中青年桥本氏甲状腺炎与骨密度的关联研究

Study on the association between hashimoto′s thyroiditis and bone mineral density in middle and young age

目的探讨中青年桥本氏甲状腺炎(HT)与骨密度的相关性。方法本研究为回顾性病例对照研究,选取2021年1月至2021年12月于内蒙古自治区人民医院健康管理中心(体检中心)体检的400例行甲状腺超声及血清学检测的纳入者,男200例,女200例,年龄(50.16±6.34)岁,年龄范围为25~60岁。根据超声及血清学检测结果将纳入者分为HT组(n=200)与非HT组(n=200),比较两组纳入者临床特征、生化指标、骨密度情况,HT组中骨密度减低及骨质疏松纳入者与骨密度正常纳入者间的临床特征和生化指标。结果HT组收缩压[(130.84±19.45)mmHg,1 mmHg=0.133 kPa]、甘油三酯[(1.95±1.72)mmol/L]、总胆固醇[(4.85±0.93)mmol/L]、尿酸[(353.52±92.90)μmol/L]、甲状腺激素(TSH)水平[(5.42±8.27)mIU/L]、抗甲状腺过氧化物酶抗体水平[(717.97±592.19)IU/ml]及抗甲状腺球蛋白抗体水平[(196.85±176.86)IU/ml]高于非HT组[(124.66±14.13)mmHg、(1.63±1.24)mmol/L、(4.67±0.87)mmol/L、(330.02±88.59)μmol/L、(2.43±1.47)mIU/L、(26.05±9.39)IU/ml、(21.05±13.69)IU/ml],25羟维生素D水平[(20.33±4.18)μg/L]低于非HT组[(22.95±3.95)μg/L],差异有统计学意义(P<0.05)。HT组纳入者骨密度减低及骨质疏松率[46.5%(93/200)]高于非HT组[31.0%(62/200)],差异有统计学意义(P<0.05)。骨密度减低及骨质疏松纳入者年龄[(53.47±4.13)岁]高于骨密度正常纳入者[(46.37±7.30)岁]、男性率[61.3%(57/93)]高于骨密度正常纳入者[40.2%(43/107)]、HT病程[(8.30±3.52)年]长于骨密度正常纳入者[(5.77±2.08)年]、体质量指数[(24.39±2.85)kg/m2]低于骨密度正常纳入者[(25.57±2.90)kg/m2]、TSH[(7.27±11.28)mIU/L]高于骨密度正常纳入者[(3.82±3.52)mIU/L],差异均有统计学意义(P<0.05)。HT病程(OR=0.811)和年龄(OR=0.755)为中青年HT骨密度减低和骨质疏松发病的独立危险因素,差异有统计学意义(P<0.05)。结论中青年HT与骨密度具有相关性,年龄及HT病程是中青年HT患者骨密度减低及骨质疏松的独立危险因素。

Objective To investigate the correlation between Hashimoto′s thyroiditis(HT)and bone density in young and middle-aged.Methods This study was a retrospective case-control study,a total of 400 cases of inclusion who received with underwent thyroid ultrasonography and serological examination in the Health Management Center(Physical Examination Center)of Inner Mongolia People′s Hospital from January 2021 to December 2021,including 200 males and 200 females,aged(50.16±6.34)years old,ranging from 25 to 60 years old.The subjects were divided into HT group(n=200)and non-HT group(n=200)according to the ultrasonic and serological test results.The clinical characteristics,biochemical indexes and bone mineral density of the two groups were compared,and the clinical characteristics and biochemical indexes of patients with low bone mineral density and osteoporosis in HT group and patients with normal bone mineral density were compared.Results HT group systolic blood pressure[(130.84±19.45)mmHg,1 mmHg=0.133 kPa],triglyceride[(1.95±1.72)mmol/L],total cholesterol[(4.85±0.93)mmol/L],uric acid[(353.52±92.90)μmol/L],thyroid stimulating hormone[TSH,(5.42±8.27)mIU/L],anti-thyroid peroxidase antibody[(717.97±592.19)IU/ml]and anti-thyroid globulin antibody[(196.85±176.86)IU/ml]were higher than those in non-HT group[(124.66±14.13)mmHg,(1.63±1.24)mmol/L,(4.67±0.87)mmol/L,(330.02±88.59)μmol/L,(2.43±1.47)mIU/L,(26.05±9.39)IU/ml,(21.05±13.69)IU/ml],The level of 25 hydroxyvitamin D[(20.33±4.18)μg/L]was lower than that of non-HT group[(22.95±3.95)μg/L],and the differences were statistically significant(P<0.05).The rate of bone mineral density reduction and osteoporosis in HT group[46.5%(93/200)]was higher than that in non-HT group[31.0%(62/200)],and the difference was statistically significant(P<0.05).The age of patients with low bone mineral density and osteoporosis[(53.47±4.13)years old]was higher than that of patients with normal bone mineral density[(46.37±7.30)years old],the male rate[61.3%(57/93)]was higher than that of patients with normal bone mineral density[40.2%(43/107)],and the course of HT[(8.30±3.52)years].The year was longer than that of the subjects with normal bone mineral density[(5.77±2.08)years],the body mass index[(24.39±2.85)kg/m^(2)]was lower than that of the subjects with normal bone mineral density[(25.57±2.90)kg/m^(2)],and the TSH[(7.27±11.28)mIU/L]were higher than that of the subjects with normal bone mineral density[(3.82±3.52)mIU/L],the differences were statistically significant(P<0.05).The duration of HT(OR=0.811)and age(OR=0.755)were independent risk factors for decreased bone density and osteoporosis in young and middle-aged HT,and the differences were statistically significant(P<0.05).Conclusions HT is correlated with bone mineral density in young and middle-aged patients.Age and HT course of disease are independent risk factors for decreasing bone mineral density and osteoporosis in young and middle-aged patients with HT.