Serum cytokines and bone metabolism in patients with thyroid dysfunction

Hyperthyroidism is associated with increased bone turnover. Besides the hormones of calcium metabolism, locally produced factors are important in maintaining normal bone metabolism. Interleukin-6 (IL-6), in particular, has a major influence on bone turnover. In this study, serum IL-6 and tumor necrosis factor-alpha (TNF-α) levels, as well as bone turnover markers and relationships between them, were investigated in hyperthyroidism and hypothyroidism. A total of 20 female patients with hyperthyroidism, 15 with subclinical hyperthyroidism, 16 with hypothyroidism, and 15 with subclinical hypothyroidism constituted the patient groups. In all, 15 age-matched healthy female volunteers were recruited as controls. When compared with controls, serum TNF-a levels showed no significant difference in any of the patient groups (P<.05). In the groups with hyperthyroidism and subclinical hyperthyroidism, IL-6 levels were significantly higher compared with control group values (P< .05). Hyperthyroid patients showed higher levels of alkaline phosphatase (ALP) and osteocalcin, and a higher urinary deoxypyridinoline/creatinine ratio, compared with controls (P< .05). In subclinical hyperthyroidism, only ALP was found to be higher compared with control values. No significant correlations were made in any group between serum IL-6 or TNF-α level and bone turnover markers. Results suggest that serum IL-6 level and markers of bone turnover rate seem to be increased in hyperthyroidism. This finding may support the role of IL-6 in induction of bone turnover in hyperthyroid states.     

Parameters of lipid metabolism during perimenopause and thyroid pathology

A total of 210 perimenopausal women were examined. Lipid status was evaluated in groups of patients differing by thyroid function and characteristics of the perimenopausal period. Case histories were analyzed using a universal information chart. Serum levels of T3, T4, TTH, LH, FSH, PRL, E2, and progesterone were radioimmunoassayed. Blood lipid spectrum was evaluated on a Kone device (Finland) by special standard methods. High levels of cholesterol and triglycerides, a tendency to an increase in CH-LDL and CH-VLDL, a decrease in CH-HDL, and a high atherogenicity coefficient were detected in women with endemic goiter and hypothyrosis in comparison with perimenopausal women without thyroid disease. The highest levels of cholesterol, triglycerides, CH-LDL, and atherogenicity coefficient were detected in women with endemic goiter and climacteric syndrome, which suggests that hypothyrosis in the presence of climacteric syndrome aggravates disordered lipid metabolism.     

青春期甲状腺功能亢进患者骨龄及骨代谢的特点分析

目的:探讨甲状腺功能亢进症(甲亢)对青春期甲亢患者骨龄及骨代谢的影响.方法:检测60例青春期甲亢患者及50例健康受试者的血清游离甲状腺激素、生长激素(GH)、碱性磷酸酶(ALP)、骨钙素(BPG)及骨龄测定.结果:甲亢组骨龄明显落后于对照组,GH明显低于对照组,骨代谢指标高于对照组;甲亢组FT3与骨龄落后差值呈正相关,与GH呈负相关;甲亢病程≤1年组骨龄落后差值及ALP均明显低于病程＞1年组,GH高于病程＞1年组.结论:青春期甲亢患者骨龄发育落后;FT3与骨龄落后关系更为密切;甲亢病程越长,骨龄落后程度越明显;骨代谢增高及GH减少可能是引起骨龄落后的重要因素.     

Mineral and bone metabolism in thyroid disease: a review

This review discusses the abnormalities in bone and mineral metabolism encountered in thyroid disorders. Thyroid hormones probably stimulate bone resorption directly, thereby increasing serum calcium and phosphorus concentrations and suppressing serum parathyroid hormone and 1,25-dihydroxyvitamin D3 concentrations. The decrease in these bone-resorbing hormones limits further increase in serum calcium concentration but also results in an enhanced intestinal calcium absorption. Such a negative calcium balance will eventually lead to hyperthyroid osteopenia. In adult hypothyroidism the opposite effects are seen.     

