原发性甲状腺功能减退症对记忆功能的影响

目的研究成人初诊原发性甲状腺功能减退症患者的记忆功能。方法运用修订韦氏记忆量表和正背倒背任务检测22例初诊成人原发性甲状腺功能减退症患者,23例正常对照者的记忆功能。结果修订韦氏记忆量表检测显示原发性甲状腺功能减退症组记忆商较对照组明显低下(P<0.01)。正背倒背任务检测,原发性甲状腺功能减退症患者组4位倒背数字任务正确率显著低于对照组(P<0.05)。结论原发性甲状腺功能减退患者存在记忆功能损害。     

抑郁症患者治疗前后神经心理学测验变化分析

目的 通过研究抑郁症患者治疗前后神经心理学测验,评价其认知功能的变化.方法 将45例抑郁症患者设为研究组,于入组当日及治疗8周后分别进行韦氏成人记忆量表中国版和中国修订韦氏成人智力量表测试;随机抽取本院职工、学生及志愿者30名设为对照组,于入组时进行两个量表的评定.结果 研究组治疗后韦氏成人记忆量表、韦氏成人智力量表各因子评分均显著高于治疗前(P＜0.01).研究组治疗前韦氏成人记忆量表、韦氏成人智力量表各因子评分均显著低于对照组(P＜0.05或0.01),治疗后长时记忆、短时记忆、瞬时记忆及记忆商数评分显著低于对照组(P＜0.05或0.01).结论 抑郁症患者发作期存在明显记忆、智能障碍,治疗后,随着临床症状的缓解其功能得到部分改善,但不能完全恢复到正常水平.     

利培酮 奥氮平 奎硫平对康复期精神分裂症认知功能的影响

目的 探讨利培酮、奥氮平、奎硫平对康复期精神分裂症患者认知功能和社会功能的影响. 方法 将60例康复期精神分裂症患者随机分为三组,每组20例,分别口服利培酮、奥氮平、奎硫平治疗,观察12周.于治疗前及治疗12周末采用韦氏记忆量表、威斯康星卡片分类测验、连线测验、个人和社会功能量表、阳性与阴性症状量表及临床病情严重程度量表进行测评,并与60名健康体检者（对照组）进行对比分析. 结果 治疗前三组患者威斯康星卡片分类测验、连线测验及韦氏记忆量表的各项认知功能指标评分与对照组均有显著性差异（P＜0.05或0.01）;治疗后三组患者连线测验-B连线时间评分显著低于治疗前（P＜0.05或0.01）,而威斯康星卡片分类测验、连线测验-A连线时间、连线测验-A错误数、连线测验-B错误数及韦氏记忆量表记忆商评分与治疗前比较均无显著变化（P＞0.05）,且威斯康星卡片分类测验、连线测验-B错误数及韦氏记忆量表记忆商评分仍与对照组有显著性差异（P＜0.05或0.01）.治疗12周末,三组患者临床病情严重程度量表评分均较治疗前有显著下降（P＜0.05）;奎硫平组阳性与阴性症状量表总分减分值显著低于利培酮组和奥氮平组（P＜0.05）;三组不良反应均轻微. 结论 利培酮、奥氮平、奎硫平均能改善康复期精神分裂症患者的部分认知功能和社会功能,疗效相当,但短期内对执行功能及韦氏记忆量表记忆商无显著改善.     

齐拉西酮与阿立哌唑对首发精神分裂症患者认知功能的影响

目的 探讨齐拉西酮与阿立哌唑对首发精神分裂症患者的临床疗效及认知功能的影响.方法 将62例首发精神分裂症患者随机分为齐拉西酮组30例和阿立哌唑组32例,分别口服齐拉西酮与阿立哌唑治疗,观察8周.于治疗前及治疗4周、8周末采用阳性与阴性症状量表评定临床疗效;于治疗前及治疗8周末,采用韦氏记忆量表评定记忆功能.抽取同期健康志愿职工30名设为对照组,于入组时采用韦氏记忆量表评定记忆功能.结果 治疗后两组患者阳性与阴性症状量表总分及各因子分减分率均呈持续性升高,治疗8周末均显著高于治疗4周末(P＜0.01);同期两组间比较差异均无显著性(P＞0.05).治疗前两组患者韦氏记忆量表测评1→100、100→1、积累、再认、联想、理解、背数及记忆商数因子分均显著低于对照组(P＜0.05或0.01);治疗8周末,再认、联想、理解、背数及记忆商数因子分均较治疗前有显著提高(P＜0.05或0.01),但1→100、100→1、积累因子分仍显著低于对照组(P＜0.05或0.01).结论 精神分裂症患者存在明显的认知功能缺陷,齐拉西酮与阿立哌唑在改善精神分裂症患者阳性症状和阴性症状的同时,还能显著改善记忆状况等认知功能,且两药总体效果相当,值得临床推广应用.     

