原发性甲状旁腺功能亢进症对甲状腺功能和形态的影响  

Effects of primary hyperparathyroidism on thyroid function and morphology

作　　者：张丽侠[1] 李丽[1] 许莉军 吕新全[2] 樊倩影 王志芳[1] 李冲[1] 李珊[1] 郑丽丽[1] ZHANG Li-xia;LI Li;XU Li-jun;LV Xin-quan;FAN Qian-ying;WANG Zhi-fang;LI ChongLI Shan;ZHENG Li-li(Department of Endocrinology and Metabolism,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院内分泌与代谢科,郑州450052 [2]郑州大学第一附属医院病理科,郑州450052

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2019年第6期572-577,共6页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的分析原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者甲状腺功能和形态的变化。方法以2012年1月至2017年12月至郑州大学第一附属医院就诊的有明确病理报告的PHPT患者为PHPT组,同期健康体检者为对照组,分析所有研究对象的一般资料、生化及影像学检查、甲状腺功能。结果 PHPT组共纳入243例PHPT患者,对照组253例,两组间性别、年龄差异无统计学意义(P>0.05)。PHPT组血钙、碱性磷酸酶(alkaline phosphatase,ALP)、肌酐、尿酸均高于对照组,总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)低于对照组,差异均有统计学意义[血钙:(3.14±0.54) vs.(2.36±0.10) mmol/L;ALP:(271.96±379.90) vs.(71.02±18.79) U/L;肌酐:(73.45±35.23) vs.(63.47±13.54)μmol/L;尿酸:(320.85±121.28) vs.(276.33±78.20)μmol/L;TC:(4.39±0.99) vs.(4.79±0.92) mmol/L;HDL-C:(1.17±0.33) vs.(1.45±0.43) mmol/L,均P<0.05]。PHPT组游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、促甲状腺素(thyroid-stimulating hormone,TSH)均低于对照组,差异均有统计学意义[FT3:(4.85±0.78) vs.(5.18±1.74) pmol/L;TSH:(1.97±1.35) vs.(2.61±1.52)μIU/m L,均P<0.05)]。PHPT组和对照组甲状腺结节发生率差异无统计学意义(P>0.05)。PHPT组根据血钙水平分组分析显示,不同血钙组间TSH、FT3也存在差异(P<0.05),血钙和TSH及FT3呈负相关(r=-0.325和r=-0.212,P<0.05),而对照组血钙与TSH无相关性(P>0.05)。结论 PHPT患者的高钙血症不但影响肾功能及血脂等代谢指标,还可能抑制甲状腺功能,包括TSH和FT3,对于临床上具有显著高钙血症的患者,应考虑到其甲状腺功能可能出现的变化及血脂异常。Objective To analyze the effects of primary hyperparathyroidism(PHPT) on thyroid function and morphology.Methods From January 2012 to December 2017,the patients with PHPT with pathology report from the First Affiliated Hospital of Zhengzhou University were included.The healthy subjects were recruited as the control group.The general data,biochemistry,imaging examination,thyroid function of all subjects were analyzed.Results There were 243 PHPT patients in the PHPT group and 253 healthy subjects in the control group.There was no significant difference in sex and age between the two groups(P>0.05).The blood calcium,alkaline phosphatase(ALP),creatinine,and uric acid in the PHPT group were higher than those in the control group,and TC and HDL-C in the PHPT group were lower than those in the control group [blood calcium:(3.14± 0.54) vs.(2.36± 0.10) mmol/L;ALP:(271.96 ± 379.90) vs.(71.02 ±18.79) U/L;creatinine:(73.45 ± 35.23) vs.(63.47 ± 13.54) μmol/L;uric acid:(320.85 ± 121.28) vs.(276.33 ±78.20) μmol/L;TC:(4.39±0.99) vs.(4.79±0.92) mmol/L;HDL-C:(1.17±0.33) vs.(1.45±0.43) mmol/L;all P<0.05].The levels of FT3 and TSH in the PHPT group were lower than those in the control group [FT3:(4.85±0.78)vs.(5.18±1.74) pmol/L;TSH:(1.97±1.35) vs.(2.61±1.52) μIU/mL;all P<0.05].The incidence of thyroid nodules was not significantly different between the PHPT group and the control group(P> 0.05).In the PHPT group,there were differences in TSH and FT3 between different blood calcium groups(P<0.05);there was a negative correlation between serum calcium and TSH and FT3 levels(r=-0.325 and r=-0.212,P<0.05).However,there was no correlation between TSH and serum calcium level in the control group(P>0.05).Conclusions Hypercalcemia in PHPT patients not only affects metabolic parameters such as renal function and blood lipids,but also may inhibit thyroid function,including TSH and FT3.Therefore,for patients with clinically significant hypercalcemia,consideration should be given to possible changes in thyroid function and dys

关 键 词：原发性甲状旁腺功能亢进症 高钙血症 甲状腺功能 甲状腺结节 

分 类 号：R581.1[医药卫生—内分泌]