Edible mushrooms as a potent therapeutics of subclinical thyroid dysfunction among adults,especially in obese individuals:a prospective cohort study

Background:Mushrooms are a good source of many nutrients which are potentially beneficial for chronic diseases.We speculated that due to its abundant nutrients edible mushrooms might have a beneficial effect on the prevention of subclinical thyroid dysfunction(SCTD).Therefore,we designed a large-scale cohort study to examine whether mushrooms consumption is a protective factor for SCTD in adults.Methods:This prospective cohort study investigated 6631 participants(mean age:(45.0±10.2)years;55.1%men).Edible mushrooms consumption was measured at baseline using a validated food frequency questionnaire.SCTD was defined as abnormal serum thyroid-stimulating hormone levels and normal free thyroxine.Cox proportional hazards regression models were used to examine the association of edible mushrooms consumption with incident SCTD.Results:During follow-up period,a total of 262 new cases of SCTD were identified,the incidence rate of subclinical hypothyroidism was 8.9/1000 person-years and subclinical hyperthyroidism was 7.2/1000 person-years.After adjusting potential confounding factors,the multivariable hazard ratios(95%confidence intervals)for subclinical hypothyroidism were 1.00(reference)for almost never,0.53(0.29,0.97)for 1-3 times/week and 0.30(0.10,0.87)for≥4 times/week(P for trend=0.02).It also showed edible mushrooms consumption was inversely associated with subclinical hypothyroidism in obese individuals but not non-obese individuals,the final hazard ratios(95%confidence intervals)were 0.14(0.03,0.73)(P for trend<0.01).Conclusions:This population-based prospective cohort study has firstly demonstrated that higher edible mushrooms consumption was significantly associated with lower incidence of subclinical hypothyroidism among general adult population,especially in obese individuals.

Non-alcoholic fatty liver disease and thyroid dysfunction:A systematic review

Thyroid hormones are totally involved in the regulation of body weight, lipid metabolism, and insulin resistance. Therefore it is anticipated that thyroid hormones may have a role in the pathogenesis of non alcoholic fatty liver disease(NAFLD) and non alcoholic steatohepatitis(NASH). In this study, we reviewed the current literature on the association between thyroid dysfunction and NAFLD/NASH. A search for English language medical literature reporting an association between thyroid dysfunction and NAFLD/NASH in humans was conducted across PubMed, ISI Web of Science, and Scopus in August, 2013. Out of 140 studies initially identified through the search, 11 relevant articles were included in the final review. Thyroid dysfunctions in the form of overt or subclinical hypothyroidism are prevalent among patients with NAFLD/NASH. Hypothyroidism appears to be an independent risk factor for NAFLD/NASH in some studies; however, other newly published studies failed to find such anassociation. The results of the studies on the role of thyroid abnormalities in NAFLD/NASH are inconsistent, and further research is recommended to determine the relationship between hypothyroidism and NAFLD/NASH and the underlying mechanisms.

Thyroid dysfunction in Chinese hepatitis C patients: Prevalence and correlation with TPOAb and CXCL10

AIM: To investigate the relationship among pretreatment serum CXC chemokine ligand 10(CXCL10),thyroid peroxidase antibody(TPOAb) levels and thyroid dysfunction(TD) in Chinese hepatitis C patients.METHODS: One hundred and thirty-nine treatmentnaive genotype 1 chronic hepatitis C patients with no history of TD or treatment with thyroid hormones were enrolled in this study.Patients underwent peginterferon alfa-2a/ribavirin(Peg IFNα-2a/RBV) treatment for 48 wk,followed by detection of clinical factors at each follow-up point.Hepatitis C virus(HCV) antibodies were analyzed using microsomal chemiluminescence,and serum HCV RNA was measured by real-time PCR assay at 0,4,12,24 and 48 wk after the initiation of therapy and 24 wk after the end of therapy.To assess thyroid function,serum thyroid stimulating hormone(TSH),free thyroxine(FT4),free triodothyronine(FT3) and TPOAb/thyroglobulin antibody(TGAb) levels were determined using chemiluminescent immunoassays every 3 mo.Serum CXCL10 levels were determined at baseline.RESULTS: The prevalence of TD was 18.0%.Twentyone(84.0%) out of twenty-five patients exhibited normal thyroid function at week 24 after therapy.The rate of sustained virological response to Peg IFNα-2a/RBV in our study was 59.0%(82/139),independent of thyroid function.Pretreatment serum CXCL10 levels were significantly increased in patients with euthyroidstatus compared with patients with TD(495.2 ± 244.2 pg/m L vs 310.0 ± 163.4 pg/m L,P = 0.012).Patients with TD were more frequently TPOAb-positive than non-TD(NTD) patients(24.2% vs 12.3%,P = 0.047) at baseline.Three of the one hundred and fifteen patients without TPOAb at baseline developed TD at the end of treatment(37.5% vs 2.6%,P = 0.000).Female patients exhibited an increased risk for developing TD compared with male patients(P = 0.014).CONCLUSION: Lower pretreatment serum CXCL10 levels are associated with TD,and TD prevalence increases in female patients and patients who are positive for TPOAb at baseline.