石杉碱甲对慢性精神分裂症记忆障碍的影响

目的 探讨石杉碱甲对慢性精神分裂症记忆障碍的影响.方法 将60例慢性精神分裂症患者随机分为两组,每组30例,研究组口服利培酮联合石杉碱甲治疗,治疗组单用利培酮治疗,观察6个月.于治疗前及治疗6个月末检测事件相关电位P300,采用韦氏记忆量表、韦氏成人智力量表测定认知记忆功能,采用阳性与阴性症状量表评定精神症状.抽取同期正常体检者30名设为对照组,于入组时进行P300及认知记忆功能测定.结果 治疗前研究组和治疗组P300潜伏期延长、波幅降低,与对照组比较差异均有极显著性(P＜0.01);韦氏记忆量表及韦氏成人智力量表测验成绩均显著低于对照组(P＜0.01).治疗6个月末研究组脑诱发电位P300潜伏期缩短,波幅提高,韦氏记忆量表及韦氏成人智力量表测验除背数外各项指标均较治疗前显著提高(P＜0.05或0.01);治疗组治疗后脑诱发电位P300潜伏期、波幅及韦氏记忆量表、韦氏成人智力量表测验与治疗前比较均无显著变化(P＞0.05).研究组治疗后阳性与阴性症状量表总分较治疗前有显著下降(P＜0.01),治疗组总分虽较治疗前有所下降,但差异无显著性(P＞0.05).结论 石杉碱甲能有效改善慢性精神分裂症患者认知记忆功能,对促进患者的全面康复具有显著的增效作用.     

难治性抑郁症患者认知功能与神经内分泌激素相关性研究

目的 探讨难治性抑郁症患者认知功能与神经内分泌激素的相关性.方法 将60例难治性抑郁症患者设为研究组,抽取同期住院的60例非难治性抑郁症患者设为对照组.检测两组血清胰岛素、皮质醇、促肾上腺皮质激素、三碘甲状腺原氨酸、游离三碘甲状腺原氨酸、甲状腺素、游离甲状腺素、促甲状腺激素等神经内分泌激素;采用威斯康星卡片分类测试、韦氏记忆量表、字色干扰实验、连线实验、语言流畅性测试、画钟实验评定两组患者的认知功能,对评定结果进行相关分析.结果 研究组血清胰岛素水平显著低于对照组,促肾上腺皮质激素水平显著高于对照组(P＜0.05或0.01);威斯康星卡片分类测试总应答数、持续错误数、随机错误数显著高于对照组(P＜0.01),正确应答数及韦氏记忆量表图片回忆、视觉再认、视觉再生、触觉因子分,词汇流畅性检测、画钟实验评分均显著低于对照组(P＜0.05或0.01).研究组血清胰岛素水平与威斯康星卡片分类测试正确应答数,韦氏记忆量表记忆商数、图片回忆、视觉再认、视觉再生因子,连线实验A,语言流畅性测试均呈显著正相关(P＜0.05或0.01);与威斯康星卡片分类测试持续错误数、随机错误数呈显著负相关(P＜0.01).皮质醇与威斯康星卡片分类测试持续错误数呈显著正相关(P＜0.05);与总应答数、正确应答数及韦氏记忆量表数字倒数,连线实验,画钟实验呈显著负相关(P＜0.05或0.01).甲状腺素与画钟实验呈显著负相关(P＜0.05).游离甲状腺素与韦氏记忆量表时空定向呈显著正相关(P＜0.05).促甲状腺激素与威斯康星卡片分类测试总应答数、韦氏记忆量表数字倒数语言流畅性测试等呈显著正相关(P＜0.05),与威斯康星卡片分类测试持续错误数、随机错误数呈显著负相关(P＜0.05).结论 难治性抑郁症患者在注意、短时记忆、执行能力等方面的认知功能缺陷更为严重,且与胰岛素等神经内分泌激素水平密切相关.     

