问题 多项选择题 案例分析题

患者女,22岁。单位体检发现甲功异常,查体:甲状腺不大。实验室检查:TSH6.15mIU/L(0.35~4.94mIU/L),FT412.78pmol/L(9.01~19.05pmol/L),FT33.14pmol/L(2.63~5.70pmol/L),TPOAb4.94(0~5.61IU/ml),TGAb2.28(0~4.11IU/ml),两个月后复查甲功,TSH5.87mIU/L,FT413.17pmol/L,FT32.96pmol/L。

该疾病对人体的主要危害是()

A.发展为临床甲减

B.血脂代谢异常

C.骨质疏松症

D.妊娠期亚临床甲减会对后代智力产生影响

E.无特殊危害

F.是缺血性心脏病的危险因素

答案

参考答案:A, B, D, F

解析:

1.FT4、FT3正常,TSH高,诊断亚临床甲状腺功能减退症。

2.患者存在抗TSH的自身抗体可使TSH假性升高;低T综合征的恢复期可出现TSH升高,可能是机体对应激的一种调整;糖皮质激素缺乏可导致TSH轻度升高;部分终末期肾病患者可出现TSH升高,可能与TSH清除减慢、过量碘摄入、结合于蛋白的甲状腺激素丢失有关;中枢性甲减的25%病例可出现TSH升高(5~10mIU/L);暴露寒冷中9个月,血清TSH升高30%~50%。

3.亚临床甲减的危害主要是血脂代谢异常及其导致的动脉粥样硬化、发展为临床甲减、对妊娠妇女的后代智力造成影响,另外有研究显示亚临床甲减是缺血性心脏病的独立危险因素。

4.患者已发展为临床甲减,应予L-T治疗。

5.临床甲减妇女怀孕后,L-T的替代剂量需要增加25%~30%。

阅读理解

As the railroads and the highways shaped the American West in the past centuries, a new electrical generating(发电)and transmission (输送) system for the 21st century will leave a lasting mark on the West, for better or worse. Much of the real significance of railroads and highways is not in their direct physical effect on the scenery, but in the ways that they affect the surrounding community. The same is true of big solar plants and the power lines that will be laid down to move electricity around.

The 19 th century saw land grants(政府拨地) offered to railroad companies to build the transcontinental railroads, leaving public land in between privately owned land. In much of the West, some of the railroad sections were developed while others remained undeveloped, and in both cases the landownership has presented unique challenges to land management. With the completion of the interstate highway system, many of the small towns, which sprang up as railway stops and developed well, have lost their lifeblood and died.

Big solar plants and their power lines will also have effects far beyond their direct footprint in the West. This is not an argument against building them. We need alternative energy badly, and to really take advantage of it we need to be able to move electricity around far more readily than we can now.

So trade-offs will have to be made. Some scenic spots will be sacrificed. Some species(物种) will be forced to move, or will be carefully moved to special accommodations. Deals will be struck to reduce the immediate effects.

The lasting effects of these trade-offs are another matter. The 21st century development of the American West as an ideal place for alternative energy is going to throw off a lot of power and money in the region. There are chances for that power and money to do a lot of good. But it is just as likely that they will be spent wastefully and will leave new problems behind, just like the railroads and the highways.

The money set aside in negotiated trade-offs and the institutions that control it will shape the West far beyond the immediate footprint of power plants and transmission lines. So let’s remember the effects of the railroads and the highways as we construct these new power plants in the West.

小题1:What was the problem caused by the construction of the railways?

A.Small towns along the railways became abandoned.

B.Land in the West was hard to manage.

C.Some railroad stops remained underused.

D.Land grants went into private hands.小题2:What is the major concern in the development of alternative energy according to the last two paragraphs?

A.The use of money and power.

B.The transmission of power.

C.The conservation of solar energy.

D.The selection of an ideal place.小题3:What is the author’s attitude towards building solar plants?

A.Disapproving.

B.Approving.

C.Doubtful.

D.Cautious.小题4:Which is the best title for the passage?

A.How the Railways Have Affected the West

B.How the Effects of Power Plants Can Be Reduced

C.How Solar Energy Could Reshape the West

D.How the Problems of the Highways Have Been Settled

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