甲状腺功能亢进症患者骨代谢指标的变化  

Changes of bone metabolic indexes in patients with hyperthyroidism

作　　者：王转锁[1] 吴月平[1] 宋钦华[1] 

机构地区：[1]海南医学院附属医院内分泌科,海南海口570102

出　　处：《海南医学》2015年第3期383-386,共4页Hainan Medical Journal

基　　金：海南省高等学校科学研究项目(编号:Hjkj2011-27)

摘　　要：目的观察甲状腺功能亢进症患者血钙、血磷、血碱性磷酸酶(ALP)、血甲状旁腺激素(PTH)和血25羟维生素D[25(OH)D]水平变化及其在骨代谢中的作用。方法选取109例初发或复发的甲状腺功能亢进症患者作为甲亢组,91例正常健康人群为对照组,采用电化学发光法测定其血浆25(OH)D和PTH,生化法测定血钙、血磷、血ALP。结果与对照组比较,甲亢组血钙、血磷、血ALP、血浆25(OH)D水平升高,血浆PTH降低,差异均有统计学意义(P<0.05)。甲亢组中,维生素D缺乏30例(27.5%),不足37例(33.9%),充足42例(38.5%);对照组中,维生素D缺乏54例(59.3%),不足31例(34.1%),充足6例(6.6%)。Spearman相关分析显示,甲亢组血浆25(OH)D与血浆PTH呈负相关(r=-0.323,P=0.001)。结论甲亢骨转换加速;甲亢患者血25(OH)D水平升高,可能与高血钙、血PTH降低及高血磷导致1-α-羟化酶活性降低有关;维生素D缺乏在甲亢骨代谢中的作用不大。Objective To observe the changes of the serum calcium, phosphorus, alkaline phosphatase, plasma 25-hydroxyvitamin D and parathyroid hormone in patients with hyperthyroidism, and to evaluate the influence of these indexes on bone metabolism. Methods A total of 109 patients with hyperthyroidism were enrolled into the hyperthyroidism group, and 91 healthy individuals were included in the control group. Electrochemical luminescence was used to evaluate the levels of plasma 25-hydroxyvitamin D and parathyroid hormone in both groups. And serum calcium, phosphorus and alkaline phosphatase in the two groups were measured by biochemistry methods. Results The levels of plasma 25-hydroxyvitamin D, serum calcium, phosphorus and alkaline phosphatase in hyperthyroidism group were higher than those in control group, and the plasma parathyroid hormone in hyperthyroidism group was lower than that in the control group. The differences were statistically significant（P〈0.05）. In the hyperthyroidism group,there were respectively 30 cases（27.5%）, 37 cases（33.9%）, and 42 cases（38.5%） of patients with Vitamin D deficiency, insufficiency and sufficiency, while in the control group, there were respectively 54 cases（59.3%）, 31 cases（34.1%）, and 6 cases（6.6%） of persons with Vitamin D deficiency, insufficiency and sufficiency. The Spearman analysis showed that the plasma 25-hydroxyvitamin D was negatively correlated with plasma parathyroid hormone in the hyperthyroidism group（r=-0.323, P=0.001）. Conclusion Bone turnover in patients with hyperthyroidism is accelerated. The increased plasma 25-hydroxyvitamin D in patients with hyperthyroidism may be related to reduced 1-α-hydroxylase activity secondary to hypercalcemia, reduced plasma PTH and hyperphosphatemia. The influence of vitamin D deficiency on bone metabolism in hyperthyroidism is limited.

关 键 词：甲状腺功能亢进症 甲状旁腺激素 25羟维生素D 

分 类 号：R581.1[医药卫生—内分泌]