Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in a Chinese community-based population of euthyroid people aged 40 years and older

This study investigated whether high-normal thyrotropin（TSH） levels are associated with metabolic syndrome in euthyroid Chinese people≥40 years old.Clinical and metabolic factors were assessed in 2,356 subjects（40-77 years old） with TSH levels in the normal range（0.35-5.00 mU/L）.Using 2.50 mU/L as the cut-off point of TSH level within the normal range,we divided subjects into the high-TSH（2.50-5.00 mU/L;n= 1,064） and low-TSH（0.35-2.50mU/L;n= 1,292） group.The results showed that the mean levels of body mass index（BMI）,total cholesterol（TC）,low density lipoprotein cholesterol（LDL-C）,and fasting plasma glucose（FPG） were higher in the high-TSH group and TSH levels were significantly positively con-elated with BMI,LDL-C,TC,and FPG.The prevalence of central obesity,hypertriglyceridemia,low high density lipoprotein cholesterol（HDL-C）,and high FPG（〉5.60 mmol/L） was significantly higher in females and subjects with high-TSH levels.Metabolic syndrome was also more prevalent in the high-TSH group.People over the age of 40 years with high-normal TSH levels had a 1.2-fold increased risk of metabolic syndrome,compared with those with low-normal TSII levels,after adjusting for age and gender.In conclusion,high normal TSH is a risk factor for metabolic syndrome in people ≥40 years old.

甲状腺功能水平与肌少症相关特征表型的关联

背景:多项观察性研究发现甲状腺功能水平与肌少症之间存在密切关系,但是甲状腺功能水平与肌少症发病之间的因果关系尚不明确。目的:采用两样本孟德尔随机化方法研究甲状腺功能水平与肌少症的因果关系。方法:利用促甲状腺激素、游离三碘甲状腺原氨酸、游离四碘甲状腺原氨酸、亚临床甲状腺功能亢进症、亚临床甲状腺功能减退症和肌少症的4种相关表型——左手握力、右手握力、四肢瘦体质量、步速的全基因组关联研究汇总数据进行两样本孟德尔随机化分析,分别采用逆方差加权法、加权中位数法、简单模式法、加权中值方法和MR-Egger回归法作为分析方法,同时采用异质性检验、多效性检验、MR-PRESSO、留一法、漏斗图等方法进行敏感性分析。结果与结论:促甲状腺激素的增高会增加左手握力(β=0.02,SE=0.01,P=0.01)、右手握力(β=0.02,SE=0.01,P=0.01),游离三碘甲状腺原氨酸的增高会降低左手握力(β=-0.06,SE=0.02,P=9.5×10^(-5))、右手握力(β=-0.07,SE=0.02,P=9.3×10^(-5)),亚临床甲状腺功能亢进症会降低步速(β=-4.4×10^(-3),SE=1.7×10^(-3),P=0.01)。敏感性分析结果与主要分析基本一致。结果表明:促甲状腺激素上升是肌少症保护因素,游离三碘甲状腺原氨酸上升和亚临床甲状腺功能亢进症可能导致肌少症发生风险增加。

A Mother-to-Child Transmission Study in Nigeria:The Impact of Maternal HIV Infection and HAART on Plasma Immunoglobulins,Cytokine Profiles and Infant Outcome

Prevention of mother-to-child transmission(PMTCT)of HIV with highly active antiretroviral therapy(HARRT)allows the HIV^+pregnant mothers to have vaginal delivery and breastfeed.Here we investigated the maternal plasma immunoglobulin,cytokine secretion and the outcome of the exposed infants among the HIV^+HAART treated pregnan women in Nigeria.In this study,different plasma immunoglobulins and cytokines were measured in the HIV^+HAART treated pregnant mothers.Pooled culture supernatants of B and T lymphocytes showed lower levels of IFN-γ,IL-10 and IL-4.There were lower IFN-γand IL-10 secretions at 1st trimester;however,IL-10 continued to be lower throughout 2nd and 3rd trimesters.TNF-αsecretion significantly decreased as pregnancy progressed to term.There were high plasma IgG and low IgM in the HIV^+HAART treated pregnant women.Plasma IgG was high during 1st and 3rd trimesters.After one year of follow up,all the exposed children were seronegative for HIV-1 and HIV-2.Vaginal delivery and breastfeeding among HIV^+HAART treated mothers have shown to be safe.The use of HAART by the infected mothers and the use of septrin and niverapin by the exposed infants prevented mother to-child transmission of HIV.

