复发率,寻找可以判断ATD治疗GD预后的标志物十分重要。近来,核酸分子标志物,如单核苷酸基因多态性(SNP)和微小RNA(microRNAs)以及代谢组学标志物等分子标志物逐渐被用于GD的诊断和预后评估。其中,SNP在预测ATD治疗GD的缓解或复发中有较大价值。明确上述小分子物质与ATD治疗后GD复发的相关性,有助于寻找新的影响GD预后的因素,为治疗决策提供更精准的指导。本文对新型分子标志物在GD复发风险预测中的价值和未来研究方向做一综述。     

在不同促甲状腺素(TSH)水平加用甲状腺素对Graves病患者病情反复的影响

G raves病是一种器官特异性自身免疫性疾病,抗甲状腺药物(ATD)是治疗G raves病的主要方法,安全可靠,但具有较高的复发率。目前有学者研究认为加用甲状腺素治疗可以降低G raves病的复发率、预防药物性甲状腺功能减退症的发生,防止甲状腺肿大和突眼的加重。但目前未见在G raves病     

Immunoreactive' TSH' in urinary concentrates of Graves' disease patients: a radioimrnunoassay artefact

Abstract. A double antibody radioimmunoassay was used to analyse immunoreactive thyrotrophin in urinary concentrates from fourteen patients with hyperthyroid-ism due to Graves' disease, in three subjects with primary hypothyroidism, and in six normal subjects. Immunoreactive thyrotrophin was detectable in eleven subjects with Graves' disease, in one subject with primary hypothyroidism, and in four normal subjects. The mean urinary thyrotrophin concentration was significantly higher in Graves' disease (492 ± 99.9 μU/24h (SEM) ( n = 11)) than in normal subjects ((177 ± 26.4 μU/ 24 h (SEM) ( n = 4) (P<0.01)). The fact that bioassay-able thyrotrophin was undetectable in urinary concentrates in Graves' disease and that radioimmunoassay of other polypeptide hormones in urine can be influenced nonspecifically, led to the suspicion that the immunoreactive thyrotrophin measured in urinary concentrates was an assay artefact. This was strongly supported by the absence of a radioimmunoassayable thyrotrophin in urinary concentrates after extensive dialysis (96 h) without loss of added ¹³¹I-labelled thyrotrophin, differences between the elution pattern on Sephadex G-100 columns of ¹³¹I-labelled thyrotrophin and the immunoreactive thyrotrophin detected after chromato-graphy of the urinary concentrates on the same column, and the ability of different salts in various concentration to mimic dose-response curves in the radioimmunoassay for thyrotrophin as well as for thyroglobulin. In addition, since urinary proteins and IgG levels were elevated in concentrates of Graves' disease when compared with normal subjects, it has been suggested that the filtering mechanism of kidney is affected in Graves' disease, a disorder which has recently been associated with circulating antigen—antibody complexes.     

Reduction in thyroid volume after radioiodine therapy of Graves' hyperthyroidism: results of a prospective, randomized, multicentre study

The reduction in thyroid size in 92 patients treated with radioiodine for Graves' thyrotoxicosis was monitored by ultrasound volumetry. The patients were randomly treated with either a standard ¹³¹I activity of 555 MBq or an activity calculated to deliver a thyroid dose of 100 Gy. Within 1 year after radioiodine treatment, a remarkable volume reduction of about 71% (median) (quantile 25% (Q 25) = 49%, Q 75 = 82%, n = 67) was observed. The bulk of this reduction (median 57%, Q 25 = 21%, Q 75 = 74%, n = 92) was found within the first 6 months. Statistical analysis reveals that the effect was clearly related to the thyroid dose actually achieved during therapy. The median reduction obtained 6 months after radioiodine application was 45% for <100 Gy, 56% for 100–200 Gy and 67% for >200 Gy (n = 28, 39, 25 respectively). Twelve months after radioiodine application, the effect became less evident: 53%, 68% and 75% respectively (n = 17, 29, 21). The higher median thyroid dose actually achieved by standard than by calculated activity (215 Gy vs. 116 Gy) explains the more pronounced volume reduction in the standard group than in the calculated group: 60% vs. 47% 6 months (n = 47, 45) after radioiodine treatments and 74% vs. 66% 12 months (n = 31, 36) after radioiodine application. The relative reduction in thyroid size was just as marked in patients with large thyroids as in those with small glands. The goitre prevalence (thyroid volume > 20 mL in women and > 25 mL in men) was reduced from 73% to only 16% 1 year after radioiodine treatment. In patients with a thyroid volume of more than 60 mL, the median pretherapeutic thyroid volume of 102 mL was reduced to 29 mL. In conclusion, radioiodine treatment in Graves' hyperthyroidism sufficiently reduces thyroid volume in a dose-dependent manner. The findings of this study demonstrate that radioiodine is also an attractive mode of therapy for Graves' patients with substantial thyroid enlargement.     

Oxidative stress peripheral parameters in Graves' disease: the effect of methimazole treatment in patients with and without infiltrative ophthalmopathy

OBJECTIVES: The study was designed to estimate the influence of hyperthyroidism and antithyroid treatment on oxidative stress peripheral parameters in Graves' disease patients with and without infiltrative ophthalmopathy. DESIGN AND METHODS: Free radical generation and scavenging plasma indices were determined in 47 patients with hyperthyroidism due to Graves' disease (22 with and 25 without infiltrative ophthalmopathy), as well as in 24 healthy volunteers after euthyroidism achievement with methimazole. RESULTS: In the hyperthyroid patients, hydrogen peroxide, lipid hydroperoxides, thiobarbituric acid-reacting substances, ceruloplasmin, superoxide dismutase, and catalase were increased. Glutathione peroxidase and glutathione reductase, however, were reduced. Methimazole treatment resulted in all markers being normalized in the patients without infiltrative ophthalmopathy, yet oxidative stress was still present in the ophthalmopathy group. CONCLUSION: We suggest that apart from the thyroid metabolic status influence, it is orbital inflammation that triggers changes in blood extracellular indices of reactive oxygen species metabolism.     

妊娠期高血压疾病对妊娠结局的影响

目的探讨妊娠期高血压疾病对妊娠结局的影响。方法选择妊娠期高血压疾病患者63例作为观察组．同时选择同期的健康产妇60例作为对照组。分别记录两组孕妇的分娩方式、并发症发生率和围生儿并发症发生率、死亡率等情况。结果观察组孕妇非自然分娩率和并发症发生率分别为71．4％（45／63）、55．6％（35／63）,明显高于对照组的26．7％（16／60）、5．0％（3／60）,组间比较,差异均具有显著性（P〈0．01）。观察组围生儿不良事件的发生率为74．6％（47／63）,与对照组的15．0％（9／60）比较,差异具有显著性（P〈0．01）。结论积极防治妊娠期高血压疾病对改善妊娠结局具有重要的意义。