Comparison of Thyroglobulin and Thyroid Function in Pregnant Women between Counties with a Median Urinary Iodine Concentration of 100-149 μg/L and 150-249 μg/L

Objective This study explored whether thyroglobulin and thyroid disease prevalence rates were higher in pregnant Chinese women with a median urinary iodine concentration of 100-149μg/L,compared with those with a median urinary iodine concentration of 150-249μg/L maintained through sustainable universal salt iodization.Methods This was a cross-sectional study in which 812 healthy pregnant women were enrolled to collect samples of their household edible salt,urine,and blood during their routine antenatal care in the18 counties in Fujian Province,China.The levels of salt iodine concentration,urinary iodine concentration(UIC),free triiodothyronine(FT3),free thyroid hormone(FT4),thyroid-stimulating hormone(TSH),thyroglobulin(Tg),thyroid peroxidase antibody and thyroglobulin antibody were assessed during the routine antenatal care visits.Results The median UIC(m UIC)in pregnant women was 130.8μg/L(interquartile range=91.5-198.1μg/L)in the counties with an m UIC of 100-149μg/L(Group I),and 172.0μg/L(interquartile range=123.5-244.4μg/L)in the counties with an m UIC of 150-249μg/L(Group II).Goiter prevalence and thyroid nodule detection rates showed no difference between Group I and Group II(P>0.05).Except for FT4 values,the TSH,FT4,FT3,Tg and Tg values>40(μg/L)and the thyroid diseases prevalence rate(TDR)showed no significant differences between Group I and Group II(P>0.05),whether or not iodine supplementation measures were taken.Conclusion Compared with an m UIC of 150-249μg/L,not only there was no difference in thyroid morphology,but also the Tg value,rate of Tg values>40μg/L,and TDR were not higher in pregnant women in the counties with an m UIC of 100-149μg/L achieved through sustainable universal salt iodization in Fujian Province,China.

Burden, Type, and Associated Factors of Thyroid Dysfunction in Patients with Heart Failure in Sub-Saharan Africa: A Cross-Sectional Study

Background: Various thyroid abnormalities have been reported during heart failure (HF). The present study aimed to evaluate the burden, type, and associated factors of thyroid disorders in Cameroonian patients with heart failure. Materials and Methods: We conducted a cross-sectional study from January to May 2020, involving volunteer adults followed for heart failure at the Yaoundé Central Hospital. Those receiving treatment that could cause thyroid dysfunction were excluded. Thyroid hormone levels (TSH, free T3, and free T4) were measured by enzyme-linked immunosorbent assay. Results: A total of 63 patients (30 women;47.6%) were included. The median age was 65 (IQR: 56 - 70) years. The main etiology of heart failure was hypertension (52.4%) followed by valvular heart disease (14.3%). Thyroid dysfunction was seen in 38 (60.3%, [95% CI: 47.2 - 72.4]) patients, of which 30 (79%) had hypothyroidism and 8 (21%) had hyperthyroidism. The most frequent thyroid dysfunction was Low T3 syndrome in 27% (95% CI: 16.6 - 39.7) of the study population followed sub-clinical hypothyroidism in 19.1% (95% CI: 10.3 - 30.9) of patients. Patients with HF and reduced ejection fraction (HFrEF) were more likely to have hypothyroidism than those with preserved ejection fraction (OR: 3.5, [95% CI: 1.2 - 9.9], p = 0.016). Also, patients with more than one hospital admission in the past 12 months were more likely to have hypothyroidism (OR: 5.3, [95% CI: 1.3 - 21.5], p = 0.013). Conclusion: The burden of thyroid dysfunction was high in this group of patients with HF. These were mainly low T3 syndrome and sub-clinical hypothyroidism. These were associated with heart failure with reduced ejection fraction and those with more than one hospitalization within the past 12-months.