Relationship between Serum TSH Level with Obesity and NAFLD in Euthyroid Subjects

To explore the relationship between serum thyroid stimulating hormone (TSH) level and obesity and nonalcoholic fatty liver disease (NAFLD) in euthyroid subjects,1322 subjects were sub-jected to a questionnaire survey and physical examination.Fasting blood samples were collected to test serum TSH,plasma glucose and lipids.Fatty liver was diagnosed by type B ultrasonography.The rela-tionship between serum TSH level and body mass index (BMI),percentage of body fat and NAFLD was analyzed.The results showed that serum TSH level was significantly higher in females than in males at the same group,and it was significantly higher in overweight group than in control group.Levels of body weight,BMI,waist circumference and percentage of body fat were increased in TSH >2.5 group compared to TSH ≤2.5 group in women.However,plasma lipids showed no significant differences.In males all the parameters showed no significant differences between two groups.Serum TSH was sig-nificantly correlated with body weight,BMI,waist circumference and percentage of body fat after ad-justment for age in females.Multiple linear regression analysis revealed that percentage of body fat and BMI contributed significantly to the variance of TSH.Serum TSH level was significantly higher in non-alcoholic fatty liver group than in normal group in females.Multiple logistic regression analysis showed that TSH level was not the independent risk factor of NAFLD.Taken together the data suggest that se-rum TSH in normal range is significantly correlated with BMI and percentage of body fat in females.And the change of TSH level would not influence the prevalence of NAFLD.

BRAF V600E/TERT promoter mutations and NIS/TSHR expression in differentiated thyroid carcinomaand their clinical significance

Objective Telomerase reverse transcriptase(TERT) promoter mutations have recently been described in thyroid carcinoma.The purpose of this study was to investigate the clinical significance of(v-raf murine sarcoma viral oncogene homolog B1) BRAF V600 E and TERT promoter mutations in differentiated thyroid carcinoma(DTC).The relationship between the two mutations and NIS/TSHR expression was also analyzed.Methods We have detected BRAF V600 E and TERT promoter mutations by direct sequencing and NIS/TSHR expression by immunohistochemistry in 229 cases of DTC,52 cases of benign nodular goiter,and 31 cases of normal thyroid tissue.Results The BRAF V600 E mutation was detected in 142(62.0%) of 229 cases of DTC [141 cases of papillary thyroid carcinoma(PTC) and 1 case of follicular thyroid carcinoma(FTC)].TERT promoter mutations were detected in 18(7.9%) of 229 cases of DTC(14 cases of PTC and 4 cases of FTC),including the mutations C228T(0.9%) and C250T(7.0%),which were mutually exclusive.Moreover,11(61.1%) cases also harbored the BRAF V600 E mutation,which was not associated with gender,age,tumor size,lymph node metastasis,and recurrence risk stratification(P >0.05).The rate of TERT promoter mutation was higher in males,age ≥45,and in the middle/high-risk group(P <0.05),and the rate of simultaneous BRAF V600 E and TERT promoter mutations were higher in the middle/high-risk group(P <0.05).In addition,NIS positive rate in the concurrent BRAF V600 E and TERT promoter mutation group(45.5 %) was lower than in other groups(that is,the DTC group with BRAF V600 E or TERT promoter mutations(55.1%),the DTC group with no BRAF V600 E or TERT promoter mutation(57.5%),the nodules and normal group(75.9%);| r | = 0.171,P = 0.002).Conclusion TERT promoter mutations were lower in patients with DTC,with the C250 T mutation being the most common.The detection of BRAF V600 E mutation combined with TERT promoter mutations was instructive for the prognosis assessment and treatment of DTC.

Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field

We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment;the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on antiretroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted.

Suicide attempt of an overt hypothyroid patient with levothyroxine:A case report

Rationale: Levothyroxine is the most commonly used agent in thyroid hormone replacement therapy. Although there are many hypothyroid patients who use levothyroxine as a treatment, high level of thyroid stimulating hormone is found in a limited number of levothyroxine overdose cases worldwide.Patient concern: A 34-year-old male patient taking 4.5 mg levothyroxine for suicide. Diagnosis: Overdose of levothyroxine. Interventions: The patient was admitted to the intensive care unit for follow-up treatment. Cardiac rithym and vital parameters of patient were closely monitored. Outcomes: The patient discharged without any life-threatening complications. Lessons: Patient with initial high thyroid stimulating hormone levels may not be in hyperthyroidism crisis by levothyroxine poisoning.

