ABSTRACT
Objective To determine the reference intervals for thyroid function tests during the second half of pregnancy (20-40 gestational weeks),and to assess the relationship between thyroid peroxidase antibody (TPOAb) levels and the incidence of gestational thyroid diseases.Methods Levels of thyroid stimulating hormone (TSH),free thyroxine (FT4),TPOAb and urinary iodine excretion were determined in 4 729 pregnant women,who received prenatal health care at First Affiliated Hospital of Nanjing Medical University from July 2011 to August 2013.Among these women,2 568 were selected using the recommendations of the American National Academy of Clinical Biochemistry,and were divided into five groups according to their gestational age:≥ 20 to ＜24 weeks (682 cases),≥ 24 to ＜28 weeks (1 322 cases),≥ 28 to ＜32 weeks (178 cases),≥ 32 to ＜36 weeks (185 cases) and ≥ 36 to ≤ 40 weeks (201 cases).Reference intervals of thyroid function tests in the second half of pregnancy were calculated.The reference values of thyroid functions in different gestational weeks were compared,and the reference intervals of thyroid functions in the second half of pregnancy were determined.The effects of maternal age and positive TPOAb on gestational thyroid diseases were analyzed.A non-parametric test,analysis of variance or Chi-square test was used for statistical analysis.Results (1) Reference intervals for maternal thyroid function in the second half of pregnancy in our hospital were established [TSH:0.65-5.27 mU/L and FT4:8.74-14.84 pmol/L].(2) The percentage of thyroid diseases was higher using the non-pregnancy reference intervals (TSH:0.27-4.20 mU/L and FT4:12.00-22.00 pmol/L) than using the pregnancy reference intervals [64.0％ (3 025/4 729) vs 16.1％ (763/4 729),x2=47.465,P ＜ 0.01],which manifested as a higher rate of clinical hypothyroidism and simple hypothyroxinemia [5.4％ (255/4 729) vs 0.4％ (20/4 729),x2=14.321;54.1％ (2 560/4 729) vs 9.1％ (429/4 729),x2=47.108;both P＜0.01] and a lower rate of subclinical and clinical hyperthyroidism [1.2％ (58/4 729) vs 3.3％ (155/4 729),x2=6.650;0.3％ (13/4 729) vs 0.6％ (27/4 729),x2=2.062;both P＜0.05].(3) The incidence of clinical hypothyroidism and simple hypothyroxinemia in pregnant women aged ＞30 years was higher than in those aged ≤ 30 years [0.7％ (10/1 377) vs 0.3％ (10/3 352),x2=4.257;11.7％ (161/1 377) vs 8.0％ (268/3 352),x2=16.102;both P＜0.05].The incidence of clinical hypothyroidism and clinical hyperthyroidism in TPOAb positive women was higher than that in TPOAb negative women [2.7％ (9/335) vs 0.3％ (11/4 394),x2=44.009;3.9％ (13/335) vs 1.2％ (52/4 394),x2=16.784;both P＜0.01].Conclusions The established pregnancy-specific reference ranges of thyroid function tests can reduce the missed diagnosis and misdiagnosis of gestational thyroid diseases.Maternal age ＞30 years and positive TPOAb may increase the risk ofgestational thyroid diseases.
ABSTRACT
Objective To observe clinical efficacy of laparoscopy combined with gonadotropin-releasing hormone agonist (GnRH-a ) in the treatment of endometriosis (EMs).Methods 158 patients who underwent laparoscopic surgery and were diagnosed endometriosis in our hospital during Sep.2010 to Dec.2010 were chosen and divided into three groups:control group were treated with pure laparoscopic surgery,group A were treated with laparoscopic surgery and follow-up GnRH-a medication,and group B were treated with laparoscopic surgery,follow-up GnTH-a medication and add-back therapy.The total effective rates,recurrence rates,the changes of hormone levels before and after the treatment and adverse reaction rates after treatment were compared and analyzed to evaluate the efficacy of different treatments.Results The total effective rates of group A and group B (84.6%,86.2%) were significantly higher than that of control group (58.3%),and the difference was statistically significant (P=0.032,P=0.032).The recurrence rates of group A and group B (15.4%,13.8%)were significantly reduced compared with that of control group (41.6%)(P=0.012,P=0.012).The hormone levels decreased dramatically after treatment in three groups.The adverse reaction rate of group B was apparently reduced compared with that of group A,and the difference was statistically significant (P=0.001 ).Conclusion Laparoscopy combined with GnRH-a medication was a safe and effective treatment for endometriosis.The application of GnRH-a after laparoscopy can significantly increase the total effective rate of the operation and reduce the postoperative recurrence rate.For the patients who need to take long-term GnRH-a treatment,add-back therapy need to be given to decrease its adverse reaction and recurrence rate,or to delay its recurrence,thus could improve patients' living qualities significantly.
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The intrauterine growth retardation (IUGR) model was established by maternal nutrition restriction during mid- to late-gestation. IUGR rats had both impaired pancreatic development and islet β-cell dysfunction. As the animals grew, the rats gradually showed impaired glucose tolerance and decreased insulin sensitivity.
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Genechip was applied to explore gene expression profile of islets in rats at various stages of pregnancy. Compared with the normal control group, differential expressions of hundreds of genes were detected during pregnancy. Reg3α gene expression was markedly increased during pregnancy, which may be related to islet regeneration.