血清25-羟基维生素D与甲状旁腺激素及骨标志物关系的相关研究

Relationship among Serum 25 Hydroxyvitamin D,Parathyroid Hormone and Bone Markers

目的 探讨25-羟基维生素D[25（OH）D]与甲状旁腺激素（PTH）的变化关系,以及对骨代谢的影响.方法 排除影响维生素D（VD）,PTH以及骨代谢的情况,选取2013年10月～2014年5月门诊就诊的757例研究对象,年龄52.88±14.23岁.按照25（OH）D浓度不同分成4组,按照PTH水平不同分成2组.检测血清中25（OH）D,PTH,Ca,P,tPINP,β-CTX和OC的水平.对25（OH）D与PTH进行相关分析,对不同分组方式下各参数进行比较和统计分析.结果 在整个研究范围内25（OH）D浓度介于3.07～42.46 ng/ml,血清25（OH）D与PTH均呈现负相关关系（r=-0.214,P＜0.001）.但是对于25（OH） D＜30 ng/ml的研究对象,其PTH升高的比例是10.30％;＜20ng/ml的研究对象,其PTH升高的比例仅有10.91％;＜12 ng/ml的研究对象,其PTH升高的比例也只有13.04％.随着25（OH）D缺乏程度的加重,PTH高于正常参考范围的比例并没有明显增加.控制年龄和性别的影响,协方差分析显示两种分组方式下骨标志物的变化差异均无统计学意义（F=0.001～3.951,P值均＞0.05）.根据IOM的分类标准,VD的缺乏率高达52％,VD的不足率达到34％,能达到VD充足标准的比例只有14％.结论 25（OH）D与PTH的水平呈负相关.PTH在反映25（OH）D缺乏程度方面作用有限.VD缺乏现象较普遍,应引起临床的重视.

Objeetive To explore the changes in the relationship between 25（OH）D and PTH,as well as their effects on the bone metabolism. Methods 757 outpatients aged 52.88±14.23 years in average were selected from October 2013 to May 2014. The subjects which had the diseases or conditions that could alter VD, PTH and bone metabolism were eliminated. Ac- cording to the concentration of 25 （OH）D or PTH, 757 outpatients were divided into 4 or 2 groups separately. Serum 25 （OH） D, PTH as well as serum calcium, phosphorus, tPINP, β-CTX, OC were examined. Pearson＇ s correlation coefficent was used to analyze the relationship between 25（OH）D and PTH. Statistical analysis was performed to analyze the differences between parameters in different grouping patterns. Results During the whole range of study!which the concentration of 25 （OH）D was from 3.07 ng/ml to 42.46 ng/ml,Serum 25（OH）D was negatively correlated with PTH（r=-0. 214,P〈0. 001）. But the percentage of elevated PTH was 10.30% in the subjects with a 25（OH）D〈30 ng/ml. Only 10.91% of sub jects with a 25（OH）D〈20 ng/ml had an elevated PTH. Even the level of 25（OH）D had been below 12 ng/ml,the percent age of elevated PTH was only 13.04 %. With the increased ratios of low 25 （OH）D levels, the proportions of PTH higher than the reference range had no obvious increase. Controlling the influence of age and gender. No statistical difference used ANCOVA was found in the levels of bone markers between groups in 2 grouping patterns （F= 0. 001 - 3. 951, P〉0.05）. According to the standard of IOM, the incidence of vitamin D deficiency reached up to 52 %, the incidence of vitamin D insuf- ficiency was 34%. While the incidence of sufficiency was only 14%. Conclusion Serum 25（OH）D was negatively correlated with PTH. The role of PTH which reflecting the status of 25（OH）D deficiency was limited. Vitamin D deficiency was very common which should be paid attention to by clinical doctors.