Association of Serum Ferritin Levels and Thyroid Hormones

Thyroid metabolism is orchestrated by the action of various minerals and trace elements including iron, iodine, selenium, and zinc. Iron deficiency, specifically deficiency in serum ferritin levels, is one of the common causes of thyroid dysfunction. Our objective was to evaluate the relationship between serum ferritin levels and circulating thyroid hormones. For this, a retrospective analysis was performed on 16,512 individuals who tested for serum levels of ferritin and thyroid profile at Vibrant America Clinical Laboratories. Subjects were stratified based on the serum levels of ferritin. Age (p −0.03232, p < 0.0001). Analysis of Linear association by Pearson’s correlation exhibited a considerable correlation between varying serum ferritin levels with all tested thyroid hormones. The study concludes that serum ferritin levels were associated with thyroid hormone synthesis and metabolism in individuals with optimal levels of circulating ferritin.

疏肝消瘿方联合穴位敷贴治疗甲状腺结节的临床观察

目的:探讨疏肝消瘿方联合穴位敷贴治疗甲状腺结节的效果及对甲状腺激素、血流阻力指数(RI)、搏动指数(PI)、微血管密度(MVD)影响。方法:选取2022年1月至2023年6月上海交通大学医学院附属第六人民医院收治的甲状腺结节患者80例作为研究对象,按照随机数字表法随机分为对照组与观察组,每组40例。对照组患者给予西医治疗,观察组在对照组基础上,采用疏肝消瘿方联合穴位敷贴治疗。比较2组治疗效果,包括游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)及促甲状腺激素水平(TSH),以及超声指标(RI、PI、MVD)的变化情况。结果:观察组患者治疗有效率为92.50%,显著高于对照组的75.00%(P<0.05),其中医证候积分也明显低于对照组(P<0.05);2组患者治疗前后,FT3和FT4水平差异无统计学意义(P>0.05),TSH水平比治疗前下降,且观察组治疗后TSH水平降低更多(P<0.05);治疗后2组患者RI、PI、MVD值明显低于治疗前(P<0.05),且观察组RI、PI、MVD明显低于对照组(P<0.05)。结论:疏肝消瘿方联合穴位敷贴可以改善甲状腺结节患者中医证候积分,降低TSH表达水平,减少RI、PI、MVD值,效果明显。

甲状腺功能亢进症患者血清神经调节蛋白4水平及其临床意义

目的 探讨甲状腺功能亢进症(甲亢)患者血清神经调节蛋白4(NRG4)水平及其临床意义。方法 选取2019年8月至2021年8月该院收治的69例甲亢患者作为甲亢组,同期收治的57例亚临床甲亢患者作为亚临床甲亢组,同期健康体检者63例为健康对照组。对甲亢患者均给予硫酰胺类药物甲巯咪唑治疗3个月。比较3组促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平;分析甲亢患者治疗前后的TSH、FT3、FT4、NRG4水平变化;评估治疗前血清NRG4辅助诊断甲亢的价值;分析治疗前血清NRG4水平与TSH、FT3、FT4水平的相关性。结果 甲亢组治疗前TSH水平[(0.14±0.03)mU/L]低于亚临床甲亢组[(0.25±0.04)mU/L]、健康对照组[(2.61±0.45)mU/L],甲亢组治疗前FT3、FT4、NRG4水平[(15.54±2.68)pmol/L、(41.36±10.02)pmol/L、(3.42±1.12)ng/mL]高于亚临床甲亢组[(6.25±0.27)pmol/L、(20.34±3.45)pmol/L、(2.61±0.52)ng/mL]、健康对照组[(3.74±0.39)pmol/L、(12.03±2.16)pmol/L、(1.89±0.49)ng/mL],差异均有统计学意义(P<0.05)。甲亢患者FT3、FT4、NRG4水平在治疗1个月[(12.04±2.41)pmol/L、(30.25±7.84)pmol/L、(2.84±0.87)ng/mL]、3个月[(7.65±2.23)pmol/L、(19.63±4.25)pmol/L、(2.37±0.61)ng/mL]时相比治疗前降低(P<0.05),TSH水平在治疗1个月[(0.87±0.21)mU/L]、3个月[(1.42±0.32)mU/L]相比治疗前升高(P<0.05)。受试者工作特征曲线分析结果显示:血清NRG4诊断甲亢的曲线下面积为0.859(95%CI=0.799~0.919,P<0.05),灵敏度为66.7%,特异度为88.9%,最佳临界值为2.39 ng/mL,约登指数为0.556。Pearson相关分析结果显示:NRG4水平与TSH水平呈负相关(r=-0.494,P<0.05),与FT3、FT4水平均呈正相关(r=0.502、0.644,P<0.05)。结论 甲亢患者血清NRG4呈相对高水平,硫酰胺类药物治疗后其水平下降;甲亢患者NRG4水平与甲状腺激素指标水平具有相关性,对甲亢的临床诊治具有辅助评估价值。