Maternal hyperthyroidism increases the synthesis activity and the osteogenic markers expression of calvarial osteoblasts from offspring in a murine model

To evaluate the characteristics and synthesis activity of osteoblasts extracted from the calvaria of offspring of rats exposed to maternal hyperthyroidism.Twelve adult Wistar rats were divided into two groups,one control and one treated with daily administration of L-thyroxine by an orogastric tube(50μg/animal/day)during pregnancy.Three days after delivery and confirmation of the mothers’hyperthyroidism,the offspring were euthanized for the extraction of osteoblasts from the calvaria.At 7,14,and 21 days,proliferation activity was assessed using MTT assay,while alkaline phosphatase(ALP)activity was assessed by the BCIP/NBT method.At 21 days,the total area of the mineralized matrix stained by von Kossa was evaluated by morphometry.The expression of gene transcripts for Runx2,Bmp2,Fgfr1,collagen type 1(Col1),osteocalcin(Oc),and osteopontin(Op)were evaluated by real-time RT-PCR.Means were compared using the Student’s t-test.FA activity was significantly higher at 14 and 21 days in cultures of osteoblasts extracted from offspring exposed to maternal hyperthyroidism,while MTT conversion was significantly lower at 21 days in this group.Osteoblast cultures of neonates exposed to maternal hyperthyroidism also showed a larger total area of mineralized matrix and greater expression of gene transcripts for Oc and Op.Maternal hyperthyroidism increases the activity of matrix synthesis,alkaline phosphatase activity,and expression of gene transcripts for osteocalcin and osteopontin in the osteoblasts,extracted from the calvaria of the offspring,which may be one of the mechanisms of premature fusion of cranial sutures.

Thyroid Dysfunction in Children Exposed to Iodinated Contrast Media:A Meta-Analysis and Systematic Review

Iodinated contrast media(ICM)has the potential to cause thyroid dysfunction in some patients.However,it is unclear whether this relationship exists in children.We conducted a systematic review and meta-analysis aim to obtain a general overview of the relationship between ICM exposure and the risk of thyroid dysfunction in children.Methods:Computer search of Web of Science,EMbase,PubMed,Cochrane Library,collection of relevant literature on ICM and thyroid dysfunction in children,the search period was from the establishment of the database to July 2021.Meta-analysis was performed using Stata 14.0 software.Results:A total of 8 literatures with 3497 children.The incidence of hypothyroidism in children with ICM exposure was 0.05(95%CI:0.05,0.12),P<0.0001.Subgroup analysis showed that the incidence of hypothyroidism in ICM exposed children in the European region was 0.21(95%CI:0.13,0.30),P<0.0001,a statistically significant difference.Conclusion:The current evidence shows that children exposed to ICM are at risk for hypothyroidism,with a higher risk in neonates,especially children with congenital heart disease.

