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131I 治疗甲状腺功能亢进症伴2型糖尿病的护理

目的　总结甲状腺功能亢进症（甲亢）合并2 型糖尿病患者的护理方法。 方法　对2008年3月－2011年10月期间核医学科收治的20例经131I治疗的甲亢伴2型糖尿病患者的临床治疗中的护理进行回顾性分析。 结果　通过131I治疗与核医学科专科护理，20例患者中有18例甲状腺功能恢复至正常水平或得到改善，12例空腹血糖水平控制在（6.0 ± 1.2）mmol/L，餐后2 h 血糖水平控制在（7.9 ± 1.7）mmol/L。 结论　核医学科专科护理有助于131I治疗甲亢合并2 型糖尿病患者的病情控制，减少并发症的发生。

Reoperation of Hyperthyroidism (Report of 32 Cases)

选择性血管离断术治疗难控制性甲状腺功能亢进症(附11例报告)

THE CLINICAL FEATURE OF GRAVES’ DISEASE ASSOCIATED WITH THYROID CANCER

From 1972 to 1992, 333 patients underwent operations because of Graves’ disease in our hospital. Histological examination of resected thyroid tissue revealed carcinoma in 8 cases, which accounted for 2.4%(8/333). With reviewing the literatures basing on a lot of literature, we lay emphasis on the clinical feature of the disease, cause of misdiagnosis, and the diagnosis and treatment of the disease are discussed.

The Diagnosis and Treatment of Pulmonary Arterial Hypertension Due to Rare Causes

Objective To investigate the diagnosis and treatment of pulmonary arterial hypertension ( PAH) due to rare causes. Methods The clinical presentation, laboratory testing, diagnosis and treatment of 4 patients with PAH associated with rare causes in Beijing Anzhen Hospital from January 2001 to March 2008 were analysed retrospectively. Results Primary biliary cirrhosis, hyperthyroidism, antiphospholipid syndrome and pulmonary artery sarcoma may cause PAH, which were improved after corresponding diagnosis and management. Conclusion PAH can result from rare causes. The enhancement of its recognition will help earlier diagnosis and treatment and improve the prognosis.

Clinical Features and Treatment Outcomes Analysis of Hyperthyroidism with Hepatic Injury

目的　总结甲状腺功能亢进症（甲亢）并肝损害的临床特征与治疗转归。 方法　回顾性分析2009年6月－2010年6月入院诊治的119例甲亢并肝损害患者（肝损害组）的临床特点与治疗转归资料，并与同期247例甲亢不伴有肝损害患者（无肝损害组）作比较。 结果　肝损害组占同期甲亢患者的30.4%，其中108例（90.8%）无明显肝损害的临床表现，以丙氨酸氨基转移酶和天门冬酸氨基转移酶升高为主，多为轻、中度升高；患者高代谢症候群、突眼、甲状腺肿大发生率及肿大程度明显高于无肝损害组，心率明显快于无肝损害组，血清游离三碘甲状腺原氨酸、游离甲状腺素及吸131I率明显高于无肝损害组，而体质量指数则明显低于无肝损害组（P＜0.05）。两组性别、年龄、病程、甲亢类型、甲状腺球蛋白抗体及甲状腺微粒体抗体滴度差异无统计学意义（P＞0.05）。肝损害组患者随访18个月以上，101例131I治疗患者随着甲亢控制，肝功能恢复正常，未见有再发肝损害；18例抗甲状腺药物治疗，其中10例随着甲亢控制，肝功能逐渐恢复正常；8例随着甲亢控制，肝功能逐渐恢复正常，但随着甲亢复发，再出现肝功能损害。 结论　肝损害是甲亢的常见并发症之一，其肝损害症状较轻，多数患者不典型，但并随甲亢病情较重。护肝治疗结合恰当的抗甲亢治疗预后良好。

Clinical Treatment of Children with Hyperthyroidism

目的 探讨儿童甲状腺功能亢进症的治疗措施及临床效果。 方法 对入选的200例儿童甲状腺功能亢进症患儿给予甲巯咪唑0.5~1.0 mg/(kg•d)、盐酸普萘洛尔0.3 mg/(kg•d)治疗，2~4个月待患儿甲状腺功能基本恢复正常后，将患儿随机分为对照组(n=100)及研究组(n=100)。对照组只给予甲巯咪唑治疗，研究组则继续给予甲巯咪唑并联合左甲状腺素钠治疗。比较治疗前和治疗后6个月、1年及2年患儿甲状腺体积，FT4、FT3和TSH水平，观察治疗后2年不良反应发生情况。 结果 与对照组比较，治疗6个月后研究组甲状腺体积明显降低(Plt;0.05)，药物性甲状腺功能减退症发生率低(Plt;0.05)，不良反应少。 结论 两种治疗措施均能有效改善儿童甲状腺功能亢进症的高代谢症候群，使FT3、FT4及TSH水平恢复正常，甲状腺体积明显降低，但甲巯咪唑联合左甲状腺素钠治疗能更安全有效地控制甲状腺肿大及药物继发性甲状腺功能减退症，并能减少症状复发。

