合并亚临床型甲状腺功能减退的骨质疏松症62例患者骨代谢及骨转换标志物水平分析

Analysis of bone metabolism and bone turnover markers in 62 cases of osteoporosis with subclinical hypothyroidism

目的分析骨转换标志物血清1型胶原羧基端肽(β-CTX)和血清1型前胶原氨基端前肽(PINP)在亚临床型甲状腺功能减退(简称亚甲减)合并骨质疏松症患者中的表达,并探讨其能否作为判断该类患者骨质疏松程度及脆性骨折发生风险的预测指标。方法选取2016年7月至2019年6月收治的骨质疏松症合并亚甲减患者62例(骨松甲减组),以及同期收治的单纯骨质疏松症伴骨痛患者65例(骨松骨痛组),并纳入同年龄段健康体检者68例(正常对照组)。比较3组间骨代谢标志物,如血钙、血磷、血镁、碱性磷酸酶、25羟维生素D、骨密度、T值、甲状腺激素、甲状旁腺素以及骨转换标志物血清PINP及β-CTX浓度水平。结果骨松甲减组、骨松骨痛组及正常对照组骨代谢及骨转换标志物中血钙、血磷、血镁、碱性磷酸酶、甲状旁腺素水平差异无统计学意义(P均>0.05),而25羟维生素D、骨密度、T值、β-CTX及PINP水平差异有统计学意义(P均<0.05)。结论骨松甲减组PINP、β-CTX水平降低,为低转换型骨质疏松,不能依靠骨转换标志物作为骨松甲减组骨质疏松程度的判断指标及预测骨折发生风险。

Objective To analyze the expressions of type 1 collagen cross-linked C-telopeptide(β-CTX) and N-terminal propeptide of type 1 precollagen(PINP) in osteoporosis patients with subclinical hypothyroidism, and to investigate whether these bone turnover markers(BTMs) can be used as predictors of the degree of osteoporosis and the risk of brittle fracture. Methods A total of 62 patients of osteoporosis with subclinical hypothyroidism admitted during July 2016 and June 2019 were selected as the research subjects, 65 patients of osteoporosis with ostalgia admitted at the same period were enrolled as the ostalgia group, and 68 healthy people who received physical examination during the same period served as healthy controls. Bone metabolism markers including calcium, phosphorus, magnesium, alkaline phosphatase, 25 hydroxyvitamin D, bone mineral density, T value, thyroid hormone, parathyroid hormone and serum PINPand β-CTX levels were compared among the three groups. Results There were no significant differences in the levels of serum calcium, phosphorus, magnesium, alkaline phosphatase and parathyroid hormone among the three groups(all P>0.05) while significant differences in 25 hydroxyvitamin D, bone mineral density, T value, β-CTX and PINP levels were detected(all P<0.05). Conclusion The levels of PINP and β-CTX decreased in osteoporosis patients with subclinical hypothyroidism. Such cases are low conversion osteoporosis, and BTMs cannot be used to evaluate the degree of osteoporosis or predict the risk of fracture.