格拉夫斯病患者碘-131治疗前后血清甲状腺激素水平与骨代谢指标的变化及其相关性

The correlation between the changes of the parathyroid hormone level and bone metabolic indices before and after iodine⁃131 therapy in Graves disease patients

〔目的〕探讨格拉夫斯病(GD)患者碘-131治疗前后甲状旁腺激素水平等骨代谢指标的变化特点及其与甲状腺激素水平变化的关系。〔方法〕选取2017年1月至2019年1月某院GD行碘-131治疗的患者86例作为观察组,收集患者的临床资料进行回顾性分析。同时,选取体检科健康体检者68例作为对照组。观察组以碘-131治疗后3 mon为标准,比较研究组患者碘-131治疗前后血清甲状腺激素[游离三碘甲状腺原氨酸(FT_(3))、游离四碘甲状腺原氨酸(FT_(4))]、血清甲状旁腺激素(PTH)、骨代谢相关指标[血清钙(Ca^(2+))、血清磷(P3+)、血清碱性磷酸酶(ALP)、血清Ⅰ型胶原羧基端吡啶并啉交联肽(ICTP)及血清骨钙蛋白(BGP)]指标的变化水平,同时测量对照组应指标的水平,比较其与观察组对应指标的差异。〔结果〕研究发现观察组治疗前血清FT_(3)、FT_(4)、Ca^(2+)、P^(3+)、ALP、ICTP、BGP水平均高于对照组(P<0.05),血清PTH水平低于对照组(P<0.05),研究组治疗前血清FT_(3)、FT_(4)、Ca^(2+)、P^(3+)、ALP、ICTP、BGP水平均高于治疗后(P<0.05),血清PTH低于治疗后(P<0.05);观察组治疗后,血清FT_(3)、FT_(4)、Ca^(2+)、P^(3+)、ALP、ICTP、BGP水平均显著下降,与对照组相比仍偏高,血清PTH仍低于对照组,但均无统计学意义(P>0.05)。〔结论〕GD患者骨代谢水平增高,经治疗后骨代谢可基本降低至正常,骨代谢水平与甲状腺激素显著相关,骨代谢指标可作为甲亢治疗疗效及症状改善的重要评价标准,在临床工作中GD患者应重视骨代谢引起的异常。

[Objective]To investigate the changes of bone metabolic indices in Grave’s disease(GD) patients before and after the treatment,and to investigate the correlation between these changes and the variation of the thyroid hormone levels.[Methods]Retrospectively analyzed 86 cases,the studied group,which were treated with iodine-131 from Jan.2017 to Jan.2019,and collected the clinic data of the patients.68 healthy cases from department of medical check up were set as the controlled group.The patients were treated with iodine-131 for 3 months.Compared the changes of serum thyroid hormones [free triiodothyronine(FT_(3)) and free thyroxin(FT_(4))],serum parathyroid hormone(PTH) and bone metabolic indices [serum calcium(Ca^(2+)),serum phosphorus(P^(3+)),serum alkaline phosphatase(ALP),serum Carboxy terminal pyridinoline cross linked peptide of type Ⅰ collagen(ICTP) and serum osteocalcin(BGP)] before and after the treatment.Checked the corresponding levels for each factor and compared with the controlled group to confirm the difference.[Results] Before the treatment,the serum levels of FT_(3)、FT_(4)、Ca^(2+)、P^(3+)、ALP、ICTP and BGP from studied group are higher than the controlled group(P<0.05),and the serum level of PTH from studied group is lower than those of the controlled group(P<0.05).The serum levels of FT_(3)、FT_(4)、Ca^(2+)、P^(3+)、ALP.ICTP and BGP in studied group is higher(P<0.05) than those before the treatment,comparing to the levels after treatment,while the serum level of PTH is lower(P<0.05).For the studied group,the serum levels of FT_(3)、FT_(4)、Ca^(2+)、P^(3+)、ALP、ICTP and BGP are significantly lowered than those after the treatment,but the serum levels are still higher than those of the controlled group.However there is no statistical significance.The serum level of PTH is still lower than that of the controlled group(P>0.05).[Conclusion] The bone metabolic indices in GD patients are higher,which can be lowered to normal levels by the treatment.There is a significant correlation between the bone metabolic indices and the thyroid hormone levels.The bone metabolic indices can be taken as a benchmark for the treatment and symptomatic improvement of the hyperthyroidism.In clinic,the abnormal of bone metabolic indices should be monitored in GD patients.