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Objective:To investigate the effect of levothyroxine withdrawal before radioiodine therapy on blood lipids and renal function in patients with differentiated thyroid carcinoma (DTC) after operation.Methods:From Mar. 2020 to Apr. 2022, 214 patients with differentiated thyroid cancer were enrolled in the General Surgery Department, Linyi Central Hospital, Shandong Province. All patients stopped taking levothyroxine sodium after total thyroidectomy. The thyroid function index, blood lipid index and renal function index were measured and compared before and after drug withdrawal (before operation) and after drug withdrawal (before radioiodine treatment). The patients were divided into groups according to the duration of drug withdrawal (drug withdrawal group for 3 weeks, drug withdrawal group for 4 weeks), and the differences of thyroid function index, blood lipid index, and renal function index among patients with different drug withdrawal time were compared. The measurement data in accordance with normal distribution were compared between groups, and independent sample t-test was performed. Results:The levels of free thyroxin T4 (FT 4) and free triiodothyronine (FT 3) in DTC patients decreased significantly ( t=57.60, 71.74,all P<0.001), and the levels of thyroid-stimulating hormone (TSH) increased significantly ( t=102.15, P<0.001). After drug withdrawal, the serum lipid index [triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), low density lipoprotein (LDL) ] and renal function index [blood urea nitrogen (BUN), serum creatinine (SCR) ] of DTC patients increased significantly ( t=20.17, 42.50, 12.13, 30.73, 16.09, 43.73, all P<0.001). The levels of FT 3 and FT 4 in the 4-week group were significantly lower than those in the 3-week group ( t=7.75 and 10.07, both P<0.001), and TSH was significantly higher than that in the 3-week group ( t=26.46, P<0.001). The levels of TG, LDL, HDL, TC, BUN and Scr in the 4-week group were significantly higher than those in the 3-week group ( t=10.13, 10.29, 8.53, 11.47, 10.54, 8.55, all P<0.001). Correlation analysis showed that the levels of FT 3 and FT 4 in DCT patients were negatively correlated with the levels of TG, LDL, HDL, TC, BUN and Scr ( r=-0.256, -0.189, -0.249, -0.314, -0.352, -0.231, -0.342, -0.259, -0.304, -0.216, -0.391, -0.271, P=0.011, 0.029, 0.007, 0.004, 0.015, 0.036, 0.002, 0.009, 0.019, 0.017, 0.016, 0.003), and the levels of TSH were correlated with TG, LDL, HDL, TC and BUN Scr level was positively correlated ( r=0.257, 0.308, 0.219, 0.311, 0.251, 0.271, P=0.006, 0.013, 0.032, 0.004, 0.006, 0.014) . Conclusion:Stopping levothyroxine sodium before radioactive iodine treatment after DTC can easily lead to dyslipidemia and decreased renal function in patients, and the longer the withdrawal time is, the more obvious the changes of blood lipids and renal function in patients, and the withdrawal time should be shortened in clinical treatment.
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Objective:To explore the expression of serum inflammatory factors in patients with thyroid tumor and their correlation with thyroid hormones.Methods:A total of 92 patients with thyroid tumors (48 cases of thyroid cancer and 44 cases of thyroid adenoma) admitted to Department of Endocrinology in Linyi Central Hospital in Shandong Province from Jan. 2020 to Oct. 2021 were enrolled. 50 healthy volunteers who received physical examination in the hospital during the same period were enrolled in the control group. The serum inflammatory factors [tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6) , interleukin-17 (IL-17) ] and thyroid hormone expression levels [thyroid stimulating hormone (TSH) , free thyroxin T4 (FT4) , free triiodothyronine (FT3) ] of the three groups were detected. Analysis of variance was used for multi-group comparison, independent sample t test was performed for comparison between groups, Spearman correlation analysis and Logistic regression analysis were made for the risk factors of thyroid cancer. The expression of serum inflammation and thyroid hormones in patients with different stages of thyroid cancer was observed. Results:Serum TNF-α, IL-17, IL-6 from high to low were in the thyroid cancer group (74.61±7.94 ng/L, 68.65±7.05 ng/L, 20.52±2.84 ng/L) , thyroid adenoma group (26.97±3.42 ng/L, 46.31±5.31 ng/L, 13.61±1.58 ng/L) , control group (18.82±2.63 ng/L, 34.52±4.02 ng/L, 8.97±1.06 ng/L) ( F=1596.271, 468.602, 423.351, all P<0.001) ; Serum TSH levels from high to low were in the thyroid cancer group (8.64±1.34 mU/L) , the thyroid adenoma group (5.21±1.02 mU/L) , the control group (3.94±0.85 mU/L) ( F=242.182, P=0.000) . There was no significant difference in serum FT4 or FT3 levels among the three groups ( P=0.753, 0.634) . Correlation analysis indicated that serum TNF-α, IL-17, and IL-6 were positively correlated with the expression level of serum TSH ( r=0.936, 0.726, 759, all P<0.05) . The expression level of TNF- α, IL-17, IL-6 and TSH was significantly higher in patients of stage III and IV than that in patients of stage I and II ( t=2.541, 4.394, 6.390, 4.962, P=0.015, P<0.001, P<0.001, P<0.001) . Multivariate Logistic regression analysis suggested serum TNF-α, IL-17, IL-6 and TSH were all risk factors for thyroid cancer. Conclusions:Serum inflammatory factors and some thyroid hormones (TSH) are generally highly expressed in patients with thyroid tumors, the expression levels of serum inflammatory factors are correlated with the expression of TSH. There are statistically significant differences in the expression levels of serum inflammatory factors and TSH between patients with thyroid cancer of different stages, serum inflammatory factors and TSH are also involved in the occurrence and development of thyroid cancer, and are risk factors for thyroid cancer.