免疫治疗相关性甲状腺功能异常与不可切除/晚期肝细胞癌患者预后改善相关

目的:探讨免疫治疗相关性甲状腺功能异常与不可切除/晚期肝细胞癌(HCC)患者预后改善的相关性。方法:回顾性分析45例接受免疫检查点抑制剂(ICIs)治疗的不可切除/晚期HCC患者。根据ICIs治疗过程中是否出现免疫相关性甲状腺功能异常分为甲状腺功能正常组(28例)和异常组(17例),比较2组患者的预后和免疫应答情况,主要终点指标为中位总生存期(OS)、无进展生存期(PFS),次要终点指标为疾病控制率(DCR)。结果:所有患者的中位OS、PFS分别为10.8个月(95%CI:3.0~18.6)和5.0个月(95%CI:3.0~12.2)。正常组中位OS为5.8个月(95%CI:3.7~7.9),异常组中位OS尚未达到(P=0.026)。异常组中位PFS长于正常组(8.2个月vs.3.1个月,P=0.011),DCR高于正常组(52.9%vs.21.5%,P=0.030)。多因素Cox回归分析显示,甲状腺功能异常是达到6个月OS(HR=0.213,95%CI:0.048~0.944,P=0.042)和PFS(HR=0.383,95%CI:0.151~0.967,P=0.042)的独立影响因素;甲状腺功能异常(HR=0.403,95%CI:0.185~0.877,P=0.022)、基线无大血管侵犯(MVI)(HR=2.848,95%CI:1.406~5.768,P=0.004)、Child-Pugh A级(HR=2.404,95%:1.099~5.255,P=0.028)与12个月PFS相关。结论:免疫治疗相关性甲状腺功能异常的不可切除/晚期HCC患者预期生存和免疫应答效果更佳。治疗期间出现甲状腺功能异常、基线无MVI、Child-Pugh A级与患者预后改善相关。

纳武利尤单抗在真实世界中相关甲状腺不良事件的因素分析

目的分析真实世界中患者使用纳武利尤单抗治疗后甲状腺功能障碍的发生情况及危险因素。方法回顾性收集南昌大学第一附属医院从2019年10月至2023年3月使用纳武利尤单抗患者的临床信息。结果甲状腺功能障碍的发生率为23.8%,甲状腺功能减退型最高。甲状腺功能减退的发生时间为12周,甲状腺功能亢进发生时间为6周。体质量指数(BMI)小于18.5 kg/m2的患者甲状腺功能障碍发生率更高(P=0.029)。结论BMI小于18.5 kg/m2的患者使用纳武利尤单抗更容易发生甲状腺功能障碍。当患者使用纳武利尤单抗发生体重快速变化时,需要注意患者甲状腺功能变化。

抑郁症与甲状腺激素的研究进展

抑郁症发病机制十分复杂,至今尚无明确定论,其中神经内分泌假说认为,抑郁症发病与人体下丘脑-垂体-肾上腺轴或甲状腺轴功能异常有关。近年来,随着抑郁症与神经内分泌功能之间的关系被临床研究证实,神经内分泌假说逐渐被认可,然而这些研究结论之间仍存在许多矛盾与争议。为探究抑郁症与甲状腺激素的相关性及相关机制,本文将目前国内外抑郁症的治疗与甲状腺激素的相关研究作一综述。

免疫检查点抑制剂导致甲状腺功能异常的中西医诊疗思路

随着免疫检查点抑制剂(immune checkpoint inhibitor,ICPi)治疗人群的不断扩大,以及临床上的应用,接受这些药物治疗的患者生存时间明显提高,免疫相关不良反应的发生也逐渐受到重视。免疫系统的过度反应会导致不良反应的发生,这些不良反应称为免疫相关不良事件(Immune related adverse events,irAEs)。irAEs可以影响多个器官系统,其中内分泌系统是最常受累的系统之一,而甲状腺功能减退和甲状腺功能亢进的发生率最高,现代医学经常通过适当的激素替代,硫代酰胺,皮质类固醇来治疗,但仍有部分患者未能完全缓解,中医药可展现出其独特的优势和价值,很好的改善这部分患者症状,提高生存质量。本文就中西医诊疗ICPi所致甲状腺irAEs进行综述。

免疫检查点抑制剂对肝细胞癌患者甲状腺功能影响的研究进展

免疫检查点抑制剂(ICIs)给中晚期肝细胞癌(HCC)患者带来了生存希望,但通常伴随着免疫相关不良反应(irAEs)的发生。甲状腺功能障碍(TD)是最常见的ICIs内分泌相关不良反应,而HCC患者常合并有肝硬化等基础肝病,也可出现TD,二者可同时发生在同一患者中,互为促进,从而加重疾病进展。研究就ICIs对HCC患者甲状腺功能影响的研究进展进行综述,总结现有可能的发病机制、临床管理、预测生物标志物以及对HCC患者预后的影响。从而提高临床医师对甲状腺irAEs的认知,掌握发生甲状腺irAEs的HCC患者的治疗特点,早期监测、治疗后随访,减轻irAEs给癌症患者带来的影响。

