甲巯咪唑联合普萘洛尔治疗甲亢的临床价值分析

目的:探讨甲巯咪唑联合普萘洛尔治疗甲亢患者的临床应用和疗效。方法:选取我院在2010年1月至2013年1月收治的甲状腺功能亢进症(甲亢)患者63例,随机分为观察组和对照组,对照组单用甲巯咪唑治疗,观察组联合应用甲巯咪唑和普萘洛尔,并比较两组疗效。结果:观察组治疗后的FT3、FT4明显降低,TSH明显升高,总有效率为92.9%,均明显优于对照组,P<0.05;且不良反应发生率明显小于对照组,P<0.05。结论:甲巯咪唑联合普萘洛尔治疗甲亢可更好提高治疗效果,降低不良反应,值得临床推广。     

亚临床甲亢和甲减发病的实验室调查

目的　探讨本地区亚临床甲状腺疾病的发病情况。　方法　随机抽样 2 550例健康体检者作甲状腺功能检测 ,以促甲状腺素 ( TSH)水平异常的检出率来判断亚临床甲状腺疾病的发病率。　结果　亚临床甲亢的检出率为5.4 5% ,亚临床甲减的检出率为 6 .98% ;两种疾病 T3、T4、FT3、 FT4 和 TSH的均数比较具有非常显著性差异 ( P <0 .0 1)。　结论　本地区具有亚临床甲状腺疾病的发病现象 ,亚临床甲减的发病率比亚临床甲亢稍高     

甲亢性肝损害116例临床分析

目的探讨甲状腺功能亢进症（甲亢）肝损害的临床特点。方法收集228例甲亢患者的临床资料,分为肝损害组及无肝损害组,对两组患者的年龄、性别、甲亢病程、肝功能及甲状腺功能等指标进行分析比较。结果 228例甲亢患者中发生肝损害116例,发生率为50.72%。甲亢患者的性别与甲亢性肝损害的发生率无相关性;而年龄越大甲亢性肝损害发生率越高,病程越长甲亢性肝损害发生率也越高。甲亢性肝损害患者甲状腺功能指标TT4、FT3明显高于甲亢肝功能正常的患者,差异有统计学意义（P〈0.05）;肝功能测定以ALT、ALP升高多见。结论甲亢性肝损害的发病率较高,病情的严重程度与年龄、病程、甲状腺激素水平有密切关系;建议临床医生对初诊及复诊甲亢患者进行肝功能常规测定,以便合理选用治疗方案,使甲亢性肝损害得以及早治疗。     

严重贫血患者-过性感染放射状土壤杆菌

放射状土壤杆菌( Agrobacterium radiobacter)是植物致病菌,主要存在于土壤,偶尔从人类标本中分离.1999年9月11日我们自1例贫血患者中分离出1株放射状土壤杆菌,报告如下. 患者,男,76岁,因进行性面色苍白3年、发热半年于1999年9月4日以"贫血查因”入院.体温38℃,血常规:WBC 1.8×109/L,N 0.71,L 0.25,M 0.01,E 0.008,BA 0.015;RBC 1.17×1012/L;HB 33g/L,PLT 56×109/L;尿常规:外观稍混浊,蛋白(++),WBC++/HP.临床诊断为骨髓增生异常综合症:难治性贫血.给予支持疗法、PG治疗.     

肝肾不足型骨质疏松症患者体液免疫水平的变化及骨愈灵的疗效观察

目的：观察肝肾不足型骨质疏松症患者体液免疫水平的变化及骨愈灵的治疗效果。方法：选择2011年3月至2012年6月来我院行治疗的肝肾不足型骨质疏松症患者100例,将其作为研究组另选择同期来我院行健康体检者100例,将其作为对照组。患者在钙剂、降钙素、维生素D等常规药物治疗的基础上给予骨愈灵片,观察两组治疗前后骨密度（BMD）、淋巴细胞亚群、白细胞、免疫球蛋白等变化。结果：与对照组比较,观察组治疗前BMD（0.504±0.054）g/cm2、CD3（55.4±5.6）%、CD4（33.6±1.6）%、CD8（25.2±4.1）%、LYM（2.013±0.412）×109/L、LYM%（28.310±6.354）%、LgG（9.55±0.23）、LgM（1.26±0.05）均降低明显（P〈0.01）,WBC（7.621±1.023）×109/L、NEU（5.023±1.230）×109/L、NEU%（60.321±8.231）%升高（P〈0.01）,观察组BMD、CD3、CD4、CD8、WBC、LYM、LYM%、NEU、NEU%及各免疫指标水平与对照组相当（P〉0.05）。结论：肝肾不足型骨质疏松症患者特异性免疫功能较正常人受到抑制,炎性反应被激活;骨愈灵片能显著提高肝肾不足型骨质疏松症患者的BMD值,增强细胞和体液免疫功能。     