孕早期孕妇促甲状腺激素、甲状腺过氧化物酶抗体及微小RNA-873-5p水平与妊娠期糖尿病相关性研究

目的:分析研究孕早期促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)及微小RNA-873-5p(miR-873-5p)水平与妊娠期糖尿病(GDM)的相关性。方法:选取定期产检的GDM孕妇命名为GDM组(n=109),另选同期在本院产检的糖耐量正常孕妇为对照组(n=60)。收集两组孕妇的一般资料及孕早期实验室检测指标(TSH、TPOAb、miR-873-5p),采用单因素、多因素分析TSH、TPOAb、miR-873-5p水平与GDM的关系;并绘制ROC曲线分析血清TSH、TPOAb、miR-873-5p水平对GDM的预测价值。结果:GDM组的血清TSH、TPOAb、miR-873-5p水平均高于对照组,差异具有统计学意义(均P<0.05);多因素Logistic回归分析显示,年龄>30岁(OR=1.982)、孕前BMI≥24 kg/m^(2)(OR=2.020)、TSH升高(OR=2.113)、TPOAb升高(OR=2.307)及miR-873-5p水平升高(OR=2.059)是发生GDM的独立危险因素(均P<0.05);ROC曲线分析显示,血清TSH、TPOAb、miR-873-5p及联合检测的曲线下面积(AUC)分别为0.830、0.829、0.762、0.936,联合检测优于单一检测(P<0.05)。结论:TSH、TPOAb及miR-873-5p在GDM孕妇体内呈高表达,可能成为GDM发生的辅助预测指标。

甲状腺功能正常的2型糖尿病患者促甲状腺激素与代谢相关性脂肪肝的相关性研究

目的研究甲状腺功能正常的2型糖尿病(T2DM)患者促甲状腺激素(TSH)水平与代谢相关脂肪性肝病(MAFLD)的相关性。方法回顾分析我院内分泌科收治的甲状腺功能正常的T2DM患者1888例,根据是否合并MAFLD将其分为MAFLD组(1150例)和无MAFLD组(738例);依据TSH水平将所有患者进行四分位数分组(Q1~Q4组)。收集所有患者一般临床资料资料[年龄、性别、病程、BMI、腰围、MAFLD患病率、收缩压(SBP)和舒张压(DBP)]与实验室检查结果[ALT、AST、空腹葡萄糖(FPG)、血肌酐(SCr)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT_(4))、促甲状腺素(TSH)]并分组比较;采用多因素logistic回归分析评估甲状腺功能正常T2DM患者发生MAFLD的相关因素。结果MAFLD患病率为60.91%。MAFLD组BMI、腰围、ALT、AST、TG、LDL-C、TSH水平均显著高于无MAFLD组,FT3、FT_(4)及HDL-C水平均显著低于无MAFLD组(P<0.05)。Q1、Q2、Q3、Q4组MAFLD患病率依次升高;组间比较BMI、腰围、TG、HDL-C、FT_(4)水平差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,腰围、TG、TSH均是甲状腺功能正常T2DM患者发生MAFLD的独立危险因素,HDL-C是其保护因素(P<0.05)。结论甲状腺功能正常的T2DM患者TSH水平升高与MAFLD患病率相关。

Optimal Threshold of Stimulated Serum Thyroglobulin Level for ^(18)F-FDG PET/CT imaging in Patients with Thyroid Cancer

