新兵结核菌感染情况调查及对策

了解入伍新兵结核杆菌感染状况，为制定有效的控制措施提供依据。1989～1998年，我们对4403名新兵结核菌感染状况进行了初步调查，结果发现新兵结核菌感染有逐年增加的趋势，并提出相应对策。且对象和方法1．l对象4403人中，男2936人，年龄17．25土l．75岁，人伍前未进行人型结核菌素纯蛋白衍生物（PPD）试验，也未接种过卡介苗；女1467人，年龄16．85士25岁，入伍前有57％曾行PPD试验，也接种过卡介苗。1．2方法于前臂掌侧中下1／2处皮内注射PPDO．lml，试剂购自北京生物制品厂，72h后参照截流芬等「”方法观察结果。豆．3X钱和坡商检…     

Graves病患者中与性别相关的临床特点分析

Objective To investigate the gender-related differences in patients with Graves'disease (GD).Methods Seven hundred and eighty-seven consecutive patients with GD treated with anti-thyroid drug in out-patient clinic of department of endocrinology of Chinese PLA general hospital from Oct.2009 to May 2010 were included in the study.The diagnosis of GD WSB made according to common clinical and laboratory criteria.Results (1)In Graves'disease,a marked female preponderance Was found.The female/male ratio was 3.35:1.Female patients with GD presented at a younger age,compared with males[(33.20±13.07 vs 36.75±13.89)year,P=0.002],and the peak incidences of the disease occurred in female and male were 20-29 years and 40-49 years of age respectively.(2)Male patients presented a higher prevalence of weight loss,thyrotoxic cardiopathy,periodic paralysis,and non-invasive ophthalmopathy whereas tachycardia was more common in females.(3)The females presented larger diffuse goiters with higher serum TT4,FT4,and thyrotropin receptor antibody(TRAb)levels.Cases with TRAb>30 U/L were more common in females,whereas those with TRAb 10-30 U/L were frequently seen in males.(4)There was no gender-related difference in the family history of GD.(5)Remission atleast 6 months after anti-thyroid drug therapy in 211 patients,there was a relapse rate of 64.3%(137/211)without gender difference.Conclusion GD appeared at a younger age and with larger diffuse goiters in females,together with more marked elevation of serum TT4,FT4 and TRAb levels.Altogether,these findings depict different patterns for GD in males and females.     

Graves病患者中与性别相关的临床特点分析

目的 分析Graves病患者性别相关的临床特点.方法 收集2009年10月至2010年5月在解放军总医院内分泌科门诊就诊的787例Graves病患者临床资料,并按性别进行对比分析.Graves病诊断标准:甲状腺功能亢进(甲亢)同时具有下述2个或多个特征:弥漫性甲状腺肿、甲亢性突眼和促甲状腺激素受体抗体(TRAb)阳性.结果 (1)787例Graves病患者中女性多见,女:男=3.35:1;女性发病年龄更小[(33.20±13.07对36.75±13.89)岁,P=0.002],高峰年龄段明显提前[(20-29对40-49)岁];(2)Graves病常见或少见症状和体征中,男性患者体重减轻、甲亢性心脏病、周期性麻痹和非浸润性突眼更多见,女性则以窦性心动过速和不伴甲亢性突眼更常见、甲状腺弥漫性肿大程度更明显;(3)女性患者血清TT4、FT4、和TRAb水平明显高于男性,其中TRAb显著升高(>30 U/L)者中女性多见,中度升高(10-30U/L)者中则以男性多见;(4)两性患者甲亢家族史无差异,均以母系家族史多见;(5)甲亢治疗预后(问卷调查)显示211例使用抗甲状腺药物治疗至少6个月并停药的患者中复发率为64.3%(137/211),复发率没有性别差异.结论 Graves病临床特点存在明显的性别差异.