认知行为治疗对双相障碍患者认知功能及治疗依从性的影响

目的:探讨认知行为治疗对双相障碍患者认知功能及治疗依从性的影响.方法:将75例双相障碍患者按照治疗方法分为两组,观察组38例,对照组37例.两组均予以常规药物维持治疗,观察组在此基础上联合认知行为治疗,观察12周.于治疗前后采用韦氏成人记忆量表、记忆广度测试、威斯康星卡片分类测验评价认知功能,根据患者遵医行为评定治疗依从性.结果:治疗后两组治疗依从性评分均较治疗前显著降低(P＜0.05或0.01),且治疗12周末观察组显著低于对照组(P＜0.01);观察组韦氏成人记忆量表总分及记忆商数和记忆广度测试的数字广度评分显著高于对照组(P＜0.01),威斯康星卡片分类测验的卡片总数、持续错误数、随机错误数均显著低于对照组(P＜0.01).结论:认知行为治疗能显著改善双相障碍患者的认知功能及治疗依从性.     

原发性甲状腺功能减退患者服用左旋甲状腺素前后心肌酶谱的变化对比研究

目的研究原发性甲状腺功能减退患者服用左旋甲状腺素治疗前后心肌酶谱的变化。方法选取81例原发性甲状腺功能减退患者作为甲减组,均给予左旋甲状腺素钠片治疗6个月;再选取40例健康成人,不做任何治疗,分别检测2组的血清心肌酶谱(包括天冬氨酸转氨酶(AST)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)),甲状腺功能(包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺素(TSH))。结果治疗后甲减组患者FT3、FT4的水平均较治疗前的水平显著升高(P0.05),而甲减组患者的TSH水平较治疗前显著降低(P0.05);治疗后甲减组AST、CK、CK-MB及LDH均较治疗前的水平显著降低(P0.05)。结论心肌酶谱对甲状腺功能减退症患者的诊断治疗具有重要意义,采取左旋甲状腺素治疗可显著改善心肌损伤情况。     

作业疗法改善颅脑损伤患者的记忆功能

目的观察作业疗法中记忆、思维、心理训练颅脑损伤患者的临床过程,探讨作业疗法对改善颅脑损伤患者记忆功能的可能性。方法对43例颅脑损伤患者(损伤组)进行了作业疗法治疗,包括记忆训练、心理和思维训练,训练时间2个月以上,治疗前后用龚耀先修订的韦氏记忆量表(WMS)进行测评,并与29例正常人志愿者(对照组)进行比较。结果除瞬时记忆指标(背数)外,损伤组治疗前WMS分项评分和记忆商(MQ)平均值,治疗组和对照组分别为99±16和168±32,均明显低于对照组(t=1.997～2.994,P<0.05)。损伤组治疗后其余的WMS分项评分和MQ平均值(治疗前和治疗后分别为99±16和144±32)均明显高于治疗前(t=2.046～2.804,P均<0.05)。结论作业疗法改善颅脑损伤患者的长时和短时记忆功能是可能的。     

中度颈动脉狭窄与脑白质疏松对认知功能的影响

目的:研究中度颈动脉狭窄(CAS)与轻度脑白质疏松(LA)对认知功能的影响。方法:选取中度CAS患者25例(CAS组)、中度CAS合并轻度LA患者21例(CAS+LA组)、同期无CAS和LA的患者30例(对照组),均进行简易精神状态评价量表(MMSE)、阿尔茨海默病评价量表-认知分表(ADAS-Cog)第1套、韦氏数字符号转换测验、数字广度顺背、倒背测验、语言流畅性测验、临床痴呆评定量表(CDR)、日常生活能力评定量表(ADL)测试。结果:CAS组及CAS+LA组患者MMSE、韦氏数字符号转换、数字广度顺背、倒背测验、语言流畅性测试等评分均低于对照组,ADSA-Cog评分高于对照组,差异有统计学意义(P<0.05);CAS+LA组与CAS组比较,MMSE、数字广度顺背评分减低,ADAS-cog评分增高,差异有统计学意义(P<0.05)。结论:中度CAS患者出现认知功能障碍;中度CAS与轻度LA合并时,认知功能障碍进一步加重。     

Depression in primary hypothyroidism masquerading as inadequate or excessive L-thyroxine consumption

Depression may occasionally be a presenting feature of primary hypothyroidism but the influence of psychological illness upon L-thyroxine compliance in hypothyroidism has not been specifically addressed. We report six patients with primary hypothyroidism in whom repeated thyroid function tests implied that they were not taking their L-thyroxine as prescribed. The eventual recognition of underlying depression and its treatment led to appropriate treatment with thyroxine as evidenced by clinical euthyroidism and normal thyroid function tests.     