This study was to explore the optimal threshold of thyroid-stimulating hormone(TSH)-stimulated serum thyroglobulin(s-Tg) for patients who were to receive18F-fluorodeoxyglucose(18F-FDG) PET/CT scan owing to clinical suspicion of differentiated thyroid cancer(DTC) recurrence but negative post-therapeutic 131I whole-body scan(131I-WBS). A total of 60 qualified patients underwent PET/CT scanning from October 2010 to July 2014. The receiver operating characteristic(ROC) curve analyses showed that s-Tg levels over 49 μg/L led to the highest diagnostic accuracy of PET/CT to detect recurrence, with a sensitivity of 89.5% and a specificity of 90.9%. Besides, bivariate correlation analysis showed positive correlation between s-Tg levels and the maximum standardized uptake values(SUVmax) of18F-FDG in patients with positive PET/CT scanning, suggesting a significant influence of TSH both on Tg release and uptake of18F-FDG. So, positive PET/CT imaging is expected when patients have negative 131I-WBS but s-Tg levels over 49 μg/L.

^(131)I+TSH抑制治疗对分化型甲状腺癌术后患者甲状腺功能、免疫功能及复发转移的影响

目的研究分化型甲状腺癌(DTC)术后采用^(131)I+促甲状腺激素(TSH)抑制治疗的临床疗效及对患者甲状腺功能、免疫功能及复发转移的影响。方法回顾性选取2018年1月至2019年12月于该院就诊并接受治疗的97例DTC患者为研究对象,根据术后治疗方案不同分为对照组57例(采用TSH抑制治疗)和观察组40例(在对照组基础上联合^(131)I治疗)。观察两组清除残余甲状腺组织(清甲)的效果,以及甲状腺功能指标[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)及甲状腺球蛋白(Tg)]、甲状腺抗体指标[促甲状腺素受体抗体(TRAb)、甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb)]水平和免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞细胞亚群比例)变化。随访统计两组术后1、3年复发和转移情况。结果观察组完全清除率为72.5%,明显高于对照组的52.6%,差异有统计学意义(P<0.05)。治疗后,两组FT3、FT4水平明显升高(P<0.05),TSH和Tg水平明显降低(P<0.05);治疗后,观察组FT3、FT4、TSH水平与对照组比较,差异无统计学意义(P>0.05),Tg水平显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组TRAb、TgAb、TPOAb水平及CD8^(+)比例较治疗前明显降低,CD3^(+)、CD4^(+)比例较治疗前明显升高,且观察组水平优于对照组,差异有统计学意义(P<0.05)。观察组术后1、3年复发率分别为0、7.5%,转移率分别为2.5%、10.0%;对照组术后1、3年复发率分别为14.4%、22.8%,转移率分别为15.8%、28.1%,两组比较,差异均有统计学意义(P<0.05)。结论^(131)I+TSH抑制治疗能够提高清甲效果,降低TSH、Tg水平,维持甲状腺功能及改善患者免疫功能,抑制肿瘤复发、转移,提高患者预后。

不同剂量丙戊酸钠对双相情感障碍患者血清促甲状腺激素、泌乳素及多巴胺水平的影响

目的探讨不同剂量丙戊酸钠对双相情感障碍(BPD)患者血清促甲状腺激素(TSH)、泌乳素(PRL)及多巴胺(DA)水平的影响。方法选择2020年5月至2022年5月接受治疗的90例BPD患者为研究对象,随机数字表法分为A、B、C三组,均为30例,A、B、C三组每天分别口服10、15、20 mg/kg丙戊酸钠。比较3组临床疗效、治疗前后各项精神疾病评分、血药浓度相关指标、治疗前后血清水平、肝功能相关指标以及不良反应发生率。结果3组治疗后总有效率差异无统计学意义(P>0.05);治疗后3组各项评分相较于治疗前显著性改善(P<0.05);3组达稳态血药浓度谷值时间比较差异有统计学意义(P<0.05);治疗后3组TSH、PRL及DA水平相较于治疗前差异无统计学意义(P>0.05);治疗后3组ALT、AST水平相较于治疗前均有所上升(P<0.05),治疗后3组ALT、AST水平比较差异有统计学意义(P<0.05);3组不良反应发生率比较差异有统计学意义(P<0.05)。结论丙戊酸钠可有效治疗BPD患者,缓解狂躁或抑郁程度,对TSH、PRL及DA水平无明显影响,其中小剂量丙戊酸钠在保证治疗效果的同时对肝功能的影响较小,且不良反应更少,安全性高,值得临床推广。

