甲状腺功能亢进症合并骨质疏松患者生长激素变化的研究

背景甲状腺功能亢进症及其导致的骨质疏松逐年增多.研究此时患者体内生长激素的变化情况,以便进一步认识其病理生理变化的机制.目的了解甲亢合并骨质疏松患者血清生长激素水平的变化,以及甲状腺素水平、年龄、病程等相关因素对骨量丢失的影响.设计病例分析.单位河北省保定市第一中心医院内分泌科.对象本研究在河北省保定市第一中心医院内分泌科完成.选择1999-10/2000-09本院门诊及住院的初诊甲亢患者146例.按骨密度(bonemineral density,BMD)分为BMD正常组44例,骨量减少组78例和骨质疏松组24例.方法空腹采集肘静脉血,以同一批试剂测定生长激素(GH)、钙(Ca)、碱性磷酸酶(ALP)、甲状腺素T3(T3)及甲状腺素T4(T4)浓度.以直线相关分析法检验上述各变量间的相关性,并比较3组之间的差异.主要观察指标①3组患者BMD测定结果的比较.②3组患者静脉血GH,Ca,ALP,T3,T4浓度的比较.结果GH、ALP与BMD之间有非常显著负相关(r=-0.456,P＜0.001).GH与年龄,病程,T3,T4等指标之间无显著相关性(r=0.005～0.119,P＞0.10).Neck,Ward's,G.T.3部位的BMD与T3、T4及病程之间呈显著负相关[r=(-0.212)～(-0.165),P＜0.05],而L2-4的BMD与上述3指标无显著相关性(r=0.010～0.115,P＞0.10).结论甲亢合并骨质疏松患者血清GH水平随着BMD的减少而升高.腰椎的BMD受T3,T4及甲亢病程的影响较小,而与年龄增长有密切关系.髋部的BMD减低比较明显,提醒甲亢患者预防髋部骨折.

Alteration of growth hormone in hyperthyroids with osteoporosis

BACKGROUND: Hyperthyroidism and its induced osteoporosis gradually increase every year. To study the alteration of growth hormone in vivo at this period is good for the further understanding of the mechanism of its pathophysiological changes.OBJECTIVE: To comprehend the alteration of serous growth hormone in hyperthyroids with osteoporosis and the impacts of the correlative factors like thyroid level, age and the course of the disease on the loss of bone quantity.DESIGN: A case analysis. SSETTING: Department of Endocrinology, Boding First Central Hospital of Hebei Province.PARTICIPANTS: The study was performed in the Department of Endocrinology, Boding First Central Hospital of Hebei Province. Totally 146 hyperthyroids diagnosed for the first time were selected from the outpatient and inpatient departments of our hospital from Oetober 1999 to September 2000. According to their bone mineral density(BMD), the hyperthyroids were divided into normal group( n = 44), low-BMD group( n = 78) and osteoporosis group( n=24) based on bone mineral density(BMD).INTERVENTIONS: Pasting venous blood was collected from elbow vein for the detection of concentrations of growth hormone(GH), calcium(Ca), alkaline phosphatase (ALP), triiodothyronine (T3) and tetraiodothyronine ( T4 )with the reagent of the same batch. The eonelation among the above variants was analyzed by linear correlation analysis and the differences among the three groups were compared as well.among the three groups.RESULTS: There were very significant negative correlations among GH, ALP and BMD( r = -0. 456, P ＜ 0. 001) . GH had no significant correlations with age, course of disease, T3 and T4( r = 0. 005 to 0. 119, P ＞ 0. 10) .BMD of the neck, ward' s and G. T. parts were significantly negatively correlated with T3, T4 and the course of disease ( r = - 0.212 to - 0. 165 ) ( P＜ 0.05), while the BMD of L2 -4 was not correlated with the above three indices( r = 0. 010 to 0. 115, P ＞ 0. 10).CONCLUSION: The serous level of GH in hyperthyroids with osteoporosis elevates with the reduction of BMD. Lumbar BMD is relatively less affected by T3, T4 and the course of hyperthyroidism but closely related with the increase of age. The decrease of hipbone BMD is relatively obvious, which reminds the prevention of hipbone fracture in hyperthyroids.