原发性骨质疏松症患者重组人甲状旁腺素治疗前后性激素结合球蛋白水平分析

Changes of serum sex hormone binding globulin levels in osteoporosis patients after treatment with recombinant human parathyroid hormone

目的观察原发性骨质疏松症患者重组人甲状旁腺素[rhPTH(1-34)]治疗前后血清性激素结合球蛋白(SHBG)水平的变化,并分析其与rhPTH(1-34)治疗骨质疏松症效果的相关性。方法收集老年原发性骨质疏松症患者20例及健康体检者30例,原发性骨质疏松症患者进行rhPTH(1-34)治疗。分别于治疗前及治疗1年后检测血清SHBG水平、生化指标、性激素水平及腰椎(L_(2-4))骨密度(BMD),并对各项检测指标进行相关性分析。结果经rhPTH(1-34)治疗后,腰椎(L_(2-4))BMD值、T值较治疗前明显增加(P<0.05或0.01),血磷、碱性磷酸酶(ALP)及雌二醇(E_2)水平明显增高(P<0.05或0.01);血钙、促卵泡生成素(FSH)、睾酮(TT)、促黄体生成素(LH)、甘油三酯(TG)和胆固醇(TC)等指标治疗前后均无显著变化(均P>0.05)。原发性骨质疏松症患者SHBG水平与正常对照组比较明显增高(P<0.05),经rhPTH(1-34)治疗1年后SHBG水平明显降低(P<0.05)。SHBG与BMD值、T值、E_2水平变化呈明显负相关(r=-0.78、-0.67、-0.53,均P<0.01)。结论原发性骨质疏松症患者经rhPTH(1-34)治疗后,血清SHBG水平显著下降,推测SHBG参与原发性骨质疏松症的形成过程,并在rhPTH(1-34)治疗中发挥重要作用。

Objective To investigate the changes of serum sex hormone binding globulin（SHBG） levels in primary osteo-porotic patients after treatment with recombinant human parathyroid hormone rhPTH （1- 34）. Methods Twenty elderly patients with osteoporosis were recruited and treated with rhPTH （1- 34）. The serum SHBG level, biochemical index, sex hormone levels, and lumbar bone mineral density （L2-L4） were detected before and 1 year after treatment. And the correlations of these indexes were analyzed. Results After rhPTH （1- 34） treatment the BMD of lumbar spine （L2-L4） and the T value increased （P〈0.05 or 0.01）;the serum phosphorus and ALP levels were also significantly increased（P〈0.05 or 0.01）, SHBG and E2 levels were reduced （P〈0.05）;while there were no significant differences in FSH, calcium, TT, LH, triglyceride and cholesterol levels before and after treatment （P〉0.05）. SHBG levels of patients with primary osteoporosis were significantly increased compared with normal con-trols（P〈0.05） and were significantly decreased one year after treatment（P〈0.05）. The serum level of SHBG was negatively cor-related with BMD, T values and E2 （r=- 0.78, r=- 0.67 and r=- 0.53, P〈0.01）. Conclusion After effective treatment with rhPTH （1- 34）, the level of SHBG of primary osteoporosis patients is decreased significantly, which indicates that SHBG may be involved in the pathogenesis of primary osteoporosis and also associated with the efficacy of rhPTH （1- 34） treatment.