绝经后女性促甲状腺激素水平对骨代谢生化指标的影响

目的分析绝经后女性促甲状腺激素(TSH)水平对骨代谢生化指标的影响。方法选取2017年6月—2020年3月湖州市中心医院甲状腺功能正常的120例绝经后女性,按照TSH水平,分为T1组(0.27~2.00 mIU/L)45例,T2组(2.01~3.23 mIU/L)37例,T3(3.24~4.20 mIU/L)38例。比较3组血清激素、骨密度相关指标及骨代谢相关指标。结果T1组血清卵泡刺激素(FSH)和雌二醇(E₂)水平分别为(56.55±25.57)IU/L和(112.61±123.59)pmol/L,T2组血清FSH和E₂水平分别为(54.15±21.54)IU/L和(116.72±99.41)pmol/L,T3组血清FSH和E₂水平分别为(43.96±21.92)IU/L和(169.11±122.89)pmol/L,T1组和T2组血清FSH水平高于T3组(t=2.364,P=0.021;t=2.030,P=0.046),血清E₂水平低于T3组(t=2.080,P=0.041;t=2.027,P=0.046)。T1组和T3组股骨颈、L1~L4、全髋、大转子、Ward三角区及左前臂骨密度,股骨颈和L1~L4骨密度T值比较差异均有统计学意义(均P<0.05);T2组股骨颈骨密度低于T3组(P<0.05)。T3组骨保护素(OPG)和核因子κB受体活化因子配体(RANKL)水平均显著高于T1组和T2组(均P<0.05)。结论甲状腺功能正常的绝经后女性TSH水平在正常范围内波动可在一定程度上影响雌激素水平、骨密度及骨代谢指标,且低水平TSH女性的骨密度更低。

Effect of thyroid stimulating hormone level on biochemical indexes of bone metabolism in postmenopausal women

Objective To analyze the effect of thyroid stimulating hormone(TSH)level on biochemical indexes of bone metabolism in postmenopausal women.Methods From June 2017 to March 2020,120 postmenopausal women with normal thyroid function were selected from Huzhou Central Hospital,according to TSH level,the postmenopausal women were divided into T1 group(0.27-2.00 mIU/L,45 cases),T2 group(2.02-3.23 mIU/L,37 cases),and T3 group(3.24-4.20 mIU/L,38 cases).The levels of serum hormones,bone mineral density related indicators,and bone metabolism related indicators in the three groups were compared.Results The levels of serum follicle-stimulating hormone(FSH)and estradiol(E₂)in T1 group were(56.55±25.57)IU/L and(112.61±123.59)pmol/L,respectively;the levels of serum FSH and E₂ in T2 group were(54.15±21.54)IU/L and(116.72±99.41)pmol/L,respectively;the levels of serum FSH and E₂ in T3 group were(43.96±21.92)IU/L and(169.11±122.89)pmol/L,respectively,the levels of serum FSH in T1 group and T2 group were statistically significantly higher than that in T3 group(t=2.364,P=0.021;t=2.030,P=0.046),the levels of serum E₂ in T1 group and T2 group were statistically significantly lower than that in T3 group(t=2.080,P=0.041;t=2.027,P=0.046).There were statistically significant differences in bone mineral density values of femoral neck,L1-L4,hip,greater trochanter,Ward trigonum,and left forearm,bone mineral density T values of femoral neck and L1-L4 between T1 group and T3 group(P<0.05);bone mineral density level of femoral neck in T2 group was statistically significantly lower than that in T3 group(P<0.05).The levels of osteoprotegerin(OPG)and receptor activator of nuclear factor-κb ligand(RANKL)in T3 group were statistically significantly higher than those in T1 group and T2 group(P<0.05).Conclusion The levels of TSH in postmenopausal women with normal thyroid function fluctuate within range,which can affect estrogen level,bone mineral density,and bone metabolism indexes to a certain extent,and bone mineral density of women with low TSH level is lower.