新生儿足跟血TSH初筛阳性的危险因素研究

目的探讨新生儿足跟血促甲状腺激素(TSH)初筛阳性的危险因素。方法选取2020年5月至2022年5月于该院分娩的562例新生儿为研究对象。其中TSH阳性患儿纳入TSH阳性组,TSH阴性患儿纳入健康组。比较两组一般资料(包括性别、胎龄、分娩时间、出生体质量)及母体临床特征[有无妊娠期贫血、血红蛋白水平、有无妊娠期糖尿病、空腹血糖(FBG)水平、有无甲状腺功能减退、有无甲状腺功能亢进和TSH水平、游离三碘甲状腺原氨酸(FT_(3))水平、游离甲状腺素(FT_(4))水平]。采取非条件Logistic逐步回归分析新生儿足跟血TSH初筛阳性的危险因素。绘制受试者工作特征(ROC)曲线分析母体TSH、FT_(3)、FT_(4)对新生儿足跟血TSH初筛阳性的诊断效能。结果TSH初筛结果显示,足跟血TSH初筛阳性共17例(TSH阳性组),另选100例足跟血TSH初筛阴性新生儿为健康组。两组性别、胎龄、分娩时间、母体妊娠期贫血比例、母体血红蛋白水平、母体妊娠期糖尿病比例、母体FBG水平、母体甲状腺功能亢进症比例比较,差异均无统计学意义(P>0.05)。TSH阳性组低体质量新生儿比例、母体甲状腺功能减退比例、母体TSH水平显著高于健康组,母体FT_(3)、母体FT_(4)水平显著低于健康组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,出生低体质量、母体甲状腺功能减退、母体TSH水平升高、母体FT_(3)水平降低、母体FT_(4)水平降低是新生儿足跟血TSH初筛阳性的危险因素(P<0.05)。ROC曲线结果显示,母体TSH、FT_(3)、FT_(4)诊断新生儿足跟血TSH初筛阳性的曲线下面积分别为0.713、0.718、0.661。结论出生低体质量、母体甲状腺功能减退、母体TSH水平升高、母体FT_(3)水平降低、母体FT_(4)水平降低是新生儿足跟血TSH初筛阳性的危险因素,在筛查时需给予更多关注。

高灵敏化学发光法特异性检测人血清促甲状腺激素方法的建立

目的 通过双位点夹心化学发光免疫分析原理,建立一种高灵敏度测定人血清促甲状腺激素(thyroid stimulating hormone, TSH)的化学发光免疫分析方法。方法 将样本与预包被有抗促甲状腺激素(TSH)抗体的超顺磁珠,以及抗TSH-碱性磷酸结合物添加到反应管中共孵育,待测样本中的TSH通过夹心法与磁珠和抗TSH-碱性磷酸结合物与形成双位点复合物。与磁珠结合的复合物吸附到磁场上,用缓冲液洗去未结合的物质。加入发光底物3-(2-螺旋金刚烷)-4-甲氧基-4-(3-磷氧酰)-苯基-1,2-二氧环乙烷二钠盐[3-(2-spiroadamantane)-4-methoxy-4-(3-phosphoryloxy)-phenyl-1,2-dioxetane, AMPPD],测定相对光子强度(RLU),通过标准曲线计算待测样本中TSH的浓度。结果 本研究建立的TSH检测方法,最低检测限为0.003μIU/mL,批内CV小于1%,总CV小于3%,正确度样本实测值与靶值之间相对偏差均在±12.5%范围内,线性范围为0.005~100μIU/mL且相关系数(r)高于0.9900。开封稳定性试验的相对偏差<10%。结论 该方法检测血清TSH浓度具有灵敏度高、准确性好、线性范围广、稳定性强的优点,各项指标均达到临床检测要求,可以推广使用。

