瘦素在Graves’病骨代谢中作用的探讨

Role of leptin in the bone quantity in Graves' disease

目的探讨血清瘦素(leptin)在Graves’病发病中的水平变化及在Graves’病骨代谢紊乱发生中的作用。方法选取Graves’病58例为GD组,健康对照58例为正常组。采用双抗体夹心ELISA法测定血清leptin水平,并采用UBIS5000型定量超声仪测定各组的跟骨定量超声参数,包括振幅衰减(BUA)、超声波传导速度(SOS)、骨硬度指数(STI)及T评分。结果同性别两组间体重指数(BMI)及体脂百分比比较无统计学差异。GD组leptin水平及其各项骨超声参数值均较正常组同性别低(P<0.05)。两组的leptin水平皆与BMI呈显著正相关(P<0.05)。GD和正常组的骨超声参数BUA与BMI及leptin均呈显著正相关(P<0.05),且GD组的BUA与FT4呈显著负相关(P<0.05)。经多元逐步回归分析发现,GD组中BMI及血清leptin与BUA呈正相关,而血清FT4与BUA呈负相关(P<0.0001)。结论Graves’病患者发病中血清leptin水平的下降可介导Graves’病的骨量降低,leptin可作为监测Graves’病及其骨病发生、发展的参考指标,并为Graves’病及其骨病的干预治疗提供新途径。

Objective To investigate the change of serum leptin level in patients with Graves＇ disease（GD） , and to explore its effect on bone metabolism. Methods Fifty-eight patients with Graves＇ hyperthyroidism and 58 body mass index （BMI）-matched healthy controls were enrolled in the study. Serum leptin level was measured by enzyme-linked immunosorbent assay（ELISA）. Bone mass was measured by UBIS 5000 quantitative ultrasound （QUS） , such as broadband ultrasound attenuation（ BUA ）, sound of speed （SOS）, stiffness （STI） , and T score. Results Serum leptin levels and calcaneal parameters value in GD group were significantly lower than those in normal control group（ P 〈 0.05 ）. Serum leptin levels were positively correlated with BMI in GD patients and normal controls（ P 〈 0.05 ）. BUA was positively correlated with BMI and leptin in GD patients and normal controls （ P 〈 0.05 ） , and negatively correlated with FT4 in GD patients （P 〈 0.05 ）. Multivariate regression analysis showed that BUA was negatively correlated with FT4, but positively correlated with BMI and leptin in GD patients（ P 〈 0. 0001 ）. Conclusion The results suggest that the decrease of leptin level might induce the bone loss in Graves＇ hyperthyroidism patients. Leptin may be the predictors for severity of Graves＇ hyperthyroidism and its bone loss.