甲亢患者治疗前后骨生化指标和骨密度变化的临床研究

A clinical study on changes of bone biochemical parameters and bone mineral density in hyperthyroidism patients before and after treatment

目的了解甲亢病人治疗1年前、后骨生化指标和骨密度的变化,提高对甲亢性骨代谢异常的认识。方法对136例甲亢病人经抗甲状腺药物治疗或加用维生素D(或活性维生素D)和钙剂治疗1年前、后的骨生化代谢指标血钙、磷、碱性磷酸酶、24h尿钙、尿磷以及骨密度进行测定和分析。结果与正常对照组比较,甲亢患者FT3、FT4、ALP和24h尿钙均明显升高,而TSH和骨密度均明显降低;其骨量减少和骨质疏松发生率亦明显增高。治疗1年后,随着甲亢的控制,甲亢患者的血ALP和24h尿钙水平恢复正常;骨密度明显升高,但仍低于正常对照组;其骨量减少与骨质疏松发生率也有不同程度降低;进一步分析发现,加用维生素D(或活性维生素D)和钙剂治疗的患者上述指标改善较单纯抗甲状腺药物治疗者明显。结论甲亢性骨代谢异常是一种高骨转换状态,可以引起骨量减少和骨质疏松。及早并有效地控制甲亢,尤其加用维生素D(或活性维生素D)和钙剂治疗可以纠正这一异常,并有助于改善骨质量。

Aim To study the changes of biochemical parameters,bone mineral density（BMD） in patients with hyperthyroidism before and one year after treatment for better understanding of abnormal hyperthyroidism-related bone metabolism.Methods Bone biochemical parameters such as serum calcium（Ca）,phosphate（P）,alkaline phosphatase（ALP）,calcium and phosphate in the urine for 24 hours（UCa and UP）,and BMD for 136 patients with hyperthyroidism were examined and analysed before and one year after the treatments with either antithyroid drug（ATD）or plus vitamin D3 or active vitamin D[1,25-（OH） 2D3] and calcium supplement.Results Compared to normal patients,blood FT3,FT4,ALP,and 24-hour UCa were higher[（13.33±3.76） vs.（4.94±1.21） pmol/L,（39.43±9.84） vs.（15.00±2.82） pmol/L,（137.57±23.04） vs.（85.37±11.75）IU/L,and（325.46±36.10） vs.（195.67±35.40）mg/24h respectively,P=0.000],while thyroid-stimulating hormone（TSH）（0.12±0.08 vs.2.54±0.41,P=0.000）and BMD（0.94±0.11 vs.1.01±0.08 for males,P=0.006 and 0.93±0.05 vs.0.96±0.07 for females,P=0.043） were markedly lower in the patients with hyperthyroidism and higher incidence rate of both osteopenia and osteoporosis（26.47% vs.5.97% and 22.79% vs.2.99%,P0.005）.After a year of treatment the levels of blood ALP and 24-hour UCa in patients with hyperthyroidism were returned to normal（137.57±23.04 vs.90.13±14.20 IU/L and 325.46±36.10 vs.190.75±26.64mg/24h,P=0.000）.Although BMD was higher in patients with hyperthyroidism than that before treatment,it was still lower（0.98±0.06 vs.1.01±0.08 for males and 0.94±0.03 vs.0.96±0.07 for females,P0.05）than that in the normal.There were,to varied extent,reduced in the incidence rate of both osteopenia and osteoporosis（26.47% vs.16.91%,P0.005 and 22.79% vs.13.24%,P0.005）.Further analysis found that the effects of treatment with addictive vitamin D3 or 1,25-（OH） 2D3 and calcium supplement were better than that with routine ATD（P0.05）.Conclusions Abnormal hyperthyroidism-related bone metabolism is a state of higher bone turnover,which can result in osteopenia and osteoporosis.Effective treatment with hyperthyroidism as early as possible might rectify the abnormality and would beneficial for improvement of bone quality and quantity.