甲状腺功能亢进患者治疗前和治疗早期骨代谢参数的改变 关于甲状腺功能亢进患者骨吸收骨形成研究的结果对指导临床治疗的意义

Early changes of bone and mineral metabolism in patients with hyperthyroidism before and after treatment

目的了解甲状腺功能亢进(甲亢)患者治疗前和治疗早期骨矿物质代谢的变化,探讨其对骨代谢参数改变的影响机制。方法选择42例甲亢治疗前和治疗早期患者,采用放射免疫法测定了血清骨钙素(BGP)、I型胶原羧基末端肽(ICTP)、甲状旁腺素(PTH-M)及相关生化指标,并与32例健康对照者进行比较。结果甲亢治疗前血碱性磷酸酶(AKP)、骨钙素(BGP)、I型胶原羧基末端肽(ICTP)均值显著高于对照组(P<0.001)。治疗后血AKP、BGP显著下降(P<0.001)其均值仍高于对照组(P<0.05)。ICTP明显低于治疗前(P<0.001)与对照组比较差异无显著(P>0.05)。相关分析显示,血BGP与ICTP正相关,血TT3与BGP、AKP、ICTP呈正相关,血sTSH与BGP、ICTP呈负相关。结论甲亢治疗前过量甲状腺激素加速骨转换,以破骨细胞活动占优势,使骨吸收显著大于骨形成,是甲亢骨病主要原因,甲亢治疗早期,骨吸收快速降低,骨形成仍高,以成骨细胞活动占优势,有利于骨重建。

Aim To investigat the early changes of bone and mineral in patients with hyperthyrodism before and after treatment. Methods Radioimmunoassay was used to measure bone GLA protein,carboxy terminal cross linked telopeptide of type I collagen(ICTP),parathyroid hormone(PTH M) and other markers related to bone metabolism in 42 patients with hyperthyroidism before and after treatment and 32 healthy volunteers. Results Serum concentrations of AKP,BGP,ICTP were significantly higher in patients with hyperthyroidism before treatment than in healthy subjects.(P< 0.001) .The results after treatment and before treatment shows that Serum AKP,BGP,ICTP decrease significantly(P< 0.001),but serum AKP,BGP remain higher than in healthy subjects(P< 0.05).Serum ICTP were not different between in patients after treatment and in controls(P >0.05).The correlation analysis showed that the serum BGP was positively correlated with ICTP.TT3 was positively correlated with BGP,AKP and ICTP.sTSH was negatively correlated with BGP,ICTP.Conculsoin Excessive serum thyroid hormone that speeds up bone turnover and marked bone absorption compared to bone formation cause hyperthyroidism bone disease in untreated hyperthyroid patients.However,in the patients who under treatment ,bone resorption decreased rapidly and bone formation remain stimulated in favor of bone remodeling.<P>