最新产后甲状腺炎PPT课件(1)课件PPT.ppt 41页

'产后甲状腺炎PPT课件(1) 内容概述病因和病理临床表现实验室检查诊断治疗和预后筛查 PPT是自身免疫性甲状腺炎的一个类型指产后一年内出现一过性或永久性甲功异常PPT患病率1.1-21.1%，碘充足地区患病率约7%我国学者报告的PPT患病率是11.9%,其中临床型PPT7.2%，亚临床型PPT4.7%概　述EndocrineReviews,2001,22:605-630ChinJEndocrinolMetab,2005,21:99-102 PPT的病理甲状腺可以轻、中度肿大，质地中等，无触痛B超显示甲状腺内部为低回声或低回声结节甲状腺内轻度的淋巴细胞浸润，但不形成生发中心，没有Hürthle细胞 PPT的临床表现根据PPT发生甲功异常的类型，分为三个亚型:临床PPT甲亢甲减双相型:PPT的典型过程，占42.9%甲亢单相型：占45.7%甲减单相型：占11.4%亚临床PPT甲减单相型：占34.8%甲亢单相型：占65.2%无甲亢甲减双相型JEndocrinolInvest.2005,28:876-881EurJEndocrinol.2005,153(3):367-71. PPT的临床过程-甲亢期发生在产后1-6个月，通常在3个月，维持1-2个月症状是心悸、乏力、怕热、情绪激动等产生的原因是甲状腺组织被炎症破坏后，甲状腺激素漏出，导致甲状腺毒症实验室的特征性表现为血清甲状腺激素水平与131碘摄取率的“双向分离曲线”。即血清T4、T3水平升高131碘摄取率显著减低 PPT的临床过程-甲亢期PPT甲亢期需要与产后Graves病复发鉴别主要有两个鉴别点：①PPT呈“双向分离曲线”，但是受哺乳限制，患者不能做131碘摄取率②产后Graves病常有产前的Graves病史，甲亢症状较重，TRAb阳性 PPT的临床过程-甲减期发生在产后3-8个月，常在6个月左右，持续4-6个月表现为肌肉、关节疼痛和僵硬，疲劳、注意力不集中、便秘等产生的原因甲状腺滤泡上皮细胞被炎症损伤后，激素合成减少实验室检查：血清TSH水平逐渐升高，甲状腺激素水平下降 PPT的临床过程-恢复期发生在产后6～12个月此期激素水平和131碘摄取率逐渐恢复至正常大约20%的病例可以遗留为持续性甲减少数病例可以在PPT恢复后3～10年发生甲减 PPT的诊断符合下述两项条件即可诊断为PPT①产后一年之内发生甲状腺功能异常，可以表现为甲亢甲减双相型、甲亢单相型或甲减单相型②TRAb阴性血清TPOAb阳性有助于PPT的诊断，但不是必备的指标；甲状腺131碘摄取率因哺乳不能施行，不做为常规的诊断指标 治疗和预后PPT多数病例呈现自限性过程甲亢期一般不需要抗甲状腺药物干预。甲亢症状严重者可以给予β受体阻断剂等对症治疗甲减期血清TSH＜10mIU/L时不需要甲状腺激素的替代治疗，可以自行恢复曾患PPT的妇女在产后5-10年内发生永久性甲减的危险性明显增加，建议PPT每年检查TSH。一旦发生持续性甲减，应当及时治疗。如果计划再次妊娠，按照妊娠甲减处理 目前尚无足够证据建议在全部产后妇女中筛查PPT对已知TPOAb阳性的妇女，产后3～6个月要监测TSH和血清甲状腺激素目前尚无足够证据说明产后抑郁症与PPT的关系、产后抑郁症与甲状腺抗体的关系。因为甲减作为产后抑郁症的原因是可以治愈的，所以主张在产后抑郁症中要筛查甲功，以便治疗筛查JClin.Endocrinol.Metab.2007,92:S1-S47. Thanks16 LanguagepointsLessons26-27 (be)atwar处于战争／交战状态TheUSAthendeclaredthatitwasatwarwiththatcountry.Whenhecameback,hefoundthathiscountrywasatwar. desertvt.抛弃，遗弃，脱离；（在需要的时候）失去adj./n.沙漠；荒无人烟的·Thehunterdesertedhisinjuredcomrades.Whenhehadtospeaktotheheadteacher,hiscouragesuddenlydesertedhim.Therestoftheterritoryismostlydesert.Hewaslivingonadesertisland. falltopieces垮台，崩溃，倒塌，解体AfterthedeathofNapoleon,hisempirebegantofalltopieces.Theoldbuildingfelltopiecesinthewar.Theydesertedtheirorganizationanditfelltopieces. last(for)＋一段时间．持续／延续一段时间Thefilmwilllast(for)threehours.Themeetinglastedtoolongforustositstill. laydown放下;铺;制订,规定laydownone’slife牺牲生命laydownone"sarms放下武器Theyoungmotherlaidthebabydowngentlyonthebed.Theguestlaiddownhisknifeandforkwithalookofcompletesatisfaction.Thesepricelimitsarelaiddownbythegovernment.Theconferencewilllaydownthepropermeasuresandmethods. veryfew＝onlyafew＝onlyaveryfew很少／极少quiteafew＝agoodfew＝many好些／相当多notafew＝many不少／相当多 waitingtobereplaced现在分词作伴随状语Shefinishedallherworkfeelingrelaxed.Hesatinachairreadingnewspapers. replace=taketheplaceofvt.代替、取代JohnwillreplaceBillintheteam.Cananythingreplaceamother"sloveandcare?Wehavereplacedslavelabourwith/bymachines.MrAwillreplaceMrBaspresident.A先生将代替B先生任总裁。 