补充维生素D对自身免疫性甲状腺炎育龄期女性患者病情的改善作用

Effect of VitD Supplementation on the Improvement of Autoimmune Thyroiditis in Childbearing Age Females

目的分析维生素D辅助治疗对患有自身免疫性甲状腺炎(autoimmune thyroiditis,AT)的育龄期女性的甲状腺功能和自身免疫抗体及血清25(OH)D水平的影响。方法纳入唐山市工人医院内分泌科2019年1月至2021年8月收治的94例育龄期AT女性作为受试者,按照随机数字表法将受试者分为研究组(n=47)、对照组(n=47),2组为平行对照。所有受试者均接受生活、饮食方式指导,研究组予以甲状腺激素口服及维生素D辅助治疗,对照组仅接受甲状腺激素口服治疗,分别测定并比较2组不同时期的血清甲状腺激素游离三碘甲腺原氨酸(FT3)、促甲状腺激素(TSH)、游离四碘甲状腺原氨酸(FT4)、甲状腺自身抗体(TRAb、TPO-Ab)及25(OH)D水平。结果(1)甲状腺功能:治疗6个月后,2组患者的血清甲状腺激素(FT3、FT4、TSH)水平均出现不同程度的改善(P<0.01),其中研究组的血清TSH含量明显高于对照组[(2.34±0.33)μIU/mL VS(2.19±0.36)μIU/mL],差异有统计学意义(P>0.05);(2)甲状腺自身免疫抗体:治疗6个月后,研究组患者的血清TRAb和TPO-Ab水平显著低于同期对照组[(0.56±0.38)U/L VS(4.35±1.71)U/L;(35.71±8.85)U/mL VS(77.41±19.91)U/mL](P<0.01),低于同组治疗前、治疗3个月后的TRAb和TPO-Ab水平(P<0.01);(3)血清25(OH)D水平:相比治疗前,研究组治疗6个后的血清25(OH)D水平明显增高(P<0.05),显著高于同期对照组[(61.91±8.73)ng/mL VS(10.79±3.16)ng/mL](P<0.05)。结论补充维生素D治疗可明显改善自身免疫性甲状腺炎患者短期内(6个月)的自身免疫抗体滴度,提高血清25(OH)D水平,但对甲状腺功能作用不明显,可作为低维生素D水平的自身免疫性甲状腺炎患者的辅助治疗之一。

Objective To investigate the effects of vitamin D supplementation on thyroid function,autoimmune antibody and serum 25(OH)D levels in female patients with autoimmune thyroiditis(AT)in the reproductive age.Methods 94 childbearing age females with AT and admitted to the department of endocrinology of our hospital from January 2019 to August 2021 were enrolled as subjects.According to random number table method,they were randomly assigned to two groups,the control group(n=47)and the study group(n=47),and the parallel control were conducted.All the subjects received the instruction of life style and diet style,the study group received the oral Thyroid hormone and Vitamin D therapy,while the control group only received the oral Thyroid hormone therapy.Thereafter,serum Thyroid hormone levels(FT3,TSH and FT4),thyroid autoantibodies(TRAb,TPO-Ab)and 25(OH)D were measured and compared between the two groups at different stages.Results(1)Thyroid function:Compared with the situation before the treatment,serum FT3,TSH and FT4 were improved to varying degrees in 2 groups after 6 months of treatment(P<0.01),the serum TSH content in the study group was apparently higher than that in the control group[(2.34±0.33)μIU/m L VS(2.19±0.36)μIU/m L],and the results were statistically significant(P<0.05).(2)Thyroid autoimmune antibody:After 6 months of treatment,serum TRAb and TPO-Ab levels in the study group were evidently better,compared to the control group[(0.56±0.38)U/L VS(4.35±1.71)U/L;(35.71±8.85)U/m L VS(77.41±19.91)U/m L](P<0.01),lower than TRAb and TPO-Ab levels before treatment and 3 months after the treatment(P<0.01).(3)Serum 25(OH)D level:Compared with the situation before the treatment,the serum 25(OH)D level of the study group increased significantly after 6 months of treatment(P<0.05),evidently better than that in the control group[(61.91±8.73)ng/m L VS(10.79±3.16)ng/m L](P<0.05).Conclusion Vitamin D supplementation can significantly improve serum 25(OH)D level and autoimmune antibody titer in patients with autoimmune thyroiditis in the short term(6 months),but the effect on Thyroid hormone levels is not obvious and it can be used as an adjunctive treatment for autoimmune thyroiditis patientswith low vitamin D level.