Analysis of Paraoxonase 1 Activity in the Patients with Hyperhyroidism

目的:探讨甲状腺功能亢进症(甲亢)患者血浆对氧磷酯酶1(PON1)活性变化以及与其它氧化应激指标的关系。方法:分别测定50名对照组和78例甲亢组空腹血浆中游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、PON1活性、超氧化物歧化酶(SOD)、丙二醛(MAD)、氧化低密度脂蛋白(ox-LDL)及血脂含量,并进行相关性分析。 结果:甲亢患者血浆PON1活性(139 ±64)kU/L,ox-LDL(598.3±58.6)μg/L,MDA(15.11±3.26) μmol/L及SOD(80.2±25.3)NU/mL。对照组上述指标分别为:PON1(168 ±70)kU/L,ox-LDL (446.2±62.2) μg/L,MDA (10.02±3.00) μmol/L,SOD(92.9±26.9)NU/mL。血浆PON1和SOD活性显著低于对照组(Plt;0.01),ox-LDL和MDA水平显著高于对照组(Plt;0.01)。甲亢患者血浆PON1活性与SOD呈正相关(r=0. 381,Plt; 0.05),与ox-LDL、MDA呈负相关(r=-0. 411,r=-0. 445,Plt; 0.01)。 结论:甲亢患者血浆PON1活性显著降低,可能与氧化应激增强有关。

Clinical Application of Impact Method in Perioperative Management of Hyperthyroidism

目的　探讨冲击法在甲状腺功能亢进症（简称甲亢）围手术期处理中的应用价值。 方法　对2006年2月至2011年1月期间笔者所在医院收治的36例应用传统方法和32例应用冲击法进行围手术期处理的甲亢患者的临床资料进行回顾性分析，比较采用两种不同术前准备方法的患者在住院时间、术后并发症、住院费用及甲状腺激素水平变化的差异。 结果　2组患者手术过程均顺利，术后均未出现窒息、呼吸困难、声嘶、呛咳、甲状腺危象等并发症。术前准备时间、住院时间和住院费用在冲击法组分别是（8.09±1.03） d、（10.69±1.45） d和（2 230.78±220.74）元，传统方法组分别是（15.83±1.61） d、（17.97±1.44） d和（5 549.69±560.55）元，冲击法组明显短于或少于传统方法组（P＜0.05）。在给药后第7天，冲击法组患者的FT3和FRT4水平下降幅度均高于传统方法组（P＜0.05）。 结论　冲击法在甲亢围手术期处理中是安全可靠的，是甲亢的一种快速术前准备方法。

Investigation of Succession Model for Goiter in Iodine Deficiency Area

ObjectiveTo investigate the succession model for hyperthyroidism and thyroid carcinoma secondary to nodular goiter in iodine deficiency area. MethodsA total of 216 specimens of goiter patients from iodine deficiency area were collected in the former 3rd hospital of Norman Bethune Medical College from January 1980 to December 1994. Twentyfour heteroploid samples were selected by the method of Hedley with Flow cytometry (FCM) analysis. Paraffin-embedded tissues from the same position were used to perform immunohistochemical staining for proliferating cell nuclear antigen (PCNA), laminin (LN), factor Ⅷ related antigen (FⅧ-RAg), and p53. The proliferative activity, stroma change, and angiogenesis were observed. ResultsPCNA label index (PCNA-LI) and proliferation index (PI) consistent in 24 heteroploid samples with PCNA staining were significantly higher value. PCNA positive cells were mainly distributed over nonfollicular parenchymatous structures, small follicles, and multilayered structures with large bubbly follicles. Destroyed basement membrane and necrosis were found by LN staining in PCNA positive position with vigorous reproductive capacity. Combining FⅧ-RAg staining with LN staining, interstitial proliferation and angiogenesis were obvious in follicular epithelial cells with vigorous reproductive capacity, providing nutrition and superior environment for them. ConclusionsThe reproduction of thyroid follicular epithelial cells, interstitial proliferation, and angiogenesis are all involved in tuberosis and hyperthyroidism, forming precancerous lesion, which suggest the succession model of goiter in iodine deficiency area.