原发性甲状旁腺功能亢进症患者骨密度及胫骨超声速率的改变

Changes of bone mineral density in the lumbar and the femur and speed of sound in tibia in patients with primary hyperparathyroidism

目的:通过分析北京协和医院收治的原发性甲状旁腺功能亢进症(PHPT)患者的临床资料,探讨我国PHPT患者骨密度(bonemineraldensity,BMD)及胫骨超声速率(speedofsound,SOS)的改变。方法:1994年至2005年12月在北京协和医院收治的经生化检查及手术病理证实的PHPT患者101例,在甲状旁腺手术前行双能X线骨密度仪(DXA)测定BMD或胫骨SOS测定,其中83例行BMD检测,30例行胫骨SOS检测;12例同时行两项检测。结果:本组患者术前第2～4腰椎、股骨颈、Ward三角及大转子部位BMD的T分数分别为-2.85±1.48、-2.46±0.98、-2.72±0.86及-2.00±1.00,Z分数分别为-2.05±1.67、-1.95±1.27、-1.89±1.32及-1.85±1.50;胫骨SOS的T分数、Z分数分别为-11.80±6.28及-8.38±5.76。胫骨SOS的T分数、Z分数显著低于腰椎及股骨上端BMD的T分数、Z分数(P<0.01)。胫骨SOS与腰椎、股骨上端BMD的T分数、Z分数间的相关系数为0.637～0.821(P<0.05)。甲状旁腺手术后BMD较术前有明显改善(P<0.01)。结论:在PHPT患者中存在骨量减少,甲状旁腺手术可有效改善BMD。DXA测定的腰椎和股骨上端BMD及骨超声仪测定胫骨SOS均可反映PHPT患者的骨量丢失,联合测定胫骨SOS值可能有利于更早、更灵敏地发现PHPT患者骨骼系统的病变。

Objective To investigate the changes of bone mineral density （BMD） and speed of sound （SOS） in the tibia of primary hyperparathyroidism （PHPT） patients through retrospective analysis of clinical data from Peking Union Medical College Hospital （PUMCH）. Methods One hundred and one patients were diagnosed as PHPT by biochemistry and proved by pathology in PUMCH from 1994 to 2005. BMD in the lumbar and the proximal femur was measured by dual X-ray absorptionmetry（DXA） in 83 patients. SOS in the tibia was measured by ultrasound in 30 patients. Both BMD and SOS were examined in 12 patients before the operation. Results The T-scores of BMD in the L2.4, the neck, the Ward＇s triangle and the trochanter were -2.85±1.48, -2.46±0.98, -2.72±0.86 and -2.00±1.00, respectively, and the corresponding Z-scores were -2.05±1.67, -1.95±1.27, -1.89±1.32 and -1.85±1.50, respectively. The T-scores and Z- scores of the tibial SOS were -11.80±6.28 and -8.38±5.76, respectively, which were significantly lower than those of BMD in the lumbar and the femur（P〈0.01 ）. The correlation coefficients of the T-scores and Z-scores between the tibial SOS and the lumbar or the proximal femur were 0.637-0.821 （P〈0.05）. BMD values were significantly improved after parathyroidectomy compared with that before the operation （P〈0.01）. Conclusions The level of bone turnover markers increase and the bone mass decrease in patients with PHPT. BMD could be improved by parathyroidectomy. Both BMD in the lumbar and the femur and SOS in the tibia may reflect the loss of borie mass, their combined use may early and more sensitively detect the skeletal disorders in the patients with PHPT.