watchover查看，照看，负责；看守，监视等①Iamhisbestfriend,andIwillalwayswatchoverhim.②Theywerewatchedoverbythreepolicemen. protectsb./sth.from/against…保护某人／某物免受…Youshouldwearyoursunglassestoprotectyoureyesagainst/fromsunlight.Theairconditioneriscoveredwithapieceofmetalboard,whichprotectsitfromwater. besidesadv.(＝moreover＝inaddition)还有，而且。通常置于句首。prep.除…之外，还有…Idon’twanttogooutnow.Besides,I’mfeelingtired.Thetaskisdifficult；besides,timeislimited.Therearefiveotherroomsbesidesthesetwo. tomakethingsworse插入语，情况更糟的是carryonwith＝goonwith＝continue(with) spreadvt.铺开，伸开；涂，抹；传播，散布等vi.伸展，延伸；蔓延，传染；传开①Hespreadablanketonthebed.②Thesea,blueandstill,wasspreadbeforeus.③Theradiospreadthenewsassoonasithappened.④Shespreadhertoysallovertheroom.①Theforestspreadsfromheretotheriver.②Intwentyyearsthecityhasspreadquicklytothenorth.③Thefirespreadfromthefactorytothehousesnearby.④Thecaptaintoldhismentospreadout. takeon开始具有，呈现，获得雇用，接受（从事），让上车Herfacetookonanangrylook.AfterthestudentsputupChristmasdecorations,theclassroomtookonaholidayappearance.Thefactoryhasopenedanditisbeginningtotakeonnewworkers.Hetakesonadditionalworkintheevenings.Thebustookonmorepassengers. nowhere置于句首是为了强调，这时句子多用倒装。如果nowhere不置于句首，则句子不倒装。Nowhereelsecanyouenjoysuchbeautifulmusic.Nowhereisthereaplaceforhimtosettledown.Mywatchisnowheretobefound.Theoldladywentnowhere,juststayedathome. 具有否定意义并放到句首形成倒装句的词除副词nowhere外，还有seldom,hardly,never,little,notonly…butalso,nosooner…than等。①OnlythendidIrealizethatIwaswrong.②Seldomdoeshetakepartintheconversation.③NeverinmylifehaveIheardofsuchafunnystory. oppositeadj.对面的；相反的oppositeto+n./pron.在……对面,和……相反oppositeprep.在……对面，有时和opposite(adj.)to意义相近 Heranacrosstotheoppositesideofthestreet.BillandMaryhadoppositeideasabouttheweather.Hesmiledandsatdownoppositetoher.Hispoliticalpositionisoppositetoours.Thehouseoppositeourswasburntdownlastweek.Thebusstoppedjustoppositethepostoffice. coveranareaof…=haveanareaof…占／有…的面积Chinahas/coversanareaofabout9,600,000squarekilometres. aswellas＝besides除…之外还othersoflessimportancewithinthisarea＝otherbuildingswhichwerelessimportantinthisarea. includevt.包括（有时有较活译法）①You"llfindthattheplanincludesmostofyoursuggestions.②TheChinesenationincludesthan50nationalminoritiesbesidestheHans.③Everyoneheretookpartinthefightagainsttheflood,includingoldpeople.④Everybodyhadsomethingtosay,meincluded. upuntil一直到……为止till/until作介词或连词,用于肯定句,谓语动词(或主句谓语动词)用持续性动词.HelivedinBeijingtill/until1990.PleasestayheretillIcomeback. ina…state或inastateof…处于…状态中Thehousewasinadirtystate.Heisinagoodstateofmind.他心情舒畅。Atthattime,thewholecountrywasinastateofwar. where,when,if,though等引起的从句，有时可以简化，只保留从句中必要的成分，特别当主谓语是itis/was时。Hemadesomemarksinthearticlewhere(itis)necessarytodoso.Let’spractisespeakingEnglishwhenandwhere(itis)possible.'