Abstract：

Objective To investigate the gender-related differences in patients with Graves'disease (GD).Methods Seven hundred and eighty-seven consecutive patients with GD treated with anti-thyroid drug in out-patient clinic of department of endocrinology of Chinese PLA general hospital from Oct.2009 to May 2010 were included in the study.The diagnosis of GD WSB made according to common clinical and laboratory criteria.Results (1)In Graves'disease,a marked female preponderance Was found.The female/male ratio was 3.35:1.Female patients with GD presented at a younger age,compared with males[(33.20±13.07 vs 36.75±13.89)year,P=0.002],and the peak incidences of the disease occurred in female and male were 20-29 years and 40-49 years of age respectively.(2)Male patients presented a higher prevalence of weight loss,thyrotoxic cardiopathy,periodic paralysis,and non-invasive ophthalmopathy whereas tachycardia was more common in females.(3)The females presented larger diffuse goiters with higher serum TT4,FT4,and thyrotropin receptor antibody(TRAb)levels.Cases with TRAb>30 U/L were more common in females,whereas those with TRAb 10-30 U/L were frequently seen in males.(4)There was no gender-related difference in the family history of GD.(5)Remission atleast 6 months after anti-thyroid drug therapy in 211 patients,there was a relapse rate of 64.3%(137/211)without gender difference.Conclusion GD appeared at a younger age and with larger diffuse goiters in females,together with more marked elevation of serum TT4,FT4 and TRAb levels.Altogether,these findings depict different patterns for GD in males and females.     

磺脲类药物在特殊人群中的应用

随着病程的延长，2型糖尿病患者不仅存在胰岛B细胞功能逐渐下降．同时对外源性血糖控制手段的依赖性也逐渐增加。磺脲类药物是目前发现最早、使用最广泛的主要口服降糖药物之一。     

Graves病患者中与性别相关的临床特点分析

Objective To investigate the gender-related differences in patients with Graves'disease (GD).Methods Seven hundred and eighty-seven consecutive patients with GD treated with anti-thyroid drug in out-patient clinic of department of endocrinology of Chinese PLA general hospital from Oct.2009 to May 2010 were included in the study.The diagnosis of GD WSB made according to common clinical and laboratory criteria.Results (1)In Graves'disease,a marked female preponderance Was found.The female/male ratio was 3.35:1.Female patients with GD presented at a younger age,compared with males[(33.20±13.07 vs 36.75±13.89)year,P=0.002],and the peak incidences of the disease occurred in female and male were 20-29 years and 40-49 years of age respectively.(2)Male patients presented a higher prevalence of weight loss,thyrotoxic cardiopathy,periodic paralysis,and non-invasive ophthalmopathy whereas tachycardia was more common in females.(3)The females presented larger diffuse goiters with higher serum TT4,FT4,and thyrotropin receptor antibody(TRAb)levels.Cases with TRAb>30 U/L were more common in females,whereas those with TRAb 10-30 U/L were frequently seen in males.(4)There was no gender-related difference in the family history of GD.(5)Remission atleast 6 months after anti-thyroid drug therapy in 211 patients,there was a relapse rate of 64.3%(137/211)without gender difference.Conclusion GD appeared at a younger age and with larger diffuse goiters in females,together with more marked elevation of serum TT4,FT4 and TRAb levels.Altogether,these findings depict different patterns for GD in males and females.     

维持长程腹膜透析治疗的对策

近年来，终末期肾脏病(ESRD)的病人数以每年10％以上的速度增长。终末期肾病的一体化治疗中，因腹膜透析对大、中分子物质清除效果好，对机体内环境影响小，且治疗费用价廉、操作简便，病人可在家中自行透析，故占有极重要的地位。20世纪80年代以来，腹透治疗的病人呈快速增长趋势。     

甲状腺激素不敏感综合征诊疗综述

甲状腺激素不敏感综合征（thyroid hormone insensitivity syndrome，THIS）是机体靶器官、组织对甲状腺激素反应性降低的一类综合征，为罕见的常染色体显性或隐形遗传性疾病。研究发现该疾病与甲状腺激素受体β基因突变有关，由于基因突变程度不同导致临床表现复杂多样，临床上常常被误诊为Graves甲亢、甲减等常见甲状腺疾病，并因不恰当治疗造成病情加重。提高对THIS的认识、掌握规范的诊断方法和合理有效的治疗措施是广大临床医生避免误诊误治的根本。     

