【文章內(nèi)容簡介】 pril for Protecting Renal Function (N Engl J Med. 2022。351:195261. ) ? This prospective study examined whether angiotensinreceptor blockers are as effective as ACE inhibitors in protecting renal function in p39。ts with type 2 DM. ? The authors pared telmisartan, an angiotensinreceptor blocker that reduces progression to endstage renal disease (ESRD) in diabetic p39。ts with nephropathy, with traditional firstline therapy with the ACEI enalapril. HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 16 ? This multicenter, doubleblind study randomly assigned 250 diabetic p39。ts to receive 80 mg of telmisartan per day (n = 130) or 20 mg of enalapril per day (n = 120) over 5 years. The p39。ts had early nephropathy。 82% had microalbuminuria, and 18% had macroalbuminuria. The primary end point was a change in GFR. Secondary end points were serum Cr and urine albumin levels, BP, rates of ESRD, CV events, and deaths. ? After 5 years of followup, GFRs had declined at the same rate with telmisartan ( mL/min per m2) and enalapril ( mL/min per m2). The outes for secondary end points were also the same. Both groups experienced adverse effects, and 20 p39。ts in the enalapril group had to discontinue the medication. ? The authors39。 conservative conclusion was that the renal protective effects of telmisartan are not inferior to those of enalapril. Only 1 shortterm study had previously pared these 2 types of drugs. HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 17 HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 18 Risk for Fetal Loss Is increased in Subclinical Hyperthyroidism (JAMA. 2022。292:6915. ) ? The aim of this study was to determine if high circulating levels of thyroid hormone have adverse effects on the fetus in pregnant women with the syndrome of resistance to thyroid hormone (RTH). In this syndrome, circulating levels of thyroid hormone are high, but serum TSH levels are normal (rather than suppressed, as would be expected). ? The authors asked whether the high serum thyroid hormone levels increased miscarriage rates in these pregnant p39。ts even though they had normal serum TSH levels and were euthyroid. The analogous (and much more mon) model for this situation is subclinical hyperthyroidism during pregnancy. HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 19 ? The authors retrospectively pared miscarriage rates in 9 women with the syndrome (high serum free thyroxine and triiodothyronine levels with normal TSH concentrations) with rates in unaffected relatives. Affected women had a miscarriage rate of % pared with % (P ) in unaffected relatives. Furthermore, the pregnancies of affected women may result in a healthy, unaffected infant or an infant with the syndrome, depending on whether the abnormal gene is transmitted to the infant. ? In this study, healthy infants born to women with the syndrome had lower birthweights than those of affected infants. Also, the healthy infants had suppressed TSH levels, whereas the affected infants had detectable serum TSH levels. ? Thus, the high thyroid hormone levels were nonphysiologic (as indicated by the suppressed TSH levels) and deleterious to the oute of the pregnancy. ? The authors concluded that the high thyroid hormone levels that are characteristic of the syndrome are toxic to the fetus and cause a high miscarriage rate. Presumably only fetuses unaffected by the RTH receptor mutation would be vulnerable. JAMA. 2022。292:6915. HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 20 ? Although the syndrome of RTH is rare, it is probably a good model for the effects of a much more mon problem, subclinical hyperthyroidism.― ? In the United States, subclinical hyperthyroidism is most monly due to iatrogenic overdose with Lthyroxine. ? We know that mild deficiency of thyroid hormone (subclinical hypothyroidism) has an adverse effect on infant intelligence and is associated with increased rates of fetal loss. ? Elegantly employing the model of RTH in pregnancy, this study also demonstrates the potential for fetal loss in subclinical hyperthyroidism. ? Pregnant women may also be at risk if they have inadequately treated hyperthyroidism associated with Graves disease or nodular goiters. JAMA. 2022。292:6915. HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 21 Periodic Thyroid Screening Is indicated for Men Receiving Therapy for Hepatitis C (Arch intern Med. 2022。164:23716. ) ? Women who receive interferon and ribavirin for hepatitis C virus (HCV) infection are at increased risk for thyroid dysfunction. This study examined the frequency and outes of thyroid dysfunction caused by HCV therapy in men undergoing bination Tx with interferon 2b and ribavirin. The study39。s purpose was to determine whether HCV Tx poses the same risk to men as it does to women. ? The protocol consisted of prospective screening of serum TSH levels every 12 weeks in 225 HCVinfected men during therapy with interferon 2b (3 million U SC 3 times per week) and ribavirin (1 to g orally once daily) for 24 to 48 weeks. Overt hypothyroidism was defined as a serum TSH level greater than mIU/L with low concentrations of serum thyroxine and triiodothyronine。 subclinical hypothyroidism was defined as a serum TSH level greater than mIU/L with normal levels of serum thyroxine and triiodothyronine. HLJ 業(yè)精于勤荒于嬉 行成于思?xì)в陔S →【醫(yī)學(xué)生物 PPT，歡迎收藏分享】網(wǎng)友 22 ? Overt or subclinical thyroid disease developed in % and 4% of the participants, respectively. ? Antithyroid antibodies were detected in p39。ts with overt hypothyroidism, and antibodies against the TSH receptor were detected in two thirds of p39。ts with overt hyperthyroidism. ? After therapy with interferon 2b and ribavirin was discontinued, 10 of 12 overtly hypothyroid p39。ts, 2 of 3 over