Graves病患者血清25-羟维生素D水平与促甲状腺激素受体抗体及骨代谢指标的相关性  

Correlation of serum 25-hydroxyvitamin D level with Thyrotropin receptor antibody and bone metabolism markers in patients with Graves' disease

作　　者：时照明[1] 江淼[2] 张士荣[1] 吴道爱[1] 孙卫华[1] Shi Zhaoming;Jiang Miao;Zhang Shirong;WU Daoai;Sun Weihua(Department of Endocrinology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Nutrition,Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]蚌埠医学院第一附属医院内分泌科,233004 [2]安徽省立医院营养科,合肥230001

出　　处：《中华临床营养杂志》2023年第2期95-99,共5页Chinese Journal of Clinical Nutrition

摘　　要：目的:探讨Graves病(即弥漫性毒性甲状腺肿)患者血清25-羟维生素D[25-hydroxyvitamin D,25(OH)D]水平及其与促甲状腺激素受体抗体(thyrotropin receptor antibody,TRAb)、骨代谢指标的相关性。方法:选取初诊或复发的Graves病患者124例,根据血清25(OH)D水平分为维生素D缺乏组[25(OH)D<12μg/L]、维生素D不足组[25(OH)D:12~20μg/L]、维生素D充足组[25(OH)D≥20μg/L]。所有患者检测血清25(OH)D、TRAb、I型原胶原N-端前肽(type I procollagen N-terminal pro-peptide,PINP)、I型胶原交联C-末端肽(serum type I collagen cross-linked C-terminal peptide,S-CTX)、甲状旁腺激素(parathyroid hormone,PTH)、总三碘甲状腺原氨酸(total triiodothyronine,TT_(3))、总甲状腺素(total thyroxine,TT_(4))和促甲状腺激素(thyroid-stimulating hormone,TSH)水平,比较各组间生化指标的差异。结果:维生素D充足组、维生素D不足组和维生素D缺乏组间血清TT_(3)、TT_(4)、PINP、S-CTX水平依次显著升高(P<0.01),血磷水平依次显著降低(P<0.01)。维生素D充足组血PTH和血钙水平显著低于维生素D不足组和维生素D缺乏组(P<0.01)。相关分析显示,血清25(OH)D水平与TT_(3)、TT_(4)、PINP、S-CTX、PTH、钙呈负相关(P<0.01),与磷和TSH呈正相关(P<0.01)。结论:Graves病患者血清25(OH)D水平降低与骨转换、PTH和甲状腺激素水平升高密切相关,与TRAb无关。Graves病患者甲状腺激素水平对维生素D缺乏具有一定预测价值。临床应关注Graves病患者维生素D营养状态和维生素D补充,以降低骨质疏松的发生、改善抗甲状腺药物的疗效和降低复发率。Objective To investigate the serum 25-hydroxyvitamin D[25(OH)D]level in patients with Graves'disease(GD)and its correlation with thyrotropin receptor antibody(TRAb)and bone metabolism markers.Methods A total of 124 patients with newly diagnosed or relapsed GD were selected and divided into three groups according to serum 25(OH)D level,namely vitamin D deficiency group with 25(OH)D<12μg/L,vitamin D insufficiency group with 25(OH)D of 12 to 20μg/L,and vitamin D sufficiency group with 25(OH)D≥20μg/L.The levels of serum 25(OH)D,TRAb,type I procollagen N-terminal pro-peptide(PINP),type I collagen cross-linked C-terminal peptide(S-CTX),parathyroid hormone(PTH),total triiodothyronine(TT_(3)),total thyroxine(TT_(4))and thyroid-stimulating hormone(TSH)were measured in all patients,and the differences of these biochemical indices were compared across groups.Oneway analysis of variance or Kruskal-Wallis test was used for comparison between groups,and Pearson or Spearman correlation analysis was applied for correlation test.Results The levels of serum TT_(3),TT_(4),PINP,and S-CTX significantly increased(P<0.01)and the level of phosphorus(P)decreased(P<0.01)with the decreased vitamin D levels.The levels of PTH and calcium(Ca)were significantly lower in the vitamin D sufficiency group compared with the vitamin D insufficiency group and vitamin D deficiency group(P<0.01).Correlation analysis showed that serum 25(OH)D level was negatively correlated with the levels of TT_(3),TT_(4),PINP,S-CTX,PTH and Ca(P<0.01),and positively correlated with the levels of P and TSH(P<0.01).Conclusions Decreased serum 25(OH)D level is closely related with increased bone turnover,PTH,and thyroid hormone levels in patients with GD,but not related with TRAb.Thyroid hormone levels have a certain predictive value regarding vitamin D deficiency in GD patients.It is necessary to monitor the vitamin D levels in patients with GD and provide vitamin D supplementation to reduce the incidence of osteoporosis,improve the effectiveness of antithyroid trea

关 键 词：弥漫性毒性甲状腺肿 25-羟维生素D 促甲状腺激素受体抗体 骨代谢指标 

分 类 号：R581.1[医药卫生—内分泌]