甲状腺自身性免疫与辅助生殖

甲状腺自身抗体可能与流产风险增加有关,但是否存在因果关系及相关机制尚不明确。甲状腺自身性免疫(thyroid autoimmunity,TAI)对辅助生殖结局的影响尚存争议。现有研究表明使用左旋甲状腺素、糖皮质激素、免疫球蛋白等改善TAI女性辅助生殖结局的证据不足,有待进一步研究。未来研究应探索甲状腺自身抗体与不良妊娠之间的因果关系。在研究设计时应考虑到甲状腺自身抗体滴度、不同授精方式、进行新鲜胚胎移植及冻融胚胎移植等因素的影响。需进一步研究卵细胞质内单精子注射/冻融胚胎移植是否更有利于行辅助生殖治疗的TAI女性的妊娠结局。

甲状腺自身抗体阳性对甲状腺功能正常女性冻融胚胎移植妊娠结局的影响

目的探讨甲状腺自身抗体(antithyroid antibody,ATA)阳性对甲状腺功能正常女性行冻融胚胎移植(frozen-thawed embryo transfer,FET)妊娠结局的影响。方法回顾性分析2019年1月至2020年1月在山西医科大学第一医院生殖中心首次接受FET治疗且甲状腺功能正常的437例患者资料,其中ATA阳性者106例(ATA+组),ATA阴性者331例(ATA-组)。比较两组患者一般资料、临床指标的差异,分析ATA对FET妊娠结局的影响。结果两组一般资料比较(移植日内膜厚度、移植日激素水平、移植的优质胚胎个数、胚胎冻存时间等)差异无统计学意义(P>0.05),临床妊娠率、生化妊娠率、流产率、活产率、早产率、低出生体重率(59.2%,4.9%,14.8%,85.2%,25.0%,30.8%vs 49.8%,7.7%,19.3%,80.7%,23.1%,21.5%)比较差异无统计学意义(P>0.05)。结论ATA对甲状腺功能正常患者FET妊娠结局没有显著影响。

Consequences of dysthyroidism on the digestive tract and viscera

Thyroid hormones def ine basal metabolism throughout the body, particularly in the intestine and viscera. Gastrointestinal manifestations of dysthyroidism are numerous and involve all portions of the tract. Thyroid hormone action on motility has been widely studied, but more complex pathophysiologic mechanisms have been indicated by some studies although these are not fully understood. Both thyroid hormone excess and def iciency can have similar digestive manifestations, such as diarrhea, although the mechanism is different in each situation. The liver is the most affected organ in both hypo-and hyperthyroidism. Specifi c digestive diseases may be associated with autoimmune thyroid processes, such as Hashimoto's thyroiditis and Grave's disease. Among them, celiac sprue and primary biliary cirrhosis are the most frequent although a clear common mechanism has never been proven. Overall, thyroid-related digestive manifestations were described decades ago but studies are still needed in order to conf irm old concepts or elucidate undiscovered mechanisms. All practitioners must be aware of digestive symptoms due to dysthyroidism in order to avoid misdiagnosis of rare but potentially lethal situations.

Prevalence of autoantibodies and the risk of autoimmune thyroid disease in children with chronic hepatitis C virus infection treated with interferon-α

AIM： To evaluate the prevalence of autoantibodies in chronic hepatitis C virus （HCV）-infected children focusing on thyroid autoimmunity.METHODS： We investigated the prevalence of autoantibodies in 123 chronic HCV-infected children before, during and after monotherapy with interferon-alpha （IFN-α） or combined treatment with interferon-α or peginterferon-α and ribavirin. Besides antibodies against smooth muscle （SMA）, nuclei （ANA）, and liver/kidney microsomes （1KM）, the incidence of antithyroid peroxidase antibodies as well as thyroid function parameters （TSH, FT3 and FT4） were determined.RESULTS： We found that 8% of children had autoantibodies before treatment. During treatment, 18% of children were found positive for at least one autoantibody; 15.5% of children developed pathologic thyroid values during IFN-α treatment compared to only one child before therapy. Six children had to be substituted while developing laboratory signs of hypothyroidism.CONCLUSION： Our data indicate a strong correlation between interferon-α treatment and autoimmune phenomena, notably the emergence of thyroid antibodies. The fact that some children required hormone replacement underlines the need of close monitoring in particularly those who respond to therapy and have to be treated for more than 6 mo.