绝经后女性血清骨代谢指标与骨质疏松的相关性分析

目的 探讨绝经后女性血清4项骨代谢指标(25-羟基维生素D、β胶原特殊序列、总Ⅰ型胶原前肽和骨钙素)对骨质疏松的辅助诊断价值.方法 收集2019年1-12月于广州医科大学附属第二医院骨科门诊就诊的209例50岁以上绝经女性血清4项骨代谢指标及骨密度(BMD)的检测数据,根据临床诊断将其分为对照组49例、骨量减少组67例...     

Assessment of four biochemical markers of bone metabolism in postmenopausal osteoporosis

In order to sudy the specificity and sensitivity of markers of bone metabolism in postmenopausal osteoporosis we investigated bone alkaline phosphatase, osteocalcin and carboxyl-terminal propeptide of procollagen type I in sera as markers of bone formation, and deoxypyridinoline in urine as a marker of bone resorption. The investigated parameters were determined in 53 women with confirmed osteoporosis and in a control group consisting of 45 healthy postmenopausal women without bone changes who were 40 to 79 years old. All biochemical markers were determined by monoclonal competitive enzyme immunoassay tests obtained by Metra Biosystems. The activity of bone alkaline phosphatase and the concentration of osteocalcin, procollagen type IVC-terminal propeptide (PICP), and deoxypyridinoline were grouped according to age of postmenopausal healthy and osteoporotic women. The values of all bone markers gradually increased with age, but significantly higher values were obtained in groups of postmenopausal osteoporotic women. By using receiver operator characteristic curve analysis, a very high specificity and sensitivity of the investigated biochemical markers in the diagnosis of postmenopausal osteoporosis were proven. The areas under the PICP curve and the osteocalcin curve were significantly higher than the area under the deoxypyridinoline curve, demonstrating a higher discriminating power of PICP and osteocalcin than deoxypyridinoline (p < 0.05).     

骨代谢标志物与绝经后妇女骨质疏松症的相关性研究

目的探讨绝经后骨质疏松及其引起的骨折与骨代谢标志物之间的关系。方法应用单能X线骨密度仪测量绝经期妇女脚跟骨骨密度（BMD）,并根据有无骨质疏松和骨折将108例绝经后妇女分为无骨质疏松（NOP）组,骨质疏松无骨折（OP1）组和骨质疏松伴骨折（OP2）组,测定各组受试者BMD和骨代谢标志物骨钙素（N—MID）,总骨Ⅰ型前胶原N端肽（P1NP）和口胶原特殊序列（β-Crosslaps）水平。结果血清N—MID、PINP和β-Crosslaps水平：NOP组低于OP1组,OP1组低于OP2组,且差异均有统计学意义（P〈0．05）。结论绝经后骨质疏松患者血清骨代谢标志物水平与骨质疏松及骨折存在密切的相关性;血清N—MID、P1NP和β-Crosslaps是诊断绝经后妇女骨质疏松症、预测骨折风险的理想指标。     

全身振动对绝经后妇女骨量和骨代谢的影响

目的:寻找一种新型的、安全有效的防治绝经后骨质疏松的办法。方法:对北京市罗庄里小区28例49—65岁绝经后妇女进行问卷调查、腰椎骨密度(BMD)、双侧股骨上端BMD,护骨素(OPG)、抗酒石酸酸性磷酸酶(TRAP)和骨特异性磷酸酶(BALP)等测定。随机分为实验组和对照组,实验组采用振动干预,对照组无任何干预。振动方案为:频率30—45Hz、20min/次,3次/周,连续3个月。结果:在实验前和实验后,组间对比BMD均无明显变化。组内对比,实验组腰椎和股骨上端BMD较实验前无明显改变(P=0.397);而对照组左侧股骨上端BMD和双侧股骨BMD均值均较实验前降低0.01g/cm2(P<0.05);实验组与对照组血清TRAP、BALP、OPG在振动干预结束后较实验前均无明显变化。两组血清TRAP、OPG在实验前后分别进行组间对比也无明显变化(P>0.05);而实验前,实验组BALP明显高于对照组5.61μg/L(P<0.05),但3个月后,差异扩大到6.42μg/L(P<0.01),但两组的变化值间没有明显差异(P>0.05)。结论:振动方案对绝经后女性血清BALP、TRAP、OPG无明显影响,但可延缓股骨上端骨丢失。     

