彩色多普勒超声在Graves''''病诊断中的作用

目的:探讨彩色多普勒超声在Graves’病(又称弥漫性甲状腺肿)诊断中的作用。方法:用能量多普勒超声观察40例Graves’病患者及40例正常对照组双侧甲状腺组织的血液供应及分布情况;用脉冲多普勒测量颈总动脉的收缩期峰值流速(VPS),甲状腺上动脉的收缩期峰值流速(VPS)及阻力指数(RI),测量甲状腺上动脉的内径。结果:Graves’病组甲状腺实质内的血供极为丰富,血流分级以Ⅲ级为主,呈“火海征”,Graves’病组与正常对照组相比有显著性差异,P<0.005。Graves’病组颈总动脉的收缩期峰值流速为(162.1±31.5)cm/s,正常对照组颈总动脉的收缩期峰值流速为(98.2±20.9)cm/s,Graves’病组甲状腺上动脉的收缩期峰值流速(108.7±35.6)cm/s,正常对照组甲状腺上动脉的收缩期峰值流速(42.1±15.1)cm/s,以上各参数Graves’病组甲状腺上动脉的阻力指数为0.55±0.11,正常对照组甲状腺上动脉的阻力指数为0.73±0.19。Graves’病组与正常对照组相比有显著性差异P<0.01。Graves’病组甲状腺上动脉的内径为3.34±1.16mm,正常对照组甲状腺上动脉的内径为1.62±1.24mm。Graves’病组与正常对照组相比有显著性差异P<0.01。结论:彩色多普勒超声在Graves’病诊断中有重要的作用。     

Graves病介入栓塞治疗的病理研究

目的观察Graves病栓塞后的甲状腺组织动态病理变化。方法15例甲状腺动脉150 mm聚乙烯醇（PVA）微粒及平阳霉素栓塞治疗的Graves病患者,于术前、术后7天、3个月、6个月、1年、3年分别行甲状腺穿刺活检,共行44次穿刺活检,其中动脉栓塞术前15例、栓塞术后7天2例、3个月3例、6个月6例、1年5例次、3年13例次。结果栓塞后7天主要表现为凝固性坏死;栓塞后3-6个月表现为纤维组织增生变性和淋巴细胞浸润,滤泡灶性坏死为主;栓塞后1-3年主要表现为间质纤维组织增生明显和滤泡萎缩,部分散在增生滤泡被纤维间质分隔包裹,难以形成腺小叶结构,滤泡周围血管网减少。结论经甲状腺动脉栓塞治疗Graves病,甲状腺组织的病理变化是在栓塞后近期内主要表现为急性缺血坏死,然后表现为持续的慢性炎性破坏、滤泡萎缩、部分滤泡增生被明显增生的纤维组织分隔包裹的变化过程。提示微循环栓塞能肯定地破坏甲状腺组织,达到治疗Graves病较好的疗效。     

Graves病骨生化标志的变化初探

目的 探讨Graves患者骨生化标志的改变。方法 对38例Graves患者进行血AKP、Ca、P、ICTP、DPD、BGP、U-HOP/Cr及BMD测定。结果 Graves组的BMD显著低于正常对照组(P<0.01),Ca、ICTP、DPD、BCP、U-HOP/Cr显著高于对照组,Graves组的BMD与ICTP和DPD,BGP有很好的相关性(r=0.36,r=0527、r=0.401)。结论 Graves组骨吸收增加,骨形成减少。     

Graves病的发病与社会心理因素

对１０７例甲状腺机能亢进症患者和９１名正常人采用艾森克个性问卷及自编社会环境的调查显示：４６．９４％的患者起病前有负性生活事件发生，个性特征甲亢组神经不稳定型及掩饰性评分显著高于正常组，有显著性差异，此结果提示甲亢患者存在明显个性缺陷和负性生活事件，这些因素可作为甲亢发病的一种诱因。     

Clinical and immunological studies on patients with Graves' disease preoperatively treated with corticosteroids and iodides

The purpose of this study was to evaluate the acute effects of corticosteroid and iodide preoperative therapy in patients with Graves' disease in terms of thyroid function and immunological parameters. The above combination was prescribed for 4 patients who had experienced severe side effects from antithyroid drugs (ATD) in order to reduce the possibility of post-thyroidectomy thyroid storm. Corticosteroids were employed daily for four days, and iodides were given daily for two weeks prior to thyroidectomy. The free T₃ values decreased rapidly to euthyroid levels following the administration of both drugs, although the free T₄ values were still much higher than normal in 3 of the 4 patients at the time of surgery. By comparison, 3 of 8 patients treated with ATD also had thyroid hormone levels above normal. Studies of lymphocyte subsets revealed that the percentage of helper T cells was significantly less in the corticosteroidiodide treatment group than in the control and ATD groups. It is thus possible that postoperative thyroid storm might be prevented through corticosteroid-iodide therapy by virtue of the reduction of free T₃ values to within the normal range by the time of surgery. The acute suppression of helper T cells was another result of this form of therapy observed.     