Autoimmune thyroid diseases and Helicobacter pylori: The correlation is present only in Graves's disease

AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.

Recurrent Seizures Manifestations in a Case of Congenital Hypoparathyroidism:a Case Report

HYPOPARATHYROIDISM is characterized by hypocalcemia, hyperphosphatemia and low or inappropriately normal levels of parathyroid hormone （PTH）. PTH is a key calcium regulatinghormone essential for calcium homeostasis, vitamin D-dependent calcium absorption, renal calcium reabsorption and renal phosphate clearance. Hypoparathyroidism may be due to congenital or acquired disorders. Causes include autoimmune diseases, genetic abnormalities, destruction or infiltrative disorders of the parathyroid glands.

Clinical Study on Combined Moxibustion and Medication for Hashimoto’s Thyroiditis

Objective： To observe the clinical effect of combined moxibustion and medication for Hashimoto’s thyroiditis. Methods： A total of 85 cases with Hashimoto’s thyroiditis who met the inclusion criteria were randomly allocated into an observation group and a control group. Forty-two cases in the observation group were treated with combined moxibustion with oral Levothyroxine Sodium tablets, whereas 43 cases in the control group were treated with oral Levothyroxine Sodium tablets alone. Then the scores of clinical symptoms and exophthalmos before and after treatment were compared. In addition, the time period for improvement of clinical symptoms in both groups were recorded and compared. Results： After one-month treatment, the scores of clinical symptoms and exophthalmos in the observation group were significantly improved than those in the control group （P0.05）; and it took less time for the cases in the observation group to get improvement compared with the control group. Conclusion： Combined moxibustion and oral Levothyroxine Sodium tablet is an efficient reliable therapy for Hashimoto’s thyroiditis.

Effects of herbal cake-partitioned moxibustion on the expression of thyroid autophagy-related factors LC3B and Beclin-1 in rats with autoimmune thyroiditis

Objective:To observe the anti-inflammatory effect,as well as the effect on the expression of microtubule-associated protein light chain 3B(LC3B)and Beclin-1 of herbal cake-partitioned moxibustion in rats with experimental autoimmune thyroiditis(EAT).Methods:Female Sprague-Dawley rats were randomly divided into a normal group and a modeling group.The EAT rat model was prepared by a combination of antigen immunization plus iodine agent induction.After the model was prepared,rats in the modeling group were randomly and equally divided into a model group and a herbal cake-partitioned moxibustion group.In the herbal cake-partitioned moxibustion group,moxibustion was alternately applied to two groups of points[Dazhui(GV14)-Mingmen(GV4)and Tiantu(CV22)-Guanyuan(CV4)],and the treatment continued for 30 d.Rats in the normal and model groups were only fixed identically without intervention.Histopathological manifestations of thyroid glands were observed by hematoxylin-eosin staining;the concentrations of thyroid peroxidase antibodies(TPOAb),thyroglobulin antibodies(TGAb),interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay;real-time fluorescence quantitative polymerase chain reaction and immunohistochemistry were used to detect the mRNA and protein expression of autophagy-related factors LC3B and Beclin-1 in thyroid tissue.Results:There were massive follicular destruction,lymphocytic infiltration,and interstitial fibrous tissue hyperplasia of the thyroid glands in the model group.Some follicles of the thyroid glands were destroyed with few lymphocyte infiltrations and fibrous tissue hyperplasia in the moxibustion group.Compared with the normal group,the concentrations of serum TPOAb,TGAb,IL-1β,IL-6,and TNF-αwere increased in the model rats(P<0.05);the mRNA and protein expression levels of LC3B and Beclin-1 in thyroid tissue were reduced in the model group(P<0.05).Compared with the model group,the concentrations of serum TPOAb,TGAb,IL-1β,IL-6,and TNF-αwere reduced in the herbal cake-partitioned moxibustion group(P<0.05);the mRNA and protein expression levels of LC3B and Beclin-1 in thyroid tissue were increased in the herbal cake-partitioned moxibustion group(P<0.05).The mRNA and protein expression of LC3B and Beclin-1 in thyroid tissue was negatively correlated with the serum levels of TPOAb and TGAb.Conclusion:Herbal cake-partitioned moxibustion reduces the inflammatory response in the thyroid glands of EAT rats and lowers the levels of serum TPOAb and TGAb.This may be related to the regulation of mRNA and protein expression of the autophagy-associated factors LC3B and Beclin-1 in rat thyroid tissue.