Objective To investigate the current status of screening and management of thyroid diseases during pregnancy,and to provide evidence for further improvement of clinical management.Methods Clinical data of 5 981 pregnant women who delivered at Peking University First Hospital between September 1,2013 and September 30,2014 were analyzed retrospectively.Their average age was (30±4) years (18-47 years) and average gestational week was (39.2± 1.6) weeks (25.5-42.0 weeks).The reference range of thyroid stimulating hormone (TSH) was 0.1-2.5 mU/L recommended by the American Thyroid Association (ATA).The reference range of free thyroxine (FT4) was 11.48-22.70 pmol/L and the cut-off value of thyroid peroxidase antibody (TPOAb) was 34 U/ml both recommended by the kit.The specific reference range of TSH was obtained from normal pregnant women in this study (0.23-4.08 mU/L in the first trimester).Pregnant women with hypothyroidism were divided into two groups according to their TSH level at the first trimester:TSH ≥ 2.5-＜4.08 mU/L group and TSH ≥ 4.08 mU/L group.T test,Chi-square or Fisher's exact test were applied for statistical analysis.Results (1) Screening status:Of the 5 981 pregnant women,there were 13 cases (0.2％) of hyperthyroidism and 146 cases (2.4％) of hypothyroidism diagnosed before conception (133 cases of Hashimoto thyroiditis,eight cases after operation for thyroid cancer,and five cases after 131I therapy because of hyperthyroidism).Among the 5 822 cases requiring screening,4 044 cases (69.5％) received screening tests of TSH,FT4 and TPOAb during early pregnancy according to Chinese Guidelines,and 1 778 cases received neither standard screening nor screening test.(2) Treatment of hypothyroidism:Hypothyroidism treatment rate was only 61.5％ (107/174) according to the reference range recommended by the ATA,lower than that of 88.1％ (52/59) according to the reference range of this study (x2=14.430,P＜0.05).There were 60 cases receiving no treatment in TSH ≥ 2.5-＜4.08 mU/L group.Forty-three of these cases were reexamined,and one of them was abnormal,with a rate of 2.3％ (1/43).There were seven cases without treatment in TSH ≥ 4.08 mU/L group;six of them were reexamined among which one was abnormal,with a rate of 1/6.(3) Thyrotoxicosis:Among the 4 044 pregnant women,99 cases had TSH ＜0.1 mU/L,including 11 cases with FT4 ≥ 22.70 pmol/L (22.82-60.96 pmol/L).Only three cases were positive for thyrotrophin receptor antibody,and then diagnosed as hyperthyroidism and treated with propylthiouracil.(4) Thyroid cancer:Among the 5 981 pregnant women,six cases were diagnosed as thyroid cancer during pregnancy and lactation,with an incidence of 100.3/100 000.Of the six cases,five were diagnosed during pregnancy,and one at one month postpartum.All of the six cases underwent operation and were confirmed to be papillocarcinoma by pathology.Conclusions The screening rate of thyroid diseases during pregnancy is high,but the clinical management is not fully standardized.We suggested that each center should established its own normal reference range for thyroid function test.The incidence of thyroid cancer during pregnancy is increasing,thus attention should be paid to its diagnosis.

Objective To explore the effects evaluation of extended care after “one-day care” for delivery women with gestational diabetes mellitus ( GDM ) . Methods From May to September 2013 in Department of Gynaecology and Obstetrics Peking University First Hospital, a total of 354 GDM pregnant women participated “one-day care” and then they were divided into experimental group (171 cases) and control group (183 cases) according to whether attended the extended care. Using repeated variance analysis measurement, the fasting blood glucose and postprandial 2h blood glucose values were compared whether the values had statistical significance between two groups at different visit time. Results The uterine-incision rates were 48. 55%(83/171) and 49. 7%(91/183) in the experimental group and control group respectively, and the incidence of giant babies were 9. 4%(16/171) and 12. 0%(22/183) respectively in the experimental group and control group (P>0. 05). The time point of before visit, during visit and last visit in the experimental group, the fasting blood glucose and postprandial 2 h blood glucose were lower than that of the control group (P<0. 05). Conclusions “One-day care” for GDM can reduce the blood glucose level of GDM delivery women, but it has not significant effects on the control of gestation′s body weight and to decline the uterine-incision rate and incidence of giant babies.

Objective:To investigate the knowledge understanding of blood glucose control standards, food exchange usage, and blood glucose self monitoring among gestational diabetes mellitus(GDM) patients who participated in one-day outpatient management before and after the participation and to draw up a dietary guidance scheme for GDM patients to accept, understand and carry out the scheme easily. Methods:Totally 214 GDM patients who participated one-day outpatient management were investigated by unified questionnaires about the GDM knowledge before and after the participation. Results:About 97.2% GDM patients did not know the blood glucose controlstandards and 97.3% GDM patients did not know how to use food exchange and how to monitor blood glucose by themselves before participating one-day outpatient service. Totally 95.2% GDM patients finally made sense of the above methods after the participation. Conclusion:Almost all the GDM patients have insufficient knowledge about GDM regardless of their educational backgrounds. However, one-day outpatient management is a beneficent attempt to help GDM patients to study self-management methods and a new guidance mode in GDM comprehensive management.

急性胰腺炎(acute pancreatitis, AP)是临床常见的急腹症之一.老年人胰腺炎的发病率逐渐增多,急性重型胰腺炎(severe acute pancreatitis, SAP)的比例较高.现将我院收治AP患者的5年病历进行回顾性分析,比较老年AP患者与非老年AP患者临床特点,探讨老年患者的临床特征,为改善老年AP患者的预后提供参考.