老年女性甲状腺功能减退的骨代谢改变

Changes on Bony Metabolism of Old Females with Hypothyroidism

目的 通过观察青年、老年健康女性及老年女性原发性甲状腺功能减退 (甲减 )患者的骨代谢指标的变化 ,探讨增龄、绝经及甲减对骨代谢的影响。方法 分别测定 3 0例女性青年、40例女性老年健康人及 3 0例老年女性甲减患者的骨密度 (BMD) ,血清雌二醇 (E 2 )、碱性磷酸酶 (ALP)、骨钙素 (BGP)、酸性磷酸酶 (ACP)、降钙素 (CT)、甲状旁腺激素 (PTH)、钙 (Ca)、磷 (P)等进行比较。结果 老年甲减组的股骨颈、股骨三角、股骨粗隆和腰椎较青年及老年健康组BMD均低 ,差异有显著性 ,老年甲减组血清ALP ,BGP ,CT较老年健康组低 (P <0 .0 5 ) ,血清ALP ,BGP与游离甲状腺素 (FT4)呈显著正相关 ,与血清促甲状腺素 (TSH)呈显著负相关。结论 BMD减低的原因不仅与增龄、绝经有关 ,原发性甲减时BMD减低还可能是肠钙吸收减少 ,骨形成缓慢 ,骨吸收增加共同作用的结果。

Objective To discuss the influences of aging, menopause and hypothyroidism on bony metabolism through observing its changes among the healthy young and old females, and the primarily hypothyroid old females. Methods Indexes, such as bone mineral density (BMD), serum estradiol (E2), alkaline phosphatase (ALP), osteocalcin or bone Gla protein (BGP), acidic phosphatase (ACP), calcitonin (CT), parathyroid hormone (PTH), calcium (Ca) and phosphorus (P), were measured respectively in 30 young and 40 healthy old females, and in 30 old females with hypothyroidism.Results BMD in the femoral neck, triangle and carina, and lumbar vertebrae was lower in the old females with hypothyroidism than that in the other two groups. The serum ALP, BGP and CT of the old females with hypothyroidism were lower than that of the healthy old females. The differences above were significant (P<0.05). There were a positive correlation between serum ALP or BGP and free tetraiodothyronine (FT4), and a negative correlation between ALP or BGP and serum thyrotropin (TSH).Conclusion BMD diminution is correlative not only with aging and menopause, but also with the collective influences of low calcium absorption, slow bone formation and increasing bone absorption in primary hypothyroidism.