成都市郫都区人群TSH参考区间的建立及验证

目的采用间接法建立适用于成都市郫都区人群的性别、年龄特异的促甲状腺激素(TSH)参考区间。方法收集2022年3月至2023年8月成都市郫都区中医医院37514例患者的TSH数据,根据筛选标准对数据进行删减,采用偏度-峰度法进行正态性检验,Turkey法剔除离群值。不同性别和年龄TSH水平比较分别采用Mann-Whitney U检验、Kruskal-Wallis H检验。应用非参数法建立TSH参考区间,并采用2种方法验证其可靠性,当其与试剂说明书参考区间的相对偏差小于参考变化值(RCV)或用于验证人群时>90%的TSH结果在参考区间内,则证明结果可靠。结果共纳入25761例患者的有效TSH数据,男9363例,女16398例。按年龄段将其分为8个亚组,即10~<18、18~30、>30~40、>40~50、>50~60、>60~70、>70~80、>80~90岁,男性TSH参考区间依次为0.457~4.884、0.465~4.229、0.445~4.918、0.457~4.826、0.471~5.160、0.425~5.477、0.456~5.645、0.465~6.418μIU/mL,女性TSH参考区间依次为0.546~5.196、0.592~5.499、0.606~5.815、0.549~5.915、0.527~6.099、0.457~5.927、0.435~6.078、0.415~6.321μIU/mL。参考区间上限、下限与试剂说明书的相对偏差均小于RCV(49.85%);在用于验证人群时,各组均有大于90%的TSH结果在参考区间内。结论采用间接法建立了性别和年龄特异的成都市郫都区人群TSH参考区间,可为甲状腺疾病的精准诊疗提供参考依据。

术前血清TG/TSH水平预测甲状腺癌根治术后复发风险的价值

目的探讨术前血清甲状腺球蛋白(TG)/促甲状腺激素(TSH)水平预测甲状腺癌根治术后复发风险的价值。方法回顾性分析2021年3月至2023年3月本院接受甲状腺癌根治术治疗的110例甲状腺癌患者临床资料,根据随访结果分为复发组(n=27)和未复发组(n=83)。比较两组一般资料、血清TG、TSH及TG/TSH水平。采用多因素Logistic回归分析甲状腺癌根治术后复发的影响因素并通过ROC曲线分析血清TG、TG/TSH水平预测甲状腺癌根治术后复发的价值。结果两组临床分期Ⅱ期占比、淋巴转移占比及TG、TG/TSH水平比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示临床分期Ⅱ期占比、淋巴转移占比及TG、TG/TSH水平为甲状腺癌根治术后复发的影响因素(P<0.05);TG、TG/TSH水平预测甲状腺癌根治术后复发情况的曲线下面积分别为0.745、0.892(P<0.05)。结论影响甲状腺癌根治术后复发的因素较多,包括临床分期、淋巴转移占比及TG、TG/TSH水平,患者术前TG、TG/TSH水平越高患者复发风险越高。

超声AI、弹性应变率及TSH检测在甲状腺结节良恶性鉴别中的应用研究

目的探讨超声人工智能(AI)、弹性应变率及促甲状腺激素(TSH)检测在甲状腺结节良恶性鉴别中的应用价值。方法本研究为回顾性研究,选取2022年1月至2024年2月延安市人民医院收治的甲状腺结节患者168例为研究对象,根据临床病理学检查结果分为良性组(n=106)和恶性组(n=62)。两组患者均行超声AI、弹性应变率及TSH检测。记录患者的病理检查结果,并以此为金标准,计算超声AI诊断结果、弹性应变率诊断结果、TSH水平诊断结果诊断甲状腺结节良恶性的特异度、灵敏度、误诊率、漏诊率,比较两组患者的TSH水平,采用受试者操作特征(ROC)曲线分析不同检查方法及联合检查的诊断效能。结果168例甲状腺结节患者中,共有206个甲状腺结节;经病理组织检查,良性组中20例淋巴细胞性甲状腺炎,28例增生性结节,58例甲状腺腺瘤;恶性组中52例甲状腺乳头癌,9例滤泡状癌,1例未分化癌。超声AI的诊断结果与病理检查结果比较,其灵敏度为90.32%,特异度为80.19%,漏诊率为9.68%,误诊率为19.81%。弹性应变率诊断结果与病理检查结果比较,其灵敏度为87.10%,特异度为87.74%,漏诊率为12.90%,误诊率为12.26%。恶性组患者的TSH水平为(2.54±0.52)mIU/L,显著高于良性组[(1.34±0.45)mIU/L],差异有统计学意义(P<0.05)。TSH诊断结果与病理检查结果比较,其灵敏度为88.71%,特异度为89.62%,漏诊率为11.29%,误诊率为10.38%。超声AI、弹性应变率、TSH及其联合诊断甲状腺结节良恶性的曲线下面积(AUC)值为0.809、0.824、0.841、0.903。结论超声AI、弹性应变率及TSH水平检测对于甲状腺结节良恶性诊断的效能较高,其中联合检测的应用价值更高。