良性原发性甲状旁腺功能亢进症患者血清1,25-二羟基维生素D3水平变化

目的探讨良性原发性甲状旁腺功能亢进症(primary hyperparathyproidism,PHPT)患者血清1,25-二羟基维生素D31,25-dihydroxyvitamin D3,1,25(OH)2D3]水平变化及与甲状旁腺激素(parathyroid hormone,PTH)、血钙、血磷的关系。方法良性PHPT患者56例为观察组,同期体检健康者1118例为对照组,采用电化学发光法检测2组血清1,25(OH)2D3、PTH水平,比色法测定血钙水平,磷钼酸盐法测定血磷水平。比较2组维生素D缺乏1,25(OH)2D3<20μg/L]、严重缺乏1,25(OH)2D3<10μg/L]的比率及不同年龄分层患者血清1,25(OH)2D3水平变化,Pearson法分析观察组维生素D缺乏、严重缺乏患者血清1,25(OH)2D3与PTH、血钙及血磷的相关性。结果观察组维生素D缺乏比率、严重缺乏比率(94.64%、46.43%)高于对照组(62.79%、14.13%)(P<0.05);Pearson相关分析显示,观察组血清1,25(OH)2D3与PTH、血钙及血磷均无线性相关性(r=-0.226,P=0.352;r=-0.274,P=0.256;r=0.073,P=0.593)。观察组年龄18~40岁、>40~60岁、>60岁患者血清1,25(OH)2D3(10.76±3.17)、(10.61±5.01)、(10.72±4.85)μg/L]低于对照组18~40岁:(18.19±9.86)μg/L,>40~60岁:(17.18±9.19)μg/L,>60岁:(17.91±10.52)μg/L](P<0.05);观察组维生素D缺乏患者血清PTH(818.86±233.49)ng/L]、血钙(2.98±0.59)mmol/L]、血磷(0.78±0.17)mmol/L]与维生素D严重缺乏患者(640.09±622.69)ng/L、(2.96±0.69)mmol/L、(0.75±0.20)mmol/L]比较差异无统计学意义(P>0.05);观察组维生素D缺乏、严重缺乏患者血清1,25(OH)2D3与PTH(r=-0.360,P=0.060;r=0.071,P=0.723)、血钙(r=-0.225,P=0.250;r=-0.228,P=0.252)、及血磷(r=0.239,P=0.221;r=-0.208,P=0.297)均无线性相关。结论良性PHPT患者血清1,25(OH)2D3低于正常人群,维生素D缺乏比率较高,且血清1,25(OH)2D3与PTH、血钙及.血磷无线性相关。

Variation of 1, 25-dihydroxyvitamin D3 in patients with benign primary hyperparathyroidism

Objective To investigate the change of serum 1,25-dihydroxyvitamin D3(1,25(OH)2D3)in patients with benign primary hyperparathyproidism(PHPT)and its correlation with serum parathyroid hormone(PTH),serum Ca^2+and P^3+.Methods Fifty-six patients with benign PHPT(observation group)and 1118 healthy volunteers(control group)were detected the levels of serum 1,25(OH)2D)3 and PTH by electrochemiluminescence method.The serum Ca^2+and P^3+levels were detected by colorimetric method and phosphomolybdate method,respectively.The prevalences of vitamin D deficiency(1,25(OH)2D3<20μg/L)and severe vitamin D deficiency(1,25(OH)2D3<10μg/L)were compared between two groups and the changes of serum of 1,25(OH)2D3 were compared in patients with difference ages.Pearson method was used to analyze the correlation of 1,25(OH)2D3 with PTH,Ca^2+and P^3+in patients with vitamin D deficiency and severe vitamin D deficiency.Results The prevalences of vitamin D deficiency and severe deficiency were significantly higher in observation group(94.64%,46.43%)than those in control group(62.79%,14.13%)(P<0.05).Pearson correlation analysis showed that 1,25(OH)2D3 was linearly correlated with PTH,Ca2+and P3+(r=-0.226,P=0.352;r=-0.274,P=0.256,r=0.073,P=0.593)in observation group.The serum 1,25(OH)2D3 levels were significantly lower in patients aged 18 to 40 years((10.76±3.17)μg/L),>40 to 60 years((10.61±5.01)μg/L)and>60 years((10.72±4.85)μg/L)in observation group than those in control group((18.19±9.86),(17.18±9.19),(17.91±10.52)μg/L)(P<0.05).There were no significant differences in the levels of PTH((818.86±233.49)ng/L vs.(640.09±622.69)ng/L),Ca^2+((2.98±0.59)mmol/L vs.(2.96±0.69)mmol/L)and P^3+((0.78±0.17)mmol/L vs.(0.75±0.20)mmol/L)between the patients with vitamin D deficiency and severe vitamin D deficiency(P>0.05).The serum levels of 1,25(OH)2D3 in patients with vitamin D deficiency and severe vitamin D deficiency were not linearly correlated with serum PTH(r=-0.360,P=0.060;r=0.071,P=0.723),Ca^2+(r=-0.225,P=0.250;r=-0.228,P=0.252)and P^3+(r=0.239,P=0.221;r=-0.208,P=0.297).Conclusion The patients with benign PHPT have lower serum 1,25(OH)2 D3 level and higher prevalence of vitamin D deficiency than normal subjects.The serum 1,25(OH)2 D3 level is not linearly correlated with PTH,Ca^2+and P3+in PHPT patients with vitamin D deficiency.