初发甲状腺功能亢进症患者甲巯咪唑治疗前后骨钙素及β-Ⅰ型胶原羧基端肽水平变化研究

Change of osteocalcin and beta type Ⅰ collagen carboxy terminal peptide levels in patients with primary hyperthyroidism before and after methimazole treatment

目的探讨初发甲状腺功能亢进症患者甲巯咪唑治疗前后骨钙素(OCN)及β-Ⅰ型胶原羧基端肽(β-CTx)水平变化。方法选取河北北方学院附属第二医院内分泌科2014年4月至2014年9月期间收治的门诊及住院甲状腺功能亢进症初发患者45例(观察组),另选取同期在我院行健康体检者44例(对照组),观察组患者于甲巯咪唑治疗前及治疗8周后、对照组于体检时,早晨空腹采集静脉血液,检测甲状腺功能血清游离T3(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)指标和骨代谢β-CTx、OCN指标,并进行比较分析。结果观察组患者治疗前的β-CTX、OCN、FT3、FT4水平分别为(0.981±0.418)ng/m L、(48.62±19.92)ng/m L、(23.51±14.63)pmol/L、(41.08±14.03)pmol/L,均明显高于对照组的(0.445±0.268)ng/m L、(14.02±3.75)ng/m L、(15.71±1.82)pmol/L、(4.32±0.51)pmol/L,差异均有统计学意义(P<0.05或0.01);观察组患者治疗前的TSH水平为(0.031±0.014)uIU/m L,明显低于对照组的(2.133±1.016)uIU/m L,差异有显著统计学意义(P<0.01);观察组患者在甲巯咪唑治疗8周后,血清中β-CTx、OCN水平含量较治疗前进一步升高,但差异均无统计学意义(P>0.05),观察组患者治疗后的FT3、FT4、TSH水平分别为(16.47±4.32)pmol/L、(4.90±3.84)pmol/L、(1.411±0.135)uIU/m L,较治疗前的(23.51±14.63)pmol/L、(41.08±14.03)pmol/L、(0.031±0.014)uIU/m L有显著下降或显著提高,差异均有统计学意义(P<0.01)。结论初发甲状腺功能亢进症患者在治疗前及治疗初期,机体内破骨细胞与成骨细胞的活性均较健康者明显升高,且表现出破骨细胞活性明显超过成骨细胞的特点。

Objective To explore the change of osteocalcin(OCN) and beta typeⅠcollagen carboxy terminal peptide(β-CTx) levels in patients with primary hyperthyroidism before and after methimazole treatment. Methods A total of 45 patients(inpatients and outpatients) with primary hyperthyroidism in the Second Affiliated Hospital of Hebei North University from April 2014 to September 2014 were selected as the observation group. At the same time, totally44 healthy people were enrolled as the control group. The morning fasting venous blood samples were collected in observation group before treatment and after 8 weeks of treatment with methimazole, as well as in the the control group before physical examination. The indexes of serum thyroid function such as serum free T3(FT3), serum free thyroxine(FT4), thyroid stimulating hormone(TSH) and bone metabolism indexes of β-CTx, OCN were detected and compared.Results The levels of β-CTx, OCN, FT3, FT4 before treatment in observation group were respectively(0.981 ±0.418) ng/m L,(48.62±19.92) ng/m L,(23.51±14.63) pmol/L,(41.08±14.03) pmol/L, which were significantly higher than those in control group of(0.445±0.268) ng/m L,(14.02±3.75) ng/m L,(15.71±1.82) pmol/L,(4.32±0.51) pmol/L, and the differences were statistically significant(P<0.05 or 0.01). The TSH level before treatment in observation group was(0.031±0.014) u IU/m L, which were significantly lower than that in control group of(2.133±1.016) u IU/m L, and the difference was statistically significant(P<0.01). The level content of serum β-CTx, OCN were significantly increased after8 weeks of treatment with methimazole in observation group compared with before treatment, but the differences were not statistically significant(P>0.05). The levels of FT3, FT4, TSH after treatment in observation group were respectively(16.47±4.32) pmol/L,(4.90±3.84) pmol/L,(1.411±0.135) u IU/m L, which were significantly decreased or significantly increased compared with before treatment of(23.51±14.63) pmol/L,(41.08±14.03) pmol/L,(0.031±0.014) u IU/m L, and the differences were statistically significant(P<0.01). Conclusion Osteoclast and osteoblast activity in patients with primary hyperthyroidism are significantly higher than that in healthy subjects before treatment and in the early stage of treatment, and osteoclast activity is significantly higher than osteoblasts activity.