PLT,MPV,PDW对单采血小板产品聚集的影响

目的：探讨血小板含量（PLT）,血小板平均分布宽度（PDW）,血小板平均体积（MPV）对单采血小板聚集的影响,方法：随机抽取68例血小板捐献者,均成功捐献单采血小板,分为聚集组和对照组。献血前抽取静脉血,采用麦道尼克CA620血细胞分析仪进行血细胞分析,检测PLT,MPV,PDW。结果：聚集组（%）PDW 17.5±1.8,高于对照组（%）PDW12.1±0.9（P〈0.05）。聚集组（fl）MPV 11.0±0.9高于对照组（fl）MPV 7.8±0.8（P〈0.05）,差异有统计学意义,聚集组PLT（187±13.3）×109,对照组PLT（195±11.0）×109,二者无明显统计学差异（P〉0.05）。MPV,PDW分别与PLT进行相关性分析,PLT与MPV无显著相关（r=0.132,P〉0.05）;PLT与PDW无显著相关（r=0.147,P〉0.05）。结论：单采血小板产品出现聚集,其捐献者PDW,MPV高于单采产品正常捐献者,与献血者PLT计数无明显关系。     

弥漫性甲状腺肿伴甲亢的遗传度研究

木文对临床已确诊的317例弥漫性甲状腺肿伴甲亢（简称甲亢）患者（男41人,女276人）进行了 一级亲属发病率的调查。同时以民族、年龄、性别和数量均与患者相同的非甲亢患者的一级亲属作为对 照组。研究结果表明,甲亢患者一级亲属的发病率为1.894%,对照组(317人）的一级亲属的发病率为 0.047%。遗传度为69%0     

大剂量丙种球蛋白联合地塞米松治疗重度ITP疗效观察

目的评价大剂量丙种球蛋白联合地塞米松、单独大剂量地塞米松及单独大剂量丙种球蛋白3种方法治疗重度ITP的疗效.方法对人院时PLT≤25×109/L,出血倾向明显的45例患儿随机分成3个组,每组15例.联合组:静滴丙种球蛋白1.0g·kg-1·d-1,连用2天,同时静滴地塞米松1.5mg·kg-1·d-1,连用7天,第7天起口服强的松2mg·kg-1·d-1;地塞米松组:静滴地塞米松1.5mg·kg-1·d-1,连用7天,第7天起口服强的松2mg·kg-1·d-1;丙种球蛋白组:静滴丙种球蛋白1.0g·kg-1·d-1,连用2天.连续监测治疗效果.结果联合组、丙种球蛋白组、地塞米松组使PLT≥50×109/L时间分别为(2.0±1.1)天,(2.8士1.2)天,(3.9士1.3)天;≥100×109/L时间分别为(4.0±1.4)天,(5.2土1.5)天,(6.9±1.7)天;PLT的峰值(×109/L)分别为(368±131),(317±121),(213±76). 结论大剂量丙种球蛋白联合地塞米松静滴治疗重度ITP比单纯用其中任一种药物升高血小板的作用更为显著,迅速.     

