补体C3、补体C4联合甲状腺自身抗体检测对桥本甲状腺炎诊断和预后的意义

目的探讨补体C3、补体c4、抗甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体刺激抗体（TSAb）检测对桥本甲状腺炎（HT）的诊断价值和病情发展判定的意义。方法选择HT患者120例作为HT组,同期就诊的Graves病患者110例作为Graves’病组,30例健康体检者作为对照组。3组患者分别检测补体C3、补体C4、TGAb、TPOAb和TSAb,并进行比较。结果HT组和Graves病组TGAb、TPOAb和TSAb水平和阳性率较对照组明显升高,HT组TGAb和TPOAb的水平和阳性率升高较Graves病组升高更为明显,而TSAb的水平和阳性率Graves病组较HT组更为明显。HT组的补体C3和补体C4水平较对照组和Graves病组明显降低,而对照组和Graves病组无显著性差异。HT组中甲减亚组补体C3和补体C4水平的变化较甲功正常亚组和甲功亢进亚组明显降低。结论HT是最常见的自身免疫性甲状腺疾病之一,因其血清学诊断标准不具特异性,联合检测补体C3、补体C4和甲状腺自身抗体对提高HT的临床诊断以及判断病情发展具有较重要的临床意义。     

不同接触途径所致急性亚急性汞中毒的分析研究

目的 研究不同接触途径所致急性、亚急性汞中毒的临床特点。方法将33例患者按汞进入体内途径的不同分为3组,即皮肤吸收组、呼吸道吸收组和消化道吸收组,分析其临床特点。结果急性汞中毒以周身中毒症状、口腔-牙龈炎症状及胃肠道症状为著,部分病人可有皮疹、呼吸道及肾脏受累;而神经．精神症状和震颤多不明显。3种不同接触途径所致中毒其临床表现各有特点,如皮肤接触起病者,以亚急性为主,皮疹较为突出;消化道吸收者急性起病,胃肠道症状较明显;呼吸道吸收者多急性起病,呼吸系统症状较突出等。结论3种不同接触途径所致中毒有许多共同点,但又有各自特点。     

自体免疫性甲状腺炎在上海地区的人群患病情况及其诊断标准探讨

代表自体免疫的自家抗体:抗甲状腺微粒体抗体(TMA)及抗甲状腺球蛋白抗体(TGA)在自体免疫性甲状腺炎(AIT)中的阳性率可达95％以上。作者对364例经穿刺证实之AIT患者分析,结合1978年Yoshida等70例尸检资料,认为凡有上述二抗体之一阳性,不论水平高低,在排除少数几种也可有抗体阳性但具有临床典型表现而易于鉴别的其他甲状腺病,本病诊断即可成立。据此诊断标准,对5000余人进行普查,发现上海地区的一般人群AIT患病率为5.2％。     

INCREASE IN PERIPHERAL NATURAL KILLER CELL ACTIVITY IN PATIENTS WITH AUTOIMMUNE THYROID DISEASE

Changes in the activity and number of natural killer (NK) cells in peripheral blood in patients with autoimmune thyroid disease were examined. NK activity was measured in a 4-hr ⁵¹Cr-release assay and the number of NK cells was analyzed with FITC-conjugated monoclonal antibodies by use of an automated flow cytometer. NK activity in patients with untreated Graves' disease (n=25, 39.7+13.5%, P<0.05) and Hashimoto's thyroiditis (n=18, 41.0±14.2%, P<0.05) was high compared to the activity in non-pregnant controls (n=61, 32.6±15.0%). NK activity in patients with postpartum Graves' thyrotoxicosis (n=11, 48.6±18.9%) was markedly increased compared to the activity in non-pregnant controls (P<0.01) and in postpartum controls (n=29, 33.8±15.2%, P<0.05), although the mean ages of each group did not differ significantly. Moreover, NK activities in the thyrotoxic state were significantly higher than those in the euthyroid state in the same patients with postpartum Graves' thyrotoxicosis or with postpartum destructive thyrotoxicosis. The number of CD16 positive cells increased in patients with postpartum Graves' thyrotoxicosis. However the number of CD 16 and CD57 positive cells were normal in all other groups of patients. These results indicate that an increase of NK activity is associated with exacerbation of autoimmune thyroid disease both in Hashimoto's thyroiditis and in Graves' disease and suggest that NK cells might have an important role for the control of disease activity in autoimmune thyroid disease.     

MHC Restricted Recognition by Cloned T Cells

The critical role of major histocompatibility complex (MHC) gene products in T cell activation was appreciated and extensively studied well before the availability of monoclonal T cell populations. However, the availability of cloned T cells has dramatically enhanced the ability to characterize the nature of MHC-restricted recognition by T cells. In certain areas, the use of monoclonal T cells has allowed substantial extension of principles already established through the use of heterogeneous T cells. In other cases, studies employing T cell clones have led to findings which were inaccessible to approaches using only heterogeneous T cell populations. On balance, it should also be pointed out that a significant number of critical questions concerning the MHC-restricted T cell repertoire remain best approached by studying the development of interactions of functionally heterogeneous T cell populations. The present review will focus upon recent progress in several areas in which the use of cloned T cells has been particularly important in characterizing the nature of MHC-restricted recognition. In particular, the restriction of T cell recognition by class II MHC products (Ia) is examined in detail.     

桥本甲状腺炎的免疫治疗现状及展望

桥本甲状腺炎是一种器官特异性免疫疾病,属于自身免疫性甲状腺病的一种,其发病率逐年升高,是原发性甲状腺功能减退症的主要原因之一,其发病机制尚不明确,目前治疗方案主要为甲状腺激素替代及对症治疗,但其并不能遏制疾病本身进展,最终导致永久性甲状腺功能减退。一些学者在不断尝试免疫治疗、基因治疗等方法,以期达到病因治疗,从而阻止其对机体的进一步损伤亦或治愈本病。随着检测技术的不断发展,病因治疗将成为今后学者的研究方向。     

Hashimoto’s thyroiditis: TGAb,TPOAb, TRAb and recovery from hypothyroidism

Hashimoto described four patients with goiter. The histology of the goiter was characterized by diffuse lymphocytic infiltration, fibrosis and epithelial cell destruction. Thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) have been used to diagnose Hashimoto’s thyroiditis. Patients with positive TGAb and/or TPOAb have been assumed to have Hashimoto’s thyroiditis. Approximately 10% of those with positive TGAb and/or TPOAb have hypothyroidism. There are two types of autoimmune thyroiditis: goitrous Hashimoto’s thyroiditis and atrophic thyroiditis. The latter patients have blocking antibody (thyroid-stimulating hormone [TSH]-stimulation blocking antibody [TSBAb]). TSBAb is a TSH-receptor antibody (TRAb). TSBAb causes thyroid atrophy and hypothyroidism. TGAb and/or TPOAb do not necessarily cause hypothyroidism. Hypothyroid patients with Hashimoto’s thyroiditis usually receive life-long l-thyroxine therapy. However, spontaneous recovery from hypothyroidism has been reported. Patients who had Hashimoto’s hypothyroidism and then Graves’ hyperthyroidism (and vice versa), have also been reported. Hashimoto’s hypothyroidism and Graves’ hyperthyroidism could be the opposite spectrums of one disease.