甲状腺功能亢进症与骨代谢相关性分析

Correlative Analysis of Bone Metabolism in Patients with Hyperthyroidism

目的:观察甲状腺功能亢进症(甲亢)对患者骨密度及骨代谢相关指标的影响。方法:采用双能X线骨密度仪测定200例甲亢患者及50名正常对照人群的腰椎、桡骨远端及髋部骨密度(BMD),并测定血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、甲状旁腺素(PTH)、降钙素(CT)及骨钙素(osteocalcin,BGP)等指标。比较两组间骨密度、血清骨代谢指标的差异并分析甲亢与骨代谢之间的相关性。结果:病例组骨密度Z值及血CT均明显低于正常对照组(P<0.05),ALP、BGP、PTH明显高于正常对照组(P<0.05),Ca、P差异无统计学意义(P>0.05)。相关分析显示,甲亢患者骨密度值与游离三碘甲腺原氨酸(FT3)明显相关,与游离甲状腺素(FT4)、促甲状腺素(TSH)有相关趋势,与病程无关。结论:甲亢患者骨代谢紊乱,呈现骨吸收大于骨形成的趋势,容易导致骨量丢失,且骨量丢失的程度与病情严重程度有关,与病程无明显相关。

Objective Through analyze the changes of bone mineral density（BMD） and bone metabolism related indexes in pa- tients with hyperthyroidism to investigate the effects of thyroid function on bone metabolism. Methods Using dual energy X-ray ab- sorptiometry to measure bone mineral density of L24 vertebral body, distal radius and around femur of 200 patients with hyperthyroidism and 50 healthy control people. Meanwhile, detect blood serum calcium （Ca）, alkaline pbosphatase （ALP）, parathyroid hormone （PTH） ,calcitonin（CT） and osteocalcin（BGP） et al. Through compared the difference of BMD and bone metabolism related indexes to get out the relativity in patients with hyperthyroidism. Results Z-score of BbID, and CT were significantly lower in patients compared to controls （ P 〈 0.05）. ALP, BGP and PTH were significantly higher in patients than those in controls （ P 〈 0.05 ）. In the meantime, Ca and P were no significant difference from the controls （P 〉 0.05 ）. There was obvious negative correlation between Fr3 with total Z- score. Conclusion Patients with hyperthyroidism have significant bone metabolism derangement; moreover, the effect of bone resorp- tion is more than that of bone formation and lead to bone loss. The severity of the thyrotoxic state rather than the duration is directly related to the level of bone loss.