正常范围低血清促甲状腺激素和甲状腺抗体与女性骨质疏松发病风险的关系

Association of osteoporosis with low normal TSH levels and thyroid autoimmunity in euthyroid women

目的探讨正常范围低血清促甲状腺激素(TSH)和甲状腺抗体与女性骨质疏松发病风险的关系。方法选取甲状腺功能正常的女性400例,根据骨密度检查结果分为骨质疏松组(n=196)和正常对照组(n=204),比较两组血清TSH水平、甲状腺过氧化物酶抗体(TPOAb)阳性比例和促甲状腺激素受体抗体(TRAb)阳性比例的差异,采用logistic回归分析正常范围低TSH水平、TPOAb阳性及TRAb阳性与骨质疏松的关系。结果(1)骨质疏松组TPOAb阳性比例和TRAb阳性比例显著高于正常对照组,而血清TSH水平显著低于正常对照组(P<0.05);(2)根据本单位检验科检测的TSH正常值将所有研究对象分为正常范围低TSH组(0.27 mIU/L≤TSH≤2.5 mIU/L)和正常TSH组(2.5 mIU/L<TSH≤4.2 mIU/L),结果提示,正常范围低TSH组骨质疏松发生率显著高于正常TSH组(63.74%vs 36.70%,P<0.05);(3)logistic回归分析提示正常范围低TSH水平(OR=2.864,95%CI 2.115~3.681,P<0.001)、TPOAb阳性(OR=2.224,95%CI 1.783~2.877,P=0.012)和TRAb阳性(OR=2.375,95%CI 1.955~2.801,P=0.007)均是骨质疏松发生的独立危险因素。结论正常范围低TSH水平、TPOAb阳性和TRAb阳性可能影响女性骨代谢。

Objective To investigate the association of osteoporosis with low normal TSH levels and thyroid autoimmunity in euthyroid women.Methods 400 euthyroid women were enrolled and divided into two groups according to the results of bone mineral density examination:the osteoporosis group(n=196)and the control group(n=204).Serum TSH levels,the proportions of thyroid peroxidase antibody(TPOAb)positive and thyroid stimulating hormone receptor antibody(TRAb)positive were compared in two groups.Logistic regression analysis was used to analyse the association of osteoporosis with low normal TSH levels and thyroid autoimmunity.Results(1)The proportions of TPOAb positive and TRAb positive were significantly higher,while serum TSH levels were significantly lower in the osteoporosis group than those in the control group(P<0.05).(2)According to the normal TSH value detected by the clinical laboratory of our hospital,all subjects were divided into the low-normal TSH group(0.27 mIU/L≤TSH≤2.5 mIU/L)and the normal TSH group(2.5 mIU/L<TSH≤4.2 mIU/L).The incidence of osteoporosis in the low-normal TSH group was significantly higher than that in the normal TSH group(63.74%vs 36.70%,P<0.05).(3)Logistic regression analysis showed that the low-normal TSH(OR=2.864,95%CI 2.115-3.681,P<0.001),TPOAb positive(OR=2.224,95%CI 1.783-2.877,P=0.012)and TRAb positive(OR=2.375,95%CI 1.955-2.801,P=0.007)were independent risk factors for the occurrence of osteoporosis.Conclusion The low-normal TSH,TPOAb positive and TRAb positive may affect bone metabolism in women.