甲状腺功能亢进症患者治疗前后血清骨钙素和β-胶原特殊序列的变化

Changes of serum osteocalcin and β-cross laps in patients with hyperthyroidism before and after treatment

目的观察甲状腺功能亢进症患者治疗前后血清骨代谢指标变化,以了解甲状腺功能亢进症骨代谢及骨转换率特点。方法随机选取46例初诊原发性甲状腺功能亢进症患者,均用甲巯咪唑治疗,治疗前及治疗后2个月采集空腹静脉血,用电化学发光免疫分析法(ECLIA)测定血清骨钙素(OCN)、β-胶原特殊序列(β-CTx)及甲状腺功能指标,并与30例健康对照组进行比较。结果甲状腺功能亢进症患者治疗前后血清OCN、β-CTx均显著高于对照组(P<0.000),治疗前分别增加1.74倍、1.80倍,治疗后分别增加2.26倍、2.16倍;治疗前各指标相关分析显示,血清FT3水平与OCN浓度呈正相关(P<0.05),FT4水平与OCN、β-CTx浓度呈正相关(P<0.05),血清OCN与β-CTx浓度呈正相关(P<0.01)。治疗早期(2个月)血清OCN、β-CTx水平较治疗前进一步升高,差异无统计学意义(P>0.05)。结论高骨转换速率是甲状腺功能亢进症患者骨代谢的显著特征。原发性甲状腺功能亢进症患者治疗前骨代谢可能以破骨细胞活动占优势,是甲状腺功能亢进症骨代谢异常的主要原因。甲状腺功能亢进症治疗早期骨吸收和骨形成指标较治疗前均增高,但骨形成指标增幅大于骨吸收指标,提示甲状腺功能亢进症治疗早期可能以成骨细胞活动占优势,有利于骨重建。

Objective To investigate the changes of bone metabolism markers in patients with hyperthyroidism before and after treatment and the characteristics of bone turnover rate.Methods Forty-six patients with hyperthyroidism and thirty healthy controls were included into this study.Electrochemical luminescence immunoassay（ECLLA） method was used to measure serum osteocalcin and β-cross laps levels in all the hyperthyroid patients before and after antithyroid （methimazole） therapy and thirty healthy volunteers.Results The mean concentrations of both osteocalcin and β-cross laps in hyperthyroid patients before and after treatment were significantly higher than those in the healthy subjects （P ＜ 0.000）,increased by 1.74 folds and 1.80 folds respectively before treatment and 2.26 folds and 2.16 folds respectively after treatment.The correlation analysis showed that the serum FT3 was positively correlated with osteocalcin （P ＜ 0.05） and FT4 was positively correlated with osteocalcin and β-cross laps （P ＜ 0.05） before methimazole treatment.The serum osteccalcin was positively correlated with β-cross laps （P ＜ 0.01）as well.Compared with the untreated hyperthyroidism group,serum osteocalcin and β-cross laps were further increased after methimazole treatment for 2 months （P ＞ 0.05）.Conclusions High bone turnover rate characterizes the bone metabolism in the patients with hyperthyroidism.The activity of bone may dominant with esteoclast resulting in abnormal bone metabohsm in the untreated hyperthyroidism patients.However,in the patients who under treatment,both bone resorption and bone formation were further increased and bone formation were more prominent,which suggested that the osteoblast activity dominant the whole progress in favor of bone remodeling.