参麦注射液对于白血病骨髓抑制期的治疗作用

目的:探讨参麦注射液对于白血病骨髓抑制期的治疗作用。方法:选取我院2011年1月至2012年12月收治的白血病的患者47例,随机分为两组,观察组24例化疗的同时给予参麦注射液,观察组患者23例只给予化疗,比较两组患者化疗后的骨髓抑制情况和感染发生情况。结果:两组患者化疗效果显示总有效率分别为66.7%和65.2%,无显著差别(P0.05)。两组患者化疗骨髓抑制后WBC,Hb,PLT的恢复时间分别为(6.32±2.75)天,(9.32±2.12)天和(7.31±3.21)天,明显低于对照组(11.34±4.34)天,(12.54±3.21)天和(12.41±4.32)天,差异显著有统计学意义(P0.05);观察组患者中性粒细胞ANC0.5×109/L持续的时间明显少于对照组,差异明显有统计学意义(P0.05);观察组患者发生感染的比例明显低于对照组,差异显著有统计学意义(P0.05)。结论:参麦注射液可以明显减轻白血病化疗后的骨髓抑制现象,有效保护骨髓的造血功能,缩短骨髓受抑制时间,和降低感染率,明显提高患者生活质量。     

限制性输血联合高压氧预处理对THA、TKA围术期临床疗效的研究

目的:比较限制性输血联合高压氧预处理(HBOPC)和单纯限制性输血对髋、膝关节置换术(THA、THA)的围术期临床疗效。方法:选择择期在硬膜外麻醉、股神经阻滞下行髋、膝关节置换术患者40例,随机分为两组:限制性输血组(维持80 g/L≤Hb100g/L,n=20)和限制性输血联合HBOPC组(HBOPC+维持80 g/L≤Hb100 g/L,n=20)。比较两组的红细胞输注量、红细胞输注率、围术期Hb、血氧饱和度(SO2)、术中低血压发生率、住院时间以及术后患者脑梗死、急性肺栓塞、肺炎、心肌梗死、伤口感染发生率及90 d死亡率。结果:与限制性输血组比较,联合HBOPC组术后Hb、血氧饱和度(SO2)明显增加(P0.05),红细胞输注量、红细胞输注率、肺炎发生率、伤口感染发生率明显降低(P0.05)。结论:限制性输血联合高压氧预处理可改善髋、膝关节置换术患者缺氧状态、能有效减少红细胞输注、减少术后并发症,具有良好的临床疗效。     

甲状旁腺全切术后一过性甲亢的发生情况及影响因素分析

目的:分析继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者行甲状旁腺切除术(parathyroidectomy,PTX)后一过性甲亢的发生情况及影响因素。方法:选自2018年5月因SHPT连续在我院行PTX的28例患者,手术前后定期复查患者的甲状腺功能,并记录患者手术前后心率及有无心慌不适等症状。结果:纳入患者术前的甲功均正常,术后TSH由术前平均值1.96±0.94μIU/m L降到术后第四天最低平均值0.69±0.91μIU/m L(p=0.000)。术后FT3较术前平均值4.66±1.00 pmol/L升高,最高为术后第一天(12.08±8.57 pmol/L)(p=0.003);术后FT4较术前平均值11.15±2.70 pmol/L升高,最高升到术后第一天(24.09±10.91 pmol/l)(p=0.000)。术后,仅有1例合并一过性甲亢的患者(5.9%)出现严重心悸症状,予口服"β-受体阻滞剂25 mg bid"治疗后症状明显缓解。PTX术后甲状腺机能亢进的发生不受年龄、透析龄等一般情况的影响,但其发生率与SHPT严重程度、手术时间呈明显正相关。结论:SHPT患者行PTX术后一过性甲亢的发生率较高,PTX手术前后应对甲状腺功能进行常规监测。     

继发性甲状旁腺机能亢进患者在血透基础上联用骨化三醇后ALP、iPTH指标变化探究

目的:探讨继发性甲状旁腺机能亢进患者在血透基础上联用骨化三醇后全段甲状旁腺激素(intact parathyroid hormone,i PTH)、碱性磷酸酶(alkaline phosphatase,ALP)指标变化情况。方法:选取我院2019年1月到2019年12月共收治的维持血液性透析继发性甲旁亢患者80例,随机分为两组,每组40例,给予对照组常规治疗方式,给予观察组在血透基础上联用骨化三醇治疗,对比两组的治疗效果、血液相关指标变化以及不良反应的发生情况。结果:对照组治疗总有效率为72.5%,观察组的治疗总有效率为90.0%,观察组明显优于对照组(P<0.05);两组治疗前i PTH、ALP、磷(P)、钙(Ca)无明显差异(P>0.05),治疗后观察组前i PTH、ALP、P、Ca相关血液指标明显优于对照组(P<0.05);对比两组不良反应发现,患者在治疗后不良反应发生率无明显差异(P>0.05)。结论:对继发性甲旁亢患者在血透基础上联用骨化三醇能够提高患者的治疗效果,改善患者相关血液指标情况,而且不良反应发生情况与常规治疗没有明显差异,安全可靠,值得临床应用推广。     