卡瑞利珠单抗治疗经典型霍奇金淋巴瘤相关性甲状腺功能异常分析

目的分析卡瑞利珠单抗治疗经典型霍奇金淋巴瘤(cHL)相关性甲状腺功能(甲功)异常的临床特征并探讨影响因素。方法收集2017年1月1日—2020年12月31日接受卡瑞利珠单抗治疗的cHL患者病历资料,分析药物不良反应(ADR)的临床特征和影响因素。结果纳入患者47例,12例(25.53%)出现甲功异常,其中甲减3例,亚临床甲减7例,亚甲亢2例,ADR均为1或2级(轻中度),均未因甲功异常而停用卡瑞利珠单抗。甲功异常发生在治疗后第1—22个月,诱导中位时间为6个月。2例甲减患者经左甲状腺素干预后,1例恢复正常,1例好转。1例亚甲减患者经左甲状腺素干预后甲功仍持续异常但未加重。其余9例甲功异常患者均未干预,其中4例恢复正常,5例无明显变化或失访。甲功异常组患者基线促甲状腺激素(TSH)水平显著高于甲功正常组(P=0.03)。3例甲功中度异常(2级不良反应)的患者中有2例出现抗甲状腺球蛋白抗体(TgAb)与抗甲状腺过氧化物酶抗体(TPOAb)滴度异常升高。结论卡瑞利珠单抗治疗cHL相关性甲功异常发生率高,与患者基线TSH水平存在相关性,程度较轻,与TgAb和TPOAb滴度水平有关,临床表现以亚甲减或甲减为主,发生时间跨度大,一般不需停药,2级甲减患者用左甲状腺素干预后可改善。

甲状腺功能障碍与静脉血栓之间的关系:1项双样本双向孟德尔随机化研究

目的:探究甲状腺功能障碍与静脉血栓栓塞症之间的因果关系,为甲状腺功能障碍与静脉血栓栓塞症发病风险提供遗传学证据支持。方法:采用全基因组关联研究(genome-wide association studies,GWAS)数据进行分析。本研究选择促甲状腺素(thyroid stimulating hormone,TSH)、游离甲状腺素(free thyroxine,FT4)、甲状腺功能亢进(hyperthyroidism)和甲状腺功能减退(hypothyroidism)作为暴露因素。结局变量为静脉血栓栓塞症(venous thromboembolism,VTE),包括深静脉血栓(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE)。逆方差加权法(inverse-variance weighted,IVW)是评估暴露与结局之间因果关系的主要方法,并辅以MR-Egger、加权中位数法(Weighted median)、简易法(Simple mode)进行分析,同时Cochrane’s Q检验作为敏感性分析方法。结果:IVW显示甲亢与VTE(OR=1.074,95%CI=1.016~1.135,P=0.011)、PE(OR=1.054,95%CI=1.012~1.098,P=0.011)和DVT(OR=1.068,95%CI=1.014~1.126,P=0.013)存在正向的因果关系。结论:研究基于遗传数据认为甲状腺功能障碍与静脉血栓栓塞症存在因果关系,甲状腺功能亢进会增加静脉血栓发生的风险。

