未绝经女性甲亢患者血25羟维生素D水平与骨密度的关系

Correlation between plasma 25-hydroxyvitamin D and bone mineral density in premenopausal women with hyperthyroidism

目的观察未绝经女性甲亢患者骨密度及血钙、血磷、血碱性磷酸酶(ALP)、血浆25羟维生素D[25(OH)D]、血浆甲状旁腺激素(PTH)水平变化,分析未绝经女性甲亢患者血浆25(OH)D与骨密度的关系。方法选取50例初发或复发的未绝经女性甲亢患者,51例正常对照人群,应用双能X线吸收仪(DXA)测定腰椎1-4、股骨颈、股骨大转子、Ward三角和全股骨的骨密度,电化学发光法测定血浆25(OH)D和PTH,生化法测定血钙、磷、ALP。结果甲亢组L1、Ward三角骨密度均低于对照组,差异有统计学意义。与对照组相比,甲亢组血钙、血ALP、血浆25(OH)D水平升高,血浆PTH降低,差异均有统计学意义。甲亢组维生素D缺乏17例(34%),不足19例(38%),充足14例(28%)。对照组维生素D缺乏30例(59%),不足18例(35%),充足3例(6%)。相关分析示,两组血浆25(OH)D与L1、L2、L3、L4、L1-4、股骨颈、股骨大转子、Ward三角、全股骨骨密度均无相关性。Pearson相关分析示,甲亢组血浆25(OH)D与PTH呈负相关(r=-0.378,P<0.01)。结论未绝经女性甲亢患者L1、Ward三角骨密度降低。未绝经女性甲亢患者血浆25(OH)D升高,可能与高血钙、PTH分泌抑制、高血磷导致1-α-羟化酶活性降低有关。未绝经女性甲亢患者血浆25(OH)D水平与骨密度无直接关系。

Objective To observe the levels of bone mineral density( BMD),serum calcium,serum phosphorus,serum alkaline phosphatase( ALP),plasma 25-hydroxyvitamin D [25( OH) D ],and plasma parathyroid hormone( PTH) in premenopausal women with hyperthyroidism and to determine the relationship between plasma 25( OH) D and BMD in premenopausal women with hyperthyroidism. Methods Fifty premenopausal women with hyperthyroidism were enrolled into hyperthyroidism group and 51 healthy individuals as a control group. BMD of the lumbar spine( L1-4),femoral neck,greater trochanter,Ward’s triangle,and total femur was detected using dual energy X-ray absorptiometry( DXA). Electrochemical luminescence was used to evaluate the levels of plasma 25( OH) D and PTH. Serum calcium,phosphorus,and ALP were measured with biochemistry methods. Results The BMD of L1 and Ward’s triangle was lower in hyperthyroidism group than that in control group,with statistical significance.Plasma 25( OH) D,serum calcium,serum ALP was siqnificantly higher and plasma PTH was significantly lower in hyperthyroidism group compared to those in control group. In hyperthyroidism group,patients with vitamin D deficiency were 17 cases( 34%),insufficiency 19 cases(38%),and sufficiency 14 cases(28%),respectively. In control group,there were 30 cases(59%) with vitamin D deficiency,18 cases(35%) with vitamin D insufficiency,and 3 cases(6%) with vitamin D sufficiency. The correlation analysis showed that plasma 25( OH) D was not correlated to BMD of L1-4,femoral neck,greater trochanter,Ward’s triangle,and total femur in both groups. The Pearson analysis showed that plasma 25( OH) D was negatively correlated with plasma PTH( r =-0. 378,P < 0. 01) in the hyperthyroidism group. Conclusion The BMD of L1 and Ward’s triangle decreases in premenopausal women with hyperthyroidism. Plasma 25( OH) D increases in premenopausal women with hyperthyroidism,which may be due to reduced 1-α-hydroxylase activity secondary to hypercalcemia,suppressed PTH,and hyperphosphatemia. Plasma 25( OH) D level is not associated with BMD in premenopausal women with hyperthyroidism.