促甲状腺激素受体抗体在Graves病中的诊断价值

目的分析不同甲状腺疾病中促甲状腺激素受体抗体(TRAb)的水平及阳性率,探讨TRAb在Graves病中的诊断价值。方法采用酶联免疫分析法(ELISA)检测718例临床诊断的不同甲状腺疾病(298例初诊Graves病、212例原发性甲减、47例甲亢期亚急性甲状腺炎、161例甲状腺结节)患者和73例健康对照者的血清TRAb水平,并计算其阳性率。以Graves病患者和甲亢期亚急性甲状腺炎患者的TRAb作为数据源,采用SPSS 13.0绘制ROC曲线。结果不同甲状腺疾病患者中初诊Graves病患者血清TRAb水平(中位数22.45U/L)明显升高,其余甲状腺疾病组与健康对照组(中位数均为0.3U/L)差异无统计学意义。不同甲状腺疾病患者的血清TRAb阳性率之间差异有统计学意义,其中初诊Graves病患者阳性率最高(93.3%),亚急性甲状腺炎和原发性甲减组(分别为14.9%、11.3%)次之,甲状腺结节组(1.2%)最低,且与健康对照组(1.4%)差异无统计学意义。初诊Graves病患者血清TRAb在各种滴度水平均有分布,其中38.3%的患者明显增高(>30U/L)。亚急性甲状腺炎及原发性甲减也有少数患者血清TRAb明显增高(2.1%和0.5%)。ROC曲线分析显示血清TRAb用于Graves病的诊断有显著意义。Graves病与亚急性甲状腺炎的诊断切点为1.495U/L(敏感性93.9%,特异性85.1%)。在初诊的Graves病患者中,血清TRAb滴度水平与血清过氧化物酶抗体(TPO-Ab)呈正相关(P<0.01),与甲状腺球蛋白抗体(Tg-Ab)无明显相关。结论 ELISA法检测的TRAb主要为刺激性抗体,可用于Graves病和甲亢期亚急性甲状腺炎的鉴别诊断,但其滴度水平处于1.11~13.65U/L时两种疾病重叠较多。     

某部干部乙型肝炎病毒感染情况调查

目的：了解某部干部的乙型肝炎病毒感染情况，为防治乙型肝炎提供依据。方法：采静脉血3ml，分离血清后均用ELISA法检测HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc。结果：HBsAg阳性116例(5．1％)，抗-HBs阳性708例(31．29／6)，HBeAg阳性47例(2．1％)，抗-HBe阳性132例(5．8％)，抗-HBc阳性136例(6．0％)，HBV感染标志阳性299例(13．2%)。HBsAg阳性116例中，合并HBeAg和抗-HBc阳性(“大三阳”)58例(50．0％)；合并抗-HBe和抗-HBc阳性(“小三阳”)30例(25．9%)；合并抗-HBc阳性19例(16．4％)；合并HBeAg阳性4例(3．5％)；HBsAg单项阳性5例(4．3％)。结论：HBV血清学5项(“两对半”)中，除HBeAg阳性率女性显著高于男性外，HBsAg、抗-HBs、抗-HBe和抗-HBc阳性率男性均显著高于女性，“两对半”阳性率有随年龄增长而上升的趋势，其中抗-HBs和抗-HBs上升趋势更为明显。     

重症Graves眼病的治疗——临床内分泌科医师仍面临挑战

Graves眼病是一种器官特异性自身免疫性疾病,成人最常见的眼眶疾病。尽管迄今已有多项基础及临床研究,但其发病机制及有效的治疗措施尚不明确。目前针对重症眼病常用的治疗方法包括静脉糖皮质激素、球后放射治疗以及手术等,但这些均是对症状性治疗,效果并不尽如人意。免疫靶向治疗主要针对Graves眼病发病过程中的诸多靶点,是非常有发展前景的治疗方法,尽管目前临床实践和经验尚有限。无论采取何种治疗手段,戒烟是重症眼病治疗的基础。如何选择最适合于重症眼病的治疗方法并提高其疗效仍是广大临床内分泌医师面临的一项巨大挑战。