甲亢131I治疗前后骨密度测定的临床分析

目的 探讨甲亢患者131I治疗前及治疗后临床缓解持续时间的长短及其骨密度的变化情况。方法 70例甲亢患者于131I治疗前和其中37例于131I治疗后临床缓解小于6个月、9-12个月和大于18个月,分别用双能X线骨密度仪(DEXA)进行骨密度(BMD)测定,并分别与年龄匹配正常健康者95例进行对照分析。结果 (1)甲亢131I治疗前和治疗后临床缓解小于6个月、9-12个月的L2-4BMD均明确低于正常对照组,差异有非常显著性,股骨上段各区(股骨颈、Ward's区、大转子区)虽低于正常对照组,但差异无明显性;(2)131I治疗后临床缓解大于18个月的L2-4及股骨上段各区的BMD改善至接近正常人的水平,差异无显著性;(3)131I治疗后临床甲低组L2-4及股骨上段各区(尤其Ward's区)的BMD均明显低于正常对照组,差异有非常显著性。结论 甲亢经131I治疗后临床缓解6-12个月骨矿含量改善不明显,至18个月逐渐增加接近正常对照组水平;131I治疗后临床甲低持续时间大于6个月者,同样会导致骨矿含量的降低。

Clinical analysis of bone mineral density in patients of Graves'''' disease before and after[3]I therapy

Objective To investigate the changes of bone mineral density ( BMD) in patients with Graves disease (GD) before131 I therapy and duration of clinical remission after the therapy. Methods BMDs in lumbar vertebrae (L2-4) and proximal femur were measured by dual-energy X-ray absorptionmery (DEXA) in 70 patients with GD before131 I therapy, and in 37 of them at the time of clinical reuission for less than 6 months, 9-12 months and more than 18 months afte131 I therapy. The results were also compared with the BMD values in 95 healthy subjects with matched age and sex. Results (1 )The BMDs of L2-4 in the GD group before131 I therapy and at 6 months or 9-12 months after131 I therapy were significantly lower than those in the control group ( P < 0.01) . The BMD of each site of proximal femur was lower than those in the control grpup, but there was no significant dif-ference. (2) The improvement of BMD in L2-4 and each site of proximal femur, at 18 months of clinical reuission after131 I therapy was close to the normal level, and there was no significant difference. (3) The BMDs of L2-4 and each site of proximal femur especially in Ward's triangle in the group of clinical hypothyroidism were significantly lower than those in the control group. Conclusions The BMD is not significantly improved in patients with GD at the time of clinical remission for 6 months or 9-12 months after131 I therapy but it gradually increases to about the level of control group at 18 months of clinical remission after131 I therapy. The clinical hypothyroidism for more than 6 months due to131 I therapy also result in decrease in BMD.