自身免疫性甲状腺疾病对骨代谢水平的影响

Effect of autoimmune thyroid disease on bone metabolism

目的 探讨自身免疫性甲状腺疾病(AITD)对患者骨代谢水平的影响。方法 74例初诊AITD患者根据甲状腺功能分为甲状腺功能亢进组(甲亢组,53例)、甲状腺功能减退组(甲减组,12例)和甲状腺功能正常组(甲功正常组,9例)。另以11例健康体检者作为对照组。治疗前检测各组血清甲状腺功能(FT_(3)、FT_(4)、TSH)、甲状腺相关抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)和促甲状腺激素受体抗体(TRAb)]、骨代谢相关标志物[β-Ⅰ型胶原羧基端肽(β-CTx)、总Ⅰ型胶原氨基端前肽(T-P1NP)、核因子κB受体活化因子配体(RANKL)、骨保护素(OPG)]、甲状旁腺激素(PTH)、25-羟维生素D3、ALP、血钙和血磷水平。AITD患者根据病情进行相应治疗,所有甲亢患者接受抗甲状腺药物治疗。分别在治疗3、6个月时检测AITD患者甲状腺功能、甲状腺相关抗体及骨代谢相关标志物水平。结果 治疗前,甲亢组血清β-CTx、T-P1NP、ALP水平均高于甲减组、甲功正常组和对照组(P<0.05)。AITD患者血清β-CTx、T-P1NP水平与FT_(3)、FT_(4)、TRAb水平呈正相关,与TSH水平呈负相关(P<0.01);血清RANKL水平与FT_(3)水平呈正相关,与TSH水平呈负相关(P<0.05)。治疗6个月时,AITD患者血清β-CTx、T-P1NP水平与TRAb水平呈正相关,与TGAb水平呈负相关(P<0.05或P<0.01);RANKL/OPG比值与FT_(3)水平呈正相关(P<0.05)。治疗期间甲亢组血清β-CTx、T-P1NP和RANKL水平逐渐下降,OPG水平逐渐升高。结论 AITD患者甲状腺功能亢进程度与骨转换速率呈正相关。TRAb水平升高可能会加快骨转换速率,而TGAb则相反。

Objective To investigate the effect of autoimmune thyroid disease(AITD)on bone metabolism.Methods According to thyroid function,74 newly diagnosed AITD patients were divided into three groups of A(with hyperthyroidism,53 cases),B(with hypothyroidism,12 cases)and C(euthyroidism,9 cases).Another 11 healthy people were taken as the controls(group D).Serum levels of FT_(3),FT_(4),TSH,thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),thyrotrophin receptor antibody(TRAb),β-type I collagen carboxy-terminal peptide(β-CTx),total amino terminal propeptide of type I collagen(T-P1NP),receptor activator for nuclear factor-kB ligand(RANKL),osteoprotegerin(OPG),parathormone(PTH),25-(OH)D3,ALP,calcium and phosphorus were detected in each group before treatment.AITD patients received corresponding treatment,and all hyperthyroidism patients received anti-thyroid medication treatment.Serum levels of thyroid function,thyroid related antibodies,and bone metabolism related biomarkers were measured in AITD patients after 3 and 6 months of treatment,respectively.Results Before treatment,serum levels ofβ-CTx,T-PINP and ALP in group A were higher than those in groups of B,C and D(P<0.05).Serum levels ofβ-CTx and T-PINP in AITD patients were positively correlated with FT_(3),FT_(4) and TRAb levels,while negatively correlated with TSH level(P<0.O1).Serum RANKL level was positively correlated with FT:level and negatively correlated with TSH level(P<0.05).After 6 months of treatment,serum levels of p-CTx and T-PINP in AITD patients were positively correlated with TRAb level and negatively correlated with TGAb level(P<0.05 or P<0.01).The RANKL/OPG ratio was positively correlated with FT_(3) level(P<0.05).During the treatment period,serum levels ofβ-CTx,T-PINP and RANKL were gradually decreased,while serum OPG level was gradually increased in group A.Conclusion The degree of hyperthyroidism in AITD patients is positively correlated with bone turnover rate.Higher TRAb titers may play a role in accelerating the bone turnover rate,while TGAb may have an opposite effect.