免疫检查点抑制剂引起肿瘤患者甲状腺功能障碍的临床分析

目的研究恶性肿瘤患者予以免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)后发生甲状腺功能障碍(thyroiddysfunction,TD)的临床特点及相关危险因素分析。方法收集来自云南省第一人民医院2019年1月至2022年6月住院并行ICIs治疗后的157例肿瘤患者,根据是否发生TD分为甲状腺功能正常组以及甲状腺功能异常组。选取甲状腺功能正常组和异常组分别为58例患者,再随机抽取58例至云南省第一人民医院的健康成人体检者作为对照组,收集研究对象的性别、年龄、肿瘤及ICIs类型、用药前手术史、放化疗史等基线资料,分析患者肝肾功、血脂、甲状腺激素水平等相关指标,对3组病例的相关指标进行统计学分析,并将甲状腺功能正常组和异常组进行对照分析来测评使用ICIs引起TD的临床特征及相关危险因素。结果(1)在157例使用ICIs治疗的患者中,58例(36.9%)出现甲状腺功能异常,其中甲状腺功能减退症(包括亚甲减)39例,甲状腺功能亢进症(包括亚甲亢)9例,单纯相关抗体异常10例;(2)对甲状腺功能正常组、甲状腺功能异常组及对照组3组数据进行分析,结果提示3组的年龄、促甲状腺激素(thyroidstimulatinghormone,TSH)基线水平、游离三碘甲状腺原氨酸(freetriiodothyronine,FT3)基线水平和谷草转氨酶(aspartatetransaminase,AST)水平比较,差异均有统计学意义(P<0.05);甲状腺功能正常组与甲状腺功能异常组TSH基线、放疗史比较,差异均有统计学意义(P<0.05);(3)多元分析表明放疗史(OR=7.291,95%CI=1.579~33.663,P<0.05)、基线TSH水平(OR=3.917,95%CI=1.697~9.038,P<0.05)是使用ICIs治疗后肿瘤患者出现甲状腺功能异常的独立危险因素。结论甲状腺功能减退是肿瘤患者使用ICIs引起TD最常见的类型,患者基线TSH水平、既往存在放疗史是出现甲状腺功能异常的独立危险因素。

PD-1抑制剂治疗的晚期非小细胞肺癌患者甲状腺功能异常发生情况及影响因素

目的观察程序性细胞死亡蛋白1(PD-1)抑制剂治疗的晚期非小细胞肺癌患者甲状腺功能异常的发生情况,并分析其影响因素。方法接受PD-1抑制剂治疗的晚期非小细胞肺癌患者350例,根据治疗后甲状腺功能指标变化将患者分为甲状腺功能异常组和对照组,收集两组患者一般资料及实验室检查结果,分别采用单因素分析和多因素Logistic回归分析甲状腺功能异常的影响因素。结果350例患者中,77例(22.0%)发现甲状腺功能异常,甲状腺功能异常发生时间为治疗第3~31周、中位时间为治疗第9周,52例首发表现为临床甲状腺功能减退症(甲减)或亚临床甲减,25例首发表现为临床甲状腺功能亢进症(甲亢)或亚临床甲亢,发生甲亢及甲减的中位时间差异无统计学意义(P均>0.05)。与对照组相比,甲状腺功能异常组淋巴细胞计数降低,C反应蛋白、促甲状腺激素水平、基线甲状腺抗体阳性率升高,免疫治疗周期更长(P均<0.05)。多因素Logistic回归分析结果显示,基线甲状腺抗体阳性(OR=7.750,95%CI 3.878~15.487)、免疫治疗周期≥6周(OR=1.225,95%CI 1.158~1.296)是甲状腺功能异常的独立危险因素(P均<0.05)。结论PD-1抑制剂治疗的晚期非小细胞肺癌患者甲状腺功能异常发生率较高、以甲减更常见;基线甲状腺抗体阳性、免疫治疗周期长(≥6周)是PD-1抑制剂治疗的晚期非小细胞肺癌患者发生甲状腺功能异常的危险因素。

甲状腺功能异常对重要慢性疾病影响的研究进展

在健康中国战略的推动下,慢性疾病防治已成为当前医疗体系中不可忽视的一环。甲状腺疾病作为最常见的内分泌代谢性疾病,在慢性疾病综合管理中占有举足轻重的位置。当前,我国甲状腺疾病呈高发势态,成人甲状腺功能异常患病率达15.17%,甲状腺功能异常影响全身多脏器,可导致糖、脂、骨代谢异常及心血管、呼吸道疾病甚至肿瘤等多种常见慢性疾病。且甲状腺功能异常早期不易识别,将不利于与之相关的慢性疾病临床管理。因此,通过深入了解甲状腺功能异常对慢性疾病的影响,强化甲状腺功能检查在健康管理中的地位,实现甲状腺疾病早筛查、早发现、早管理,将对慢性疾病综合管理产生深远影响。