甲状腺手术患者实施临床路径的对照研究

目的：研究临床路径在甲状腺手术患者中的应用效果。方法：将120例甲状腺手术患者随机分为实验组和对照组,每组各60例,实验组患者实施临床路径治疗护理,对照组患者实施传统治疗护理,将两组的治疗、护理效果作对照。结果：实验组患者的住院费用下降,等候手术天数及住院天数缩短（P〈0.01）,术后功能锻炼提前,患者对健康教育知识掌握及对医护工作满意度均提高（P〈0.001）,两组患者术后并发症和预后无差异。结论：实施临床路径效果良好,值得推广应用。     

甲状腺功能亢进症患者骨代谢特征与结局

目的:分析甲状腺功能亢进症患者骨密度及骨代谢指标的改变,并与健康对照组比较。方法:采用双能X射线吸收法对2003-01/11青岛市海慈医院内分泌门诊及住院的73例甲状腺功能亢进患者和与患者年龄、性别及月经状况相匹配的73名健康对照者进行L2～4椎体和股骨近端骨密度测量,同时测定血清钙、碱性磷酸酶、甲状旁腺素、降钙素、计算甲状旁腺素/降钙素比值及24h尿钙值,比较其差异.结果:按意向处理分析,73例甲状腺功能亢进患者和73名健康对照者均完成检测,全部进入结果分析。①甲状腺功能亢进组24h尿钙、血清碱清性磷酸酶高于正常对照组[(6.56±2.48)mmol,(3296.20±664.47)nkat/L;(3.14±1.42)mmol,(1938.05±335.08)nkat/L,P<0.05]。②甲状腺功能亢进症组降钙素明显低于正常对照组[(10.47±4.67),(31.26±10.57)μg/L,P<0.05];甲状旁腺素/降钙素比值甲状腺功能亢进组明显高于正常对照组[(3.55±0.79),(1.05±0.52),P<0.05]。③甲状腺功能亢进症组患者L2～4骨密度测量值明显低于正常对照组[(0.80±0.07),(0.81±0.11),(0.82±0.09)g/cm2;(0.91±0.1),(0.90±0.09),(0.90±0.08)g/cm2;P<0.05]。④股骨近端的骨密度测量值明显低于正常对照组[(0.71±0.08),(0.62±0.12),(0.61±0.11)g/cm2;(0.82±0.08),(0.68±0.10),(0.71±0.13)g/cm2,P<0.05]。结论:甲状腺功能亢进症患者骨吸收和骨形成在高位运行,呈现高转换型骨代谢紊乱;且骨吸收作用大于骨形成,导致骨质疏松。     

结肠癌患者骨密度和骨代谢的改变

目的:通过研究结肠癌患者骨密度和有关骨矿物质生化指标的变化,探讨结肠癌骨质疏松症的发病机制。方法:应用双能X线吸收测定仪(DEXA)对45例结肠癌患者进行腰椎、股骨近端骨密度(BMD)测定,使用全自动生化仪器测定血清碱性磷酸酶(ALP)、血钙(Ca)、血磷(P)、血镁(Mg)、白蛋白(ALB)等生化指标,并与45例同年龄对照组比较。结果:结肠癌组的BMD值与对照组相比显著降低(P<0.01),Ca、P、Mg、ALB也显著降低(P<0.01或P<0.05),ALP无显著变化。行化疗患者与未行化疗患者相比,BMD值也显著降低(P<0.05),但Ca、P、Mg、ALP、ALB无显著变化。结论:结肠癌对患者骨代谢的影响为骨吸收增高,导致骨量丢失,引起骨质疏松症。原因可能与结肠癌患者营养物质代谢失衡、手术、年龄及化疗等因素有关。