Studies of peripheral thyroxine distribution in thyrotoxicosis and hypothyroidism

Compartmental analysis of the peripheral distribution of labeled thyroxine was applied to various groups of subjects with thyrotoxicosis and hypothyroidism. It was observed that the hepatic incorporation of thyroxine was augmented in subjects with Graves' disease when compared to non-Graves' disease control groups at all levels of thyroid function. Decreased values of hepatic incorporation occurred in primary hypothyroid subjects. These lowered values were not acutely corrected by elevation of the serum thyroxine level, but were observed to be rectified after several months' therapy with exogenous thyroid hormone. These alterations of the hepatic thyroxine-(131)I incorporation were independently verified by direct quantitative liver scintiscan determinations.Employing a dual thyroxine tracer system, we were able to demonstrate that during the early phases of equilibration of a tracer dose of thyroxine, alterations in the rate of deiodination were observed to be present in the various thyroid disease states. Increased deiodination rates were found in subjects with Graves' disease and the reverse was noted in patients with primary hypothyroidism. Kinetic analysis of thyroxine compartmental distribution during this early phase of equilibration of a labeled thyroxine tracer indicated that the primary tissue uptake occurred in the liver. These findings supported the contention that the amount of labeled thyroxine incorporated in the liver may be directly related to the deiodination rate of thyroxine by that organ. The pathogenetic basis of these alterations is presently unknown.     

Practical approach to the treatment of hypothyroidism.

Hypothyroidism most commonly is the result of primary thyroid failure due to autoimmune thyroiditis, but also may follow treated Graves' disease or may occur as transient hypothyroidism. Laboratory evaluation of thyroid function has been refined by the development of ultrasensitive thyroid-stimulating hormone determinations, allowing accurate diagnosis of primary hypothyroidism and assessment of treatment response. Determining whether therapy is appropriate for patients with subclinical hypothyroidism or euthyroid sick syndrome requires clinical judgment in addition to laboratory evaluation. Thyroid hormone replacement for hypothyroidism is best accomplished with levothyroxine. Factors that may affect serum thyroxine levels include thyroid binding globulin levels, drug interactions and variations in thyroxine absorption and clearance.     

Anemia: a cause of intolerance to thyroxine sodium

Usual causes of intolerance to thyroxine sodium include coronary artery disease, advanced age, untreated adrenal insufficiency, and severe hypothyroidism. We describe 4 patients with iron deficiency anemia and primary hypothyroidism. After treatment with thyroxine sodium, these patients developed palpitations and feelings of restlessness, which necessitated discontinuation of the thyroid hormone. After the anemia was treated with ferrous sulfate for 4 to 7 weeks, they were able to tolerate thyroxine sodium therapy. Iron deficiency anemia coexisting with primary hypothyroidism results in a hyperadrenergic state. In such patients, we postulate that thyroid hormone administration causes palpitations, nervousness, and feelings of restlessness. Correction of any existing pronounced anemia in hypothyroid patients who are intolerant to thyroxine sodium therapy may result in tolerance to this agent.     

老年亚临床甲状腺功能减低患者左旋甲状腺素治疗前后甲状腺功能及血脂水平的变化

【目的】探讨老年亚临床甲状腺功能减低（下称甲减）患者左旋甲状腺素治疗前后甲状腺功能及血脂水平的变化。[方法]75例亚临床甲低患者,经左旋甲状腺素治疗,比较治疗前后血清甲状腺三碘原氨酸（FT3）,甲状腺素（FT4）,促甲状腺素（TSH）,甘油三酯（TG）,总胆固醇（TC）,高密度脂蛋白（HDL）,低密度脂蛋白（LDL）变化情况。【结果】左旋甲状腺素治疗后患者甲状腺功能明显改善,LDL、TC水平明显低于治疗前,HDI,水平明显高于治疗前。【结论】对亚临床甲减患者进行替代治疗能使部分患者症状缓解,并能显著降低LDL,TC水平,提高HDL水平。     

