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[甲状腺激素测定的预后价值]

[The prognostic value of the determination of thyroid hormones].

作者信息

Emrich D, Schöndube H, Schreivogel I, Schürnbrand P, Schicha H

出版信息

Dtsch Med Wochenschr. 1983 Dec 16;108(50):1915-21. doi: 10.1055/s-2008-1069850.

Abstract

For recognition and exclusion of hyper- and hypothyroidism total thyroxine, index of free thyroxine, free thyroxine and total triiodothyronine were evaluated. Among 532 strictly selected patients, corresponding to the five main thyroid out-patient groups, the four parameters were estimated simultaneously. Their sensitivity and specificity including two combinations of free thyroxine and total triiodothyronine were calculated. On the basis of an average prevalence of the five above-mentioned groups among our patients and the two most frequent interfering factors (administration of oestrogens and additional iodine intake) predictive values were assessed. The following results were obtained. 1. Differences among the various in-vitro parameters are less than generally assumed. For free thyroxine and the combination of increased free thyroxine or total triiodothyronine, sensitivity and specificity were slightly higher than for other parameters. 2. There is insufficiently substantiated probability of positive evidence of hyperthyroid and hypothyroid states being supplied by all the examined parameters if these are the only criteria relied upon. The probability of positive evidence of hyperthyroid states is only acceptable if, prior to use of in-vitro tests, the prevalence has been considerably increased by history and clinical findings. 3. The probability of exclusion of hyperthyroid states supplied by the examined parameters is high. However, despite their high negative predictive value they are insufficient for the definite exclusion of hypothyroid states if the latent types are included.

摘要

为了识别和排除甲状腺功能亢进和减退,对总甲状腺素、游离甲状腺素指数、游离甲状腺素和总三碘甲状腺原氨酸进行了评估。在532例经过严格筛选的患者中,对应五个主要甲状腺门诊组,同时对这四个参数进行了评估。计算了它们的敏感性和特异性,包括游离甲状腺素和总三碘甲状腺原氨酸的两种组合。根据上述五组患者在我们研究中的平均患病率以及两种最常见的干扰因素(雌激素给药和额外碘摄入)评估了预测值。得到了以下结果。1. 各种体外参数之间的差异小于一般假设。对于游离甲状腺素以及游离甲状腺素升高或总三碘甲状腺原氨酸升高的组合,其敏感性和特异性略高于其他参数。2. 如果仅依赖这些检查参数作为唯一标准,那么所有检查参数提供甲状腺功能亢进和减退状态阳性证据的可能性缺乏充分依据。只有在使用体外检测之前,通过病史和临床检查使患病率大幅增加时,甲状腺功能亢进状态阳性证据的可能性才是可接受的。3. 检查参数提供的排除甲状腺功能亢进状态的可能性很高。然而,尽管它们具有较高的阴性预测价值,但如果包括潜在类型,它们不足以明确排除甲状腺功能减退状态。

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