Polymorphisms of tumor necrosis factor receptor 2 are not associated with insulin-dependent diabetes mellitus or Graves' disease

Insulin-dependent diabetes mellitus (IDDM) and Graves' disease (GD) are autoimmune endocrinopathies and associated with distinct HLA-DR and -DQ alleles as well as several tumor necrosis factor a (TNF-α) and β (TNF-β) alleles. TNF-α and TNF-β interact with TNF receptor (TNF-R), of which two subtypes have been described: TNF-R1 and TNF-R2. We investigated TNF-R2 alleles in 90 patients with IDDM, 101 with GD and 70 healthy controls. Genomic DNA was amplified with specific flanking primers for the untranslated 3 region of TNF-R2. SSCP analysis revealed two alleles by different fragment patterns: TNF-R2*1 and TNF-R2*2. Patients with IDDM or Graves' disease and controls did not differ significantly: TNF-R2*1/*1:IDDM(8%)/GD(2%)/KO(4%); TNF-R2*2/*2:IDDM(34%)/GD(48%)/KO(42%), heterozygosity TNF-R2*1/*2:IDDM(58%)/GD(50%)/KO(54%) (IDDM vs KO: P =0.46, χ²=1.57; GD vs KO: P =0.59, χ²=1.05). In conclusion, the studied polymorphism of TNF-R2 was associated with neither IDDM nor GD in a German population.     

Sequential psychological testing during the course of autoimmune hyperthyroidism

Summary Although the psychological disturbances accompanying Graves' disease are well known, the time required for normalisation of these disturbances during antithyroid drug treatment is not known. Therefore sequential psychological testing during the course of Graves' disease was done. There are also contradictory results concerning the possible correlation of neurophysiological and psychological test results during the course of Graves' disease with thyroid hormone values. Finally, psychological disturbances have been proposed as possible etiologic factors in Graves' disease.In our study, a significant decrease in anxiety and irritability could be observed at the time euthyroidism was achieved. Self-evaluations of depressivity, activity, exhaustion, well-being, extraversion, introversion, and the ability to concentrate changed 1 or 2 months after euthyroidism was induced. Similar test results could be observed after induction of euthyroidism by antithyroid drugs and subtotal thyroid resection. Therefore the mode of therapy does not seem to influence the course of normalisation of psychological parameters.In contrast to other investigations there was hardly any correlation between thyroid hormone values and psychological test results or the ability to concentrate. Nontheless, patients with Graves' disease showing high scores for depression and anxiety exhibit abnormal peripheral helper/suppressor T-lymphocyte relations. Furthermore, patients suffering from Graves' disease tend to be more anxious than controls. It remains to be determined whether an increased susceptibility to psychological disturbances has led to these alterations of lymphocyte subsets in Graves' disease patients with severe depression and anxiety.Supported by SFB 258     

Human lymphocyte antigens (HLA) and Graves' disease in Turkey

To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.This study was presented in part at the Annual Meeting of the National Endocrinology and Diabetes Association, Bursa, Turkey, May 25–28, 1992.     

Graves‘甲亢^131I治疗前后TGA,TMA的变化及临床意义

本文对502例Graves'病患者的甲状腺功能及TGA、TMA水平进行了观察,按治疗前TGA、TMA水平分为两组,第一组为阳性组(TGA>30%,TMA>15%),第二组为阴性组。结果显示,阳性组早发甲低率明显高于阴性组(p<0.01),其临床治愈率也高于阴性组(p<0.01);而阴性组治疗后临床症状缓解不全者明显高于阳性组。提示Graves'甲亢~(131)Ⅰ治疗前后,测定TGA、TMA有一定的临床指导意义,对于治疗前设计剂量方案及预测甲低的发生均有一定的参考价值。     

~(131)I治疗Graves’病后发生甲低与TGA,TMA及TRAb的关系

目的 :从甲状腺自身免疫方面探讨1 3 1 I治疗甲亢的效果及甲低发生的因素。方法 :选择1 3 1 I治疗的88例Graves’病甲亢患者随访 3年 ,分为第 1组 (TGA、TMA、TRAb均阳性 )和第二组 (TGA、TMA阴性 ,TRAb阳性 )。采用x2 分析自身抗体水平与甲低发生的关系。结果 :1组甲低发生率为 31 4 % ,2组为 3 8% ,1组明显高于 2组 ,差异有显著性。结论 :TGA、TMA和TRAb水平与确定1 3 1 I剂量及甲低的发生关系密切。认为TGA、TMA水平高的患者应酌情减少1 3 1 I用量