新发Graves甲亢患者血清25(OH)D水平相关因素研究

目的 探讨新发Graves甲亢患者血清25羟-维生素D[25(OH)D]水平的相关因素.方法 收集2016年5月至10月于核医学科就诊的新发Graves甲亢患者665例,血清检测甲功、促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、甲状旁腺激素(PTH)、降钙素(CT)、钙、磷及25(OH)D,SPECT法计算甲状腺质量.根据血清25(OH)D水平分为维生素D(VitD)缺乏组、不足组和充足组,分析患者病程、年龄、FT3、FT4、TSH、TRAb、TGAb、TPOAb、钙、磷、PTH和CT与25(OH)D的关系.结果 新发Graves甲亢患者中维生素D缺乏、不足、充足率分别为47.52％、30.98％、21.50％.三组比较,患者甲状腺质量、TRAb、PTH、CT和25(OH)D差异有统计学意义(P＜0.05),其中缺乏组患者甲状腺质量更大,TRAb及PTH水平更高,25(OH)D及CT水平更低;而病程、年龄、FT3、FT4、TSH、TGAb、TPOAb、钙和磷差异无统计学意义(P＞0.05).患者25(OH)D分别与TRAb(rs=-0.414)、PTH(r =-0.175)和甲状腺质量(r=-0.094)负相关(P＜0.05),与CT(r=0.115,P=0.003)正相关.多因素Logistic回归分析发现,TRAb(OR=1.124,95％ CI 1.086 ～1.153,P＜0.001)的OR值为1.124且差异有统计学意义.ROC曲线分析发现,TRAb界值＞12.99且差异有统计学意义(P＜0.001).结论 新发Graves甲亢患者血清25(OH)D水平与TRAb及甲状腺质量呈负相关.

The Study of Serum 25 (OH) D Levelsin Patients with New Graves' Hyperthyroidism and Their Correlated Factors

Objective To explore the correlation factors of serum 25-hydroxy VitaminD [25 (OH) D] levels in patients with newly diagnosed Graves hyperthyroidism.Methods From May 2016 to October 2016,665 newly diagnosed patients with Graves hyperthyroidism were enrolled for this study.Serum thyroid function,Thyrotropin receptor antibody (TRAb),Thyroid peroxidase antibody (TPOAb),Thyroglobulin antibody (TGAb),Parathyroid hormone (PTH),Calcitonin (CT),Calcium (Ca),Phosphorus (P) and 25 (OH) D levels were measured,while the volume of thyroid were calculated by SPECT method.According to the serum 25 (OH)D levels,the study were divided into VitaminD (VitD) deficiency group,insufficient group and adequate group.The effects of duration of disease,patient age,FT3,FT4,TSH,TRAb,TGAb,TPOAb,Ca,P,PTH and CT on the 25 (OH) D levels were analyzed using correlation analysis,logistic regression analysis and ROC analysis.Results The newly Graves hyperfhyroidsm patients' VitD deficiency ratio,insufficient ratio,adequate ratio were 47.52％,30.98％ and 21.50％ respectively.Among the three groups,there were significant differences between the volume of thyroid,the levels of TRAb,CT,PTH and 25 (OH) D (P ＜0.05),but not the course of disease,age,FT3,FT4,TSH,TGAb,TPOAb,Calcium and Phosphorus (P ＞0.05).In VitD deficiency group,the volume of thyroid,TRAb and PTH were increased whereas the levels of 25(OH)D and CT were decreased.Correlation analysis showed that 25 (OH)D levels were negatively correlated with TRAb (rs =-0.414),PTH (r =-0.175) and thyroid volume (r =-0.094) (P ＜ 0.05),and were positively correlated with CT(r =0.115,P =0.003).Multivariate logistic regression analysis confirmed that TRAb(OR =1.124,95％ CI 1.086 ～ 1.153,P ＜0.001) had the odds ratio of 1.124 and the difference was statistically significant (P ＜ 0.001).ROC curve analysis revealed that the critical value of TRAb was greather than 12.99IU/L and the difference was statistically significant(P ＜ 0.001).Conclusion For patients with newly diagnosed Graves hyperfhyroidsm,the Serum 25 (OH) D levels were negatively correlated with TRAb and thyroid volume.