住院Graves病患者骨代谢状况与131I治疗后转归分析

The analysis of bone metabolism in hospitalized patients with Graves disease and the changes after ^(131)I therapy

目的分析住院Graves病患者骨代谢状况及^(131)I治疗后骨代谢指标的转归。方法收集315例Graves病住院患者的临床资料,分析骨代谢特点,并与300例健康人群进行病例对照研究。随访^(131)I治疗后1年的Graves病患者60例,分析治疗前后骨代谢指标的变化。结果与健康对照人群相比,Graves病患者骨转化指标(OCN、P1NP、β-cTX、尿钙/肌酐)增高,骨密度(bone mineral density,BMD)降低,甲状腺激素水平与骨转化指标呈正性相关,与全髋BMD(Z值)呈负性相关,与腰椎、股骨颈BMD(Z值)则未见线性相关。^(131)I治疗后1年的Graves病患者骨转化指标较治疗前明显下降,BMD部分上升。结论 Graves病患者骨转化增快,BMD下降,^(131)I治疗后随着病情好转,高骨转化速率得到遏制,BMD部分恢复。

Objective To analyze the bone metabolism in hospitalized patients with Graves disease and the changes after 131I therapy. Methods The differences of bone metabolism were analyzed between 315 patients with Graves disease and 300 normal controls in a case-control study. The changes in bone turnover markers and BMD levels before and one year after 131I therapy were observed in 60 patients. Results Compared to normal control, bone turnover markers were markly higher and BMD levels were lower in patients with Graves disease. The level of thyroid hormones were positively related to bone turnover markers, while negatively related to total hip BMD （Z-score）. But there was no linear relationship with lumbarand femoral neck BMD （Z-score）. After one year of 131I therapy,bone turnover markers were markly lower than that before treatment, while BMD levels were partly higher than that before treatment. Conclusions In Graves disease patients, bone turnover markers were generally increased, while BMD levels decreased compared with normal people. After 131I therapy, along with the improvement of thyrotoxicosis, the high bone turnover rate can be suppressed, and BMD can partly recover.