PD-1/PD-L1抑制剂诱发免疫相关甲状腺功能障碍的影响因素及肿瘤总生存期分析

目的探究程序性死亡受体-1(PD-1)/程序性死亡配体-1(PD-L1)抑制剂诱发免疫相关甲状腺功能障碍(irTD)的影响因素及对肿瘤总生存期(OS)的影响。方法纳入211例PD-1/PD-L1抑制剂治疗的肿瘤患者,比较是否发生irTD组间的差异,并进行亚组分析。采用多因素Logistic回归分析探究irTD的影响因素,生存分析法探究是否发生irTD与OS的关系,组间比较采用log-rank检验,多模型COX回归分析评估irTD对OS的影响。结果irTD的发生率为26.1%,1级发生率13.3%,2级发生率10.0%,3~4级发生率2.8%,发生的中位时间为第9周(IQR:5~25周)。性别、吸烟史、靶向史、基线甲状腺抗体在是否发生irTD组间具有统计学差异(P<0.05)。irTD患者甲状腺球蛋白抗体(TGAb)在第3周开始升高,第6~30周高于基线水平,30周后开始下降并逐渐恢复至基线水平,甲状腺微粒体抗体(TMAb)的变化幅度小于TGAb。亚组分析显示,甲亢组首次接受免疫治疗的年龄较甲减组小(P<0.05),基线促甲状腺激素(TSH)水平低于甲减组(P<0.05)。多因素Logistic回归分析显示,基线甲状腺抗体阳性的患者发生irTD的风险是阴性患者的4.595倍(95%CI:2.286~9.239,P<0.001)。生存分析显示,irTD患者的OS更长。多模型COX回归分析显示:在调整年龄、性别、化疗、肿瘤类型、是否转移等因素后irTD患者的OS更长(HR=0.228,95%CI:0.079~0.656,P=0.006)。结论irTD严重程度以1~2级为主,3~4级少见。基线甲状腺抗体阳性是irTD发生的独立危险因素。发生irTD的患者具有更长的OS,可能是由于irTD患者具有更好的免疫应答。

肾病综合征患者合并甲状腺功能异常的影响因素分析

目的:分析肾病综合征(NS)合并甲状腺功能异常患者的临床特征,探讨NS患者合并甲状腺功能异常的独立影响因素,为临床诊治提供理论依据。方法:选取2015年1月—2021年12月就诊于宜昌市中心人民医院的499例NS患者,分为甲状腺功能正常组(n=187)和甲状腺功能异常组(n=312),进一步细分为亚临床甲减组(n=112)、临床甲减组(n=86)及正常甲状腺病态综合征(ESS)组(n=114)。分析比较各组患者的一般人口学资料及实验室检查指标,TH、TSH水平与临床指标之间的相关性,并采用单因素及多因素Logistic回归分析NS患者合并甲状腺功能异常的影响因素。结果:NS患者合并甲状腺功能异常的发生率为62.53%(312/499);甲状腺功能正常组和异常组患者相比,性别、住院天数、24小时尿蛋白定量(24 h-UTP)、尿素氮(BUN)、血清白蛋白(Alb)、总胆固醇(CHOL)、C反应蛋白(CRP)、血沉(ESR)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和TSH方面差异有统计学意义(均P<0.05)。亚临床甲减组及临床甲减组的ESR、CHOL水平,ESS组BUN水平均高于甲功正常组(均P<0.05)。亚临床甲减组、临床甲减组及ESS组的Alb水平均低于甲功正常组(均P<0.05);进一步的Spearman相关分析显示,NS合并甲状腺功能异常患者的FT3、FT4及TSH水平与24 h-UTP、Alb、BUN、Scr等水平相关(均P<0.05)。多因素Logistic回归分析结果表明,血清Alb水平升高(OR=0.866,95%CI:0.813,0.923)是NS患者合并甲状腺功能异常的独立保护因素,女性患者(OR=2.629,95%CI:1.603,4.312)及高水平BUN(OR=1.099,95%CI:1.023,1.181)是发生甲状腺功能异常的独立危险因素(均P<0.05)。结论:女性患者、高水平BUN是NS合并甲状腺功能异常的独立危险因素,血清Alb水平升高是其保护因素。