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Objective:To study the non-target metabolomics analysis and to analyze the metabolomic changesof cerebrospinal fluid (CSF) in patients with tuberculous meningitis.Methods:Case-control study. From July 2018 to July 2019, 20 cerebrospinal fluid specimens of diagnosed patients with tuberculous meningitis were collectedin the department of neurology from the first medical center of the PLA general hospital and the eighth medical center of the PLA general hospital and 20 CSF without tuberculous meningitis as the control. Among them, there were 12 males and 8 femalesin the tuberculous meningitis group, aged (37.9±16.1) years; there were 13 males and 7 femalesin the control group, aged (34.7±14.8) years. Using ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS) technology with three different mode, namely reverse phase chromatography positive ion mode, reverse phase chromatography negative ion mode and hydrophilic chromatography positive ion mode,to detectthe metabolic fingerprints of patients′CSF and analyzed by SIMCA software for orthogonal partial least squares discriminant analysis (OPLS-DA). The variable importance projection value of OPLS-DA model (threshold value>1) plus the P value of t-test (P<0.05) was applied to find the differential metabolites in the cerebrospinal fluid of the two groups of patients.Results:Ten differential metabolites were found in CSF, including L-isoleucine, L-phenylalanine, L-kynurenine, L-methionine, L-tyrosine acid, dimethylglycine, L-alanine, L-threonine, L-histidine and L-lysine, and all of them were up-regulated in the tuberculous meningitis group.Conclusion:Changesof the amino acid metabolism found in the cerebrospinal fluid of tuberculous meningitis patients can provide basis for differential diagnosis and basic molecular research of tuberculous meningitis.
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Objective To study the expression of CD27 and CD28 in antigen-specific CD4~+T cells in patients with pulmonary tuberculosis and healthy people, and understand the role of differentiated stages of CD4~+T cells in the pathogenesis of tuberculosis. Methods The expression of CD27 and CD28 was analyzed by CD4, CD154, CD27 and CD28 staining and flow cytometry. The distributions of CD27 and CD28 in antigen-specific CD4~+T cells were compared between patients with pulmonary tuberculosis and healthy controls. Results In patients of pulmonary tuberculosis, the frequencies of CD27 + CD28 + (early differentiated stage), CD27~- CD28~+ and CD27~+ CD28~- (intermediate differentiated stage), CD27~- CD28~-(fully differentiated stage) T cell subsets in antigen specific CD4~+T cells were (49. 55 ±6. 15)%, (26. 85 ±3. 87)% ,(7. 2 ± 1.37)% and ( 16. 35 ±3.97)%, respectively. In healthy controls, the frequencies of the four subsets in antigen-specific CD4~+T cells were ( 51.81 ± 4. 94 ) %, ( 29. 83 ± 5.33 ) %, ( 12. 65 ±4. 48)% and (5.7±2)%, respectively. The early differentiated CD4~+T cell was the major subset both in patients and healthy people, however, which had significant difference compared with the fully differentiated subset ( t = 2. 26, P < 0. 05 ). Conclusion The population frequency of the fully differentiated CD4~+T cells in patients with pulmonary tuberculosis was significantly higher than that in healthy people. This suggested that the differentiation degree of the antigen-specific CD4~+T cell might be related with pulmonary tuberculosis.
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Objective To study population frequencies of CD4+,CD154+ T cell subset in patients with pulmonary tuberculosis and controls with positive PPD reaction. Methods Flow cytometry was used to detect the CD4+,CD154+ T cell subset, the population frequen-cies in patients with pulmonary tuberculosis and controls were compared. Results The expression level of CD154 was higher when PE-la-beled CD154 antibody was added during stimulation period, compared with CD154 labeling after stimulation(1.51±0. 36/0. 40±0. 13, P <0.05). The CD154+ cells were not detectable in fresh isolated CD4+ T cells, but significantly increased after stimulation with specific anti-gens. The population of CD4+, CD154+ T cell subset was significantly reduced in patients with active pulmonary tuberculosis, compared with healthy controls with PPD positive reaction(0. 72±0. 32/1.65±0. 76, P <0. 01). Conclusions The population of CD4± ,CD154± T cell subset was significantly reduced in patients with active pulmonary tuberculosis, which indicated that it may play an important role in the de-velopment of tuberculosis.