个旧新诊断112例Graves’病患者骨代谢指标分析

Research on the bone metabolism indexes in 112 cases of first diagnosed patients with Graves’ disease in Gejiu

目的探讨个旧地区弥漫性毒性甲状腺肿(GD)患者中骨代谢指标变化及其影响因素。方法测定个旧地区112例初次诊断GD患者的血Ca、P、25(OH)D 、ALP、TRACP、PTH、Cr等指标,分别按照性别、年龄、25(OH)D缺乏程度分组比较,用多因素回归分析25(OH)D的相关影响因素。结果个旧地区GD人群25(OH)D充足、不足、缺乏、严重缺乏的比例分别为17.86%、24.11%、48.21%及9.82%,随血清25(OH)D水平降低,PTH显著升高(P<0.05);TRACP在维生素D不足组最高,在严重缺乏足最低(P<0.05);女性血清25(OH)D及Cr水平低于男性(P<0.05);40岁以下患者、40~60岁患者、60岁以上患者25(OH)D水平组间比较无统计学差异(P>0.05);60岁以下人群血PTH及血Cr显著低于60岁以上人群(P<0.05)多因素线性回归分析提示PTH(B=-7.091,P<0.001)及女性(B=-4.999,P<0.001)与25(OH)D水平负相关。结论个旧地区GD患者普遍存在25(OH)D不足甚至缺乏。女性25(OH)D水平较男性低;血PTH水平随着年龄的增长而增高,PTH水平及女性与25(OH)D水平负相关。加强对本地区GD患者骨代谢指标的早期检测及干预,可能有利于GD患者继发性骨质疏松的有效防治。

Objective To investigate the changes of bone metabolic index and their influencing factors in patients with Graves disease (GD) in Gejiu.Methods 112 cases of patients with newly diagnosed GD in Gejiu were selected.The levels of blood calcium (Ca),phosphorus(P),25-hydroxy vitamin D[25(OH)D],alkaline phosphatase (ALP),tartrate resistant acid phosphatase (TRACP),parathyroid hormone (PTH),creatinine (Cr) and other indicators were detected.Group comparison was made according to gender,age and 25(OH)D deficiency,and multivariate regression analysis was used to analyze the factors affecting 25(OH)D.Results The proportion of 25(OH)D sufficiency,insufficiency,deficiency and severe deficiency in the GD population in Gejiu was 17.86%,24.11%,48.21% and 9.82%,respectively.With the decrease of the level of serum 25(OH)D,PTH was significantly increased (P<0.05).TRACP was highest in the vitamin D insufficiency group and lowest in the severe deficiency group (P<0.05).The serum levels of 25(OH)D and Cr in female were lower than those in male (P<0.05).There was no significant difference in the 25(OH)D levels between the patients under 40 years old,those aged 40~60 years,and those over 60 years old (P>0.05).Blood PTH and Cr of patients under 60 years old were significantly lower than those over 60 years old (P<0.05).Multivariate linear regression analysis suggested that PTH (B=-7.091,P<0.001)and female (B=-4.999,P<0.001)were negatively correlated with 25(OH)D.Conclusions Insufficiency or even deficiency of 25(OH)D is common in GD patients in Gejiu.The level of 25(OH)D in female was lower than that in male.Blood PTH increased with age,and PTH and female were negatively correlated with 25(OH)D.Strengthening the early detection and intervention of bone metabolism indexes in GD patients in this region may be beneficial to the effective prevention and treatment of secondary osteoporosis in GD patients.