甲状腺功能异常患者血生化、骨代谢及骨密度特点的临床研究

目的观察甲状腺功能减退症及甲状腺功能亢进症对骨密度以及骨代谢相关指标的影响。方法纳入甲状腺功能减退症女性37例为甲减组,甲状腺功能亢进症女性41例为甲亢组,健康体检女性人员40例为对照组。观察3组甲状腺功能指标血游离三碘甲状腺原氨酸(FT_3)、游离甲状腺激素(FT_4)和高敏感促甲状腺激素(TSH);骨代谢指标血Ca~(2+)、血P~(3+)、1,25-(OH)_2D_3、甲状旁腺激素(PTH)、碱性磷酸酶(ALP)、血清Ⅰ型胶原羧基端吡啶并啉交联肽(ICTP)以及血清骨钙蛋白(BGP)以及左侧股骨颈、正位腰椎1-4(L_(1-4))的骨密度情况。结果甲亢组血清FT_3、FT_4、ALP、BGP、ICTP水平高于对照组(P0.05),甲亢组血清TSH水平低于对照组(P0.05)。甲减组血清TSH水平高于对照组(P0.05),而血清FT_3、FT_4、ALP、BGP、ICTP水平显著低于对照组(P0.05)。甲亢及甲减组L1-4及左股骨颈骨密度显著低于对照组(P0.05)。3组受试者PTH、CT、Ca~(2+)、P~(3+)、1,25-(OH)_2D_3比较无统计学意义(P0.05)。结论甲亢及甲减都可以引起骨量丢失,骨密度降低;主要通过影响骨转化来实现的;应该重视甲状腺功能异常引起的骨密度及骨代谢异常。

Clinical study on blood biochemistry, bone metabolism and bone mineral density in patients with abnormal thyroid function

Objective To observe the effects of hypothyroidism and hyperthyroidism on bone mineral density and bone metabolism. Methods 37 cases of hypothyroidism were included in the hypothyroidism group, 41 cases of hyperthyroidism were included in the hyperthyroidism group and 40 cases of healthy female patients were included in the control group. The thyroid function index of blood free triiodothyronine (FT3), free thyroid hormone (FT4) and highly sensitive thyroid stimulating hormone (TSH), bone metabolic index of Ca2+, blood P3+, 1,25- (OH)2D3, parathyroid hormone (PTH), alkaline phosphatase (ALP), serum type I collagen carboxy terminal pyridine (ICTP) and serum osteocalcin (BGP), as well as the left femoral neck and anteroposterior lumbar spine 1-4 (L1-4) bone mineral density were measured and compared. Results The levels of serum FT3, FT4, ALP, BGP and ICTP in the hyperthyroid group were higher than those in the control group (P<0.05), but the level of serum TSH in the hyperthyroid group was lower than that in the control group (P<0.05). The serum TSH level in the hypothyroidism group was higher than that in the control group (P<0.05), but the levels of serum FT3, FT4, ALP, BGP and ICTP were significantly lower than those of the control group (P<0.05). Bone mineral density of lumbar spine 1-4 and left femoral neck in the hyperthyroidism and hypothyroidism groups were significantly lower than that of the control group (P<0.05). There were no significant differences in PTH, CT, Ca2 +, P3 +, 1,25- (OH) 2D3 among the three groups (P> 0.05). Conclusion Hyperthyroidism and hypothyroidism can cause loss of bone mass and decreased bone density. It is mainly achieved by influencing bone turnover. Attention should be paid to abnormal bone mineral density and abnormal bone metabolism caused by abnormal thyroid function.