原发性甲状腺功能减退症患者的血清肌酐水平和影响因素

  目的  探讨原发性甲状腺功能减退症(甲减)患者血清肌酐(creatinine, Cr)水平变化及其影响因素。  方法  回顾性分析北京协和医院内分泌科2006年1月至2010年12月诊治的27例甲减患者的临床资料, 并根据血清游离甲状腺素(free thyroxine, FT₄)水平将患者分为临床甲减组和亚临床甲减组。使用Cockcroft-Gault公式计算患者肌酐清除率(creatinine clearance rate, CCr)。分析患者血清Cr、尿素氮、CCr与甲状腺功能以及血清肌酸激酶间的关系。  结果  14.8%的患者血清Cr水平超过正常上限。本组患者血清Cr和血清游离三碘甲腺原氨酸(free triiodothyronine, FT₃)(P < 0.001, r=-0.628)、FT4(P=0.016, r=-0.458)间均呈负相关。临床甲减组血清Cr水平明显高于亚临床甲减组[(99.89±28.93)μmol/l比(74.67±8.03)μmol/l, P < 0.01]。而甲状腺激素治疗后, FT₄明显升高(P=0.005), 血清Cr明显降低(P=0.001)。Cr和经对数转换的血清肌酸激酶间呈正相关(P=0.032, r=0.596), CCr和FT₄呈正相关(P=0.043, r=0.527)。  结论  临床上发现血清Cr水平增高的患者应常规筛查甲状腺功能。血清Cr水平的增高与CCr的下降以及肌肉的破坏均有关。甲状腺功能纠正后, 甲减引起的血清Cr水平的增高可恢复正常。     

Depression in Primary Hypothyroidism Masquerading as Inadequate or Excessive L-Thyroxine Consumption

Depression may occasionally be a presenting feature of primaryhypothyroidism but the influence of psychological illness uponL-thyroxine compliance in hypothyroidism has not been specificallyaddressed. We report six patients with primary hypothyroidismin whom repeated thyroid function tests implied that they werenot taking their L-thyroxine as prescribed. The eventual recognitionof underlying depression and its treatment led to appropriatetreatment with thyroxine as evidenced by clinical euthyroidismand normal thyroid function tests.     

甲状腺素治疗妊娠合并甲减患者的临床效果及对FT3、FT4和hs-CRP水平的影响

目的探讨甲状腺素治疗妊娠合并甲减患者的临床效果及对游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和超敏C反应蛋白(hs-CRP)水平的影响。方法选取2018年2月至2019年5月我院收治的160例妊娠合并甲减患者作为研究对象,根据双盲法随机将其分为对照组与试验组,每组80例。对照组未给予甲状腺素治疗,试验组则给予甲状腺素治疗。比较两组的治疗效果。结果试验组的治疗总有效率高于对照组(P<0.05)。治疗4周后,两组的FT3、FT4水平均升高,hs-CRP水平均降低,且试验组优于对照组(P<0.05)。治疗4周后,两组的CK、CK-MB水平均降低,且试验组低于对照组(P<0.05)。试验组的并发症总发生率低于对照组(P<0.05)。结论甲状腺素治疗妊娠合并甲减患者能够改善其甲状腺功能以及心功能,可减少并发症的发生情况,改善母婴结局。     

Short‐term overt hypothyroidism induces discrete diastolic dysfunction in patients treated for differentiated thyroid carcinoma

Background Thyroid hormone has important effects on the cardiovascular system. The consequences of episodes of acute hypothyroidism on cardiac function have been investigated in only a few studies, and their results are inconclusive. Our objective was to investigate the effects of acute hypothyroidism on cardiac function in patients with iatrogenically induced subclinical hyperthyroidism after treatment for differentiated thyroid carcinoma. Material and methods Fourteen patients with a history of differentiated thyroid carcinoma on thyroid‐stimulating hormone (TSH)‐suppressive thyroxine replacement therapy were studied. We assessed cardiac function before, and 1 and 4 weeks after withdrawal of thyroxine substitution. We measured serum levels of free thyroxine, triiodothyronine and TSH and used a new sophisticated Doppler echocardiography technique, tissue Doppler imaging (TDI), to assess detailed and quantitative assessment of systolic and diastolic cardiac function. Echocardiographic parameters in patients were compared to controls. Results Compared to controls, patients had higher left ventricular mass and wall thickness and decreased diastolic function during TSH‐suppressive l ‐thyroxine substitution therapy. Thyroxine withdrawal resulted in a decrease in both early (E) and late (A) diastolic mitral inflow velocities, without impact on E/A ratio. Using TDI, late diastolic velocity (A′) decreased without impact on E′/A′ ratio. Left ventricular dimensions, wall thickness and mass did not change during thyroxine withdrawal. Conclusions Subclinical hyperthyroidism is accompanied by diastolic dysfunction. Subsequent acute hypothyroidism induces only subtle changes in diastolic function.