Parameters of the Spinal Dorsal Surface Potential under Conditions of Experimental Hyperthyroidism

On Wistar rats with experimental hyperthyroidism (HTh) and a control group of the rats, we measured the parameters of the components of the spinal dorsal surface potentials (DSP) evoked by stimulation of the corresponding lumbar dorsal roots; the afferent spike (AS), N ₁-N ₃ components, and P wave were examined. After development of HTh, the amplitudes of all DSP components dramatically increased (by a factor from 1.8 to 3.1) with a simultaneous noticeable increase in the thresholds of the AS and N ₁-N ₃ DSP components and a drop in their chronaxia. Under the above conditions, there were no significant changes in the intensity of occlusion and characteristics of the heterosynaptic intersegmental interaction, while the intensity of presynaptic inhibition of the N ₁ DSP component decreased. Possible mechanisms of the observed modifications of the DSP parameters are discussed.     

Evoked Activity of Afferent and Efferent Fibers of the Sciatic Nerve in Rats under Conditions of Experimental Hyperthyroidism

In Wistar albino rats with experimental hyperthyroidism (HTh) and control animals, we measured parameters of the responses evoked in peripheral segments of the ventral and dorsal roots (VR and DR, respectively) by stimulation of the sciatic nerve. We found that the chronaxia of the afferent fibers of the sciatic nerve in HTh animals is shorter, while the duration of the mass action potential (AP) in the DR is somewhat longer than in the control. Under conditions of HTh, the excitation threshold of the efferent fibers became higher, the chronaxia decreased, and the second high-amplitude component could appear in the AP recorded from the VR. Possible mechanisms of changes in the excitability of afferent and efferent fibers of the sciatic nerve and specific features of the AP recorded from the VR under HTh conditions are discussed. In particular, we consider the possibility of ephaptic spreading of excitation in VR fibers under HTh conditions.     

Hyperthyroidism increases adenosine transport and metabolism in the rat heart

Hyperthyroidism induces a number of metabolic and physiological changes in the heart including hypertrophy, increase in inotropic status, and alterations of myocardial energy metabolism. The effects of hyperthyroidism on adenosine metabolism which is intimately involved in the control of many aspects of myocardial energetics, have not been clarified. The aim of this study was thus to evaluate the potential role of adenosine in the altered physiology of the hyperthyroid heart. Transport of adenosine was studied in cardiomyocytes isolated from hyperthyroid and euthyroid rats. Activities of different enzymes of purine metabolism were studied in heart homogenates and concentrations of nucleotide and creatine metabolites were determined in hearts freeze-clampedin situ.Both transport of adenosine into cardiomyocytes and the rate of intracellular phosphorylation were higher in the hyperthyroid rat. At 10 M concentration, adenosine transport rates were 275 and 197 pmol/min/mg protein in hyperthyroid and euthyroid cardiomyocytes respectively whilst rates of adenosine phosphorylation were 250 and 180 pmol/min/mg prot. An even more pronounced difference was observed if values were expressed per number of cells due to cardiomyocyte enlargement. Hyperthyroidism was associated with a 20% increase in adenosine kinase, 30% decrease in membrane 5-nucleotidase and 15% decrease in adenosine deaminase activities measured in heart homogenates. In addition there was a substantial depletion in the total creatine pool from 63.7 to 41.6 mol/g dry wt, a small decrease in the adenylate pool (from 27.2 to 24.3 mol/g dry wt) and an elevation of the guanylate pool (from 1.22 to 1.36).These results show that adenosine transport and phosphorylation capacity is enhanced in hyperthyroidism. These may represent a feedback response to accelerated nucleotide degradation suggested in turn by the decrease in steady-state adenine nucleotide content. The decrease in membrane 5-nucleotidase activity may represent another feature of hypertrophy where the cell surface to cell volume ratio decreases. The decrease of this activity may modify the conversion of extracellular nucleotides to adenosine and consequently reduce endogenous cardioprotection.