初诊Graves病患者促甲状腺激素受体抗体与骨转换标志物的相关性分析  

Thyrotropin receptor antibody and bone turnover markers in the patients with newly-diagnosed Graves′disease

作　　者：樊亚亚 邵明玮[1] 王娇[1] 张薇 王玮杰 陈远思 连梦青 卫芳祎 秦贵军[1] Fan Yaya;Shao Mingwei;Wang Jiao;Zhang Wei;Wang Weijie;Chen Yuansi;Lian Mengqing;Wei Fangyi;Qin Guijun(Department of Endocrinology,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病科,450052

出　　处：《中华内分泌代谢杂志》2022年第5期391-397,共7页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨初诊Graves病(GD)患者促甲状腺激素受体抗体(thyrotropin receptor antibody,TRAb)水平与骨转换标志物(bone turnover markers,BTMs)的相关性。方法收集2016年10月至2021年6月于郑州大学第一附属医院初诊GD患者的临床资料,包括:游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素、甲状腺相关抗体、总I型胶原氨基端前肽(PINP)、骨钙素氮端中分子片段(N-MID)、β-Ⅰ型胶原交联羧基末端肽(β-CTX)、血脂和肾功能等。结果618例GD患者的平均年龄为(43.7±13.2)岁,男∶女=1∶1.99。男性GD患者PINP和β-CTX显著高于女性(均P<0.05)。Spearman相关性分析显示,PINP、N-MID和β-CTX均与FT3、FT4、TRAb、血清钙和血清磷呈正相关,均与体重指数和低密度脂蛋白胆固醇呈负相关(均P<0.05)。线性回归分析显示,总体GD患者TRAb与lg-PINP、lg-N-MID和sqrt-β-CTX,在单变量模型中,均呈正相关(β分别为0.006,0.005和0.006;均P<0.001);校正甲状腺功能后仍呈正相关(均β=0.004,均P<0.001);校正多种混杂因素后(模型3和4),上述相关性仍存在(均P<0.05)。不同性别GD患者单变量模型和校正甲状腺功能模型的结果与总体一致(均P<0.05)。结论TRAb是GD患者骨转换加速的危险因素,且独立于甲状腺功能。Objective To investigate the correlation between the level of thyrotropin receptor antibody(TRAb)and bone turnover markers(BTMs)in the patients with newly-diagnosed Graves′disease(GD).Methods The clinical data of GD patients who were newly-diagnosed in the First Affiliated Hospital of Zhengzhou University from October 2016 to June 2021 were collected,including free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone,thyroid related antibodies,N-terminal procollagen of type I collagen(PINP),N-terminal osteocalcin(N-MID),β-cross-linked C-telopeptide of type I(β-CTX),blood lipid and renal function,etc.Results There were 618 GD patients with an average age of(43.7±13.2)years(male∶female=1∶1.99).The PINP andβ-CTX level in male GD patients were significantly higher than those in female(all P<0.05).Spearman correlation analysis showed that PINP,N-MID andβ-CTX were positively correlated with FT3,FT4,TRAb,serum calcium and serum phosphorus;and negatively correlated with body mass index and low density lipoprotein cholesterol(all P<0.05).Linear regression analysis showed that TRAb was positively correlated with lg-PINP,lg-N-MID and sqrt-β-CTX in the univariate model of total GD patients(βwere 0.006,0.005,and 0.006,respectively;all P<0.001);positive correlation remained after adjusting for thyroid function(allβ=0.004,all P<0.001);and for multiple confounding factors(model 3 and 4,all P<0.05).Results of univariate and adjusted thyroid function models with GD in different genders were consistent with the total patients(all P<0.05).Conclusion TRAb is a risk factor for accelerated bone turnover in GD patients which is independent of thyroid function.

关 键 词：格雷夫斯病 促甲状腺激素受体抗体 骨转换标志物 

分 类 号：R581.1[医药卫生—内分泌]