中青年甲亢患者血清PINP、β-CTx与骨密度关系分析  

Relationship analysis between serum PINP and β-CTx and bone metabolism in adult patients with hyperthyroidism

作　　者：陈玮[1,2] 徐将[1] 陈超[1] 祝捷[1] 王计艳[1] 吴玉洁[1] 董林[1] 杨光伟[1] 邢学农[1] 

机构地区：[1]安徽医科大学附属省立医院内分泌科,合肥230001 [2]合肥市第三人民医院内分泌科,合肥230022

出　　处：《安徽医科大学学报》2014年第6期804-807,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省科技厅重点项目(编号:11070403029)

摘　　要：目的：探讨中青年毒性弥漫性甲状腺肿（甲亢）患者血清Ⅰ型前胶原氨基端前肽（ PINP）及Ⅰ型胶原羧基端肽（β-CTx）的变化及其与甲状腺激素水平和骨密度（ BMD）的关系。方法选择中青年甲亢患者150例为甲亢组,60例年龄匹配的正常者为对照组。使用双能 X 线骨密度仪（ DXA）分别测定受试者前臂（桡骨全部）、腰椎（ L2~4）及股骨颈BMD；用ELISA法测定受试者PINP及β-CTx。用化学发光法测定甲亢患者的游离三碘甲腺原氨酸（ FT3）、游离甲状腺激素（FT4）及促甲状腺激素（TSH）。用自动生化分析仪测定钙（ Ca）、磷（ P）。根据国际骨质疏松基金会（ IOF）对伴有影响骨代谢疾病的中青年骨质疏松诊断定义,按BMD T值将甲亢组分为骨量正常组（ ON组）、骨量减少组（ OD组）及骨质疏松组（ OP组）,比较3组间上述各项指标的差异。结果与对照组比较,甲亢组PINP、β-CTx、Ca显著升高（ P＜0．01）,前臂、L2~4及股骨颈BMD均降低（P＜0．05）。甲亢患者中,OP组与 ON 组比较, PINP、β-CTx、FT3、FT4明显升高,TSH明显降低（ P＜0．01）, OP组与OD组比较, PINP、β-CTx、FT3及TSH差异有统计学意义（ P＜0．01）,而OD组与ON组比较, PINP、β-CTx、TSH 差异有统计学意义（ P ＜0．01）。相关分析显示,中青年甲亢患者PINP、β-CTx分别与FT3、FT4呈正相关（ P＜0．05）,与TSH及前臂BMD呈负相关（P＜0．05）。结论中青年甲亢患者骨转换加快,破骨细胞功能增强伴成骨细胞活性增加。 PINP及β-CTx联合BMD检测可更准确的反映中青年甲亢患者骨代谢情况。Objective To explore the changes in serum type I procollagen N-terminal propeptide （ PINP） and c-terminal telopeptide region of collagen type 1 （β-CTx） and their relationship with thyroid hormone levels and bone mineral density （ BMD） in adult patients under 50 years old with hyperthyroidism. Methods 150 adult patients under 50 years old with hyperthyroidism and 60 healthy adults in the same age range （ comparison group） were re-cruited to participate in the study. Subjects ’ BMD was assessed using the dual-energy X-ray absorptiometry （DXA） at forearm （whole radius）, lumbar spine （L2~4）, and femoral neck. The free triiodothyronine （FT3）, free thyroxine （ FT4 ） and thyroid stimulating hormone （ TSH） in patients with hyperthyroidism were determined by chemiluminescence. The hyperthyroidism group was further divided into normal bone mass group （ ON group） , os-teopenia group （ OD group） and osteoporotic group （ OP group） based on T scores of BMD. Subjects’ PINP andβ-CTx levels were measured with ELISA, and their calcium （ Ca） and phosphorus （ P） were measured using an auto-matic biochemical analyzer. The levels of PINP,β-CTx, Ca and P were compared between the hyperthyroidism and comparison groups and among the three hyperthyroidism subgroups. Results When compared with comparison group, the hyperthyroidism group had significantly higher levels of PINP,β-CTx and Ca （P〈0. 01）, and signifi-cantly lower BMD at forearm, L2~4 and femoral neck （ P〈0. 05 ） . Among patients with hyperthyroidism, the OP group had significantly higher PINP,β-CTx, FT3 and FT4 levels （P〈0. 01） and significantly lower TSH level （P〈0. 01） than the ON group had, and the OP group had significantly higher PINP,β-CTx, FT3 levels （P〈0. 01） and significantly lower TSH level （ P 〈0. 01 ） than the OD group had. Besides, the OD group had significantly higher PINP, β-CTx levels （ P 〈0. 01 ） and significantly lower TSH level （ P 〈0. 01 ） th

关 键 词：甲亢 骨质疏松 骨密度 PINP β-CTx 

分 类 号：R581.1[医药卫生—内分泌] R589.9[医药卫生—内科学]