骨化三醇在桥本甲状腺炎甲状腺功能减退症患者中的应用

Application of calcitriol in Hashimoto's thyroiditis patients with hypothyroidism

目的探讨常规替代治疗基础上联合使用骨化三醇胶丸对桥本甲状腺炎(HT)伴甲状腺功能减退患者甲状腺激素及自身抗体的影响。方法选择2014年1月至2015年12月河南省永煤集团总医院收治的128例HT伴甲状腺功能减退患者,根据患者治疗意愿分为观察组(65例)和对照组(63例),并选择同期60例健康体检者为正常组。正常组受试者不予治疗,对照组患者口服左旋甲状腺素片,观察组患者在对照组治疗基础上加用骨化三醇胶丸,疗程均为16周;检测观察组、对照组患者治疗前后和正常组受试者血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、抗甲状腺过氧化物酶抗体(TPOAb),同时检测抗甲状腺球蛋白抗体(TGAb)和1,25-羟维生素D_3[1,25-(OH)_2D_3]水平,并对检测结果进行比较。结果治疗前,观察组、对照组患者血清FT_3、FT_4、TSH、TPOAb、TGAb和1,25-(OH)D_3比较差异均无统计学意义(P>0.05);观察组、对照组患者血清FT_3、FT_4、1,25-(OH)_2D_3均显著低于正常组,TSH、TPOAb、TGAb均显著高于正常组(P<0.05)。治疗16周后,观察组、对照组患者FT_3、FT_4、1,25-(OH)_2D_3均较治疗前显著升高,TSH、TPOAb、TGAb均较治疗前显著下降(P<0.05);观察组患者治疗后FT_3、FT_4、1,25-(OH)_2D_3显著高于对照组,TSH、TPOAb、TGAb显著低于对照组(P<0.05);与正常组比较,观察组和对照组治疗后FT_3、FT_4、1,25-(OH)_2D_3均达到正常组水平,差异均无统计学意义(P>0.05),但TSH、TPOAb、TGAb指标仍高于正常组(P<0.05)。结论 HT合并甲状腺功能减退患者普遍存在低维生素D血症;替代治疗基础上加服骨化三醇胶丸有助于改善低维生素D血症,提高甲状腺激素水平,降低甲状腺自身抗体水平。

Objective To explore the effect of regular replacement therapy combined with calcitriol capsule on the thyroid hormone and autoantibodies of Hashimoto＆#39;s thyroiditis （HT） patients with hypothyroidism.Methods One hundred and twenty HT patients with hypothyroidism in General Hospital of Henan Yong Coal Group from January 2014 to December 2015 were selected and divided into observation group （n =65） and control group （n =63） according to the treatment willingness of the patients.At the same period,60 healthy subjects were selected as normal group.The subjects in normal group did not give intervention;the patients in control group were given L-thyroxine orally;the patients in observation group were given L-thyroxine and calcitriol capsule;the course of treatment was 16 weeks.The serum thyroid stimulating hormone （TSH）,three free iodine thyroid former glycine （FT3）,free thyroxine （FT4）,resistance to thyroid peroxidase antibody （TPOAb）,anti thyroglobulin antibody （TGAb） and 1,25-（OH） 2D3 levels of patients in the observation group and control group before and after treatment and subjects in the normal goup were detected.Results Before treatment,there was no statistic difference in the serum levels of FT3,FT4,TSH,TPOAb,TGAb and 1,25-（OH） 2D3 between the observation group and control group （P 〉 0.05）.The serum levels of FT3,FT4,1,25-（OH） 2D3 of patients in the observation group and control group were significantly lower than those in the normal group;but the TSH,TPOAb,TGAb levels were significantly higher than those in the normal group （P 〈 0.05）.After 16 weeks treatment,the FT3,FT4,1,25-（OH）2D3 levels of patients in the observation group and control group were significantly higher than those before treatment;the TSH,TPOAb,TGAb levels were significantly lower than those before treatment （P 〈 0.05）;there was no statistic difference in the FT3,FT4,1,25-（OH） 2D3 levels of patients between observation group,control group and normal group （P 〉 0.05）;the TSH,TPOAb,TGAb level of patients in the observation group and control group were significantly higher than those in the normal group （P 〈 0.05）.Conclusion Hypovitaminosis D is common in HT patients with hypothyroidism.The replacement therapy combined with calcitriol capsule can improve hypovitaminosis D,improve the level of thyroid hormone,and decrease the thyroid autoantibodies.