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甲状腺功能亢进症患者的钙 磷和骨代谢改变 |
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赵新宇 孟迅吾 白耀 周学瀛 郭芝生
刘怀成 胡莹莹 秦明伟 田均平
【摘要】 目的 研究甲状腺功能亢进症病人的钙磷代谢、骨转换和骨密度改变。方法 应用双能X线吸收法测量38例甲状腺功能亢进症患者的骨密度，并与年龄和性别相匹配的健康志愿者(对照组)相比较。结果 甲状腺功能亢进症患者的血游离钙水平(1.22±0.09 mmol/L)与24小时尿钙排量(6.5±2.5 mmol/24h)显著高于健康对照组(1.18±0.05 mmol/L和3.1±1.2 mmol/24h，P值均＜0.001)。血磷水平(1.1±0.2 mmol/L)和24小时尿磷排量(21.7±6.5 mmol/24 h)较对照组增高(1.0±0.2 mmol/L和18.0±4.0 mmol/24h，P值均＜0.05)。血抗酒石酸酸性磷酸酶和24小时尿羟脯氨酸(HYP)排量高于对照组(P值均＜0.001)，血骨钙素(BGP)和碱性磷酸酶(ALP)也较对照组升高(P值均＜0.001)。尿HYP排量和血BGP均与血游离三碘甲状腺原氨酸呈正相关(r=0.38，P＜0.05；r=0.33，P＜0.05)。骨密度测定显示全组骨量丢失在前臂远端1/10部位为58%(22例)，1/3部位为82%(31例)，腰椎2～4为16%(6例)，股骨颈35%(13例)，Wards三角55%(21例)，大转子35%(13例)。结论 甲状腺功能亢进症病人存在钙磷代谢负平衡，骨转移增高，皮质骨骨量的丢失早于松质骨。
【关键词】 甲状腺功能亢进症 骨密度 钙代谢 磷代谢
Changes of bone and mineral metabolism in Chinese patients with hyperthyroidism Zhao Xinyu*, Meng Xunwu, Bai Yao, et al. *Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730
【Abstract】 Objective To investigate the changes of bone, mineral metabolism and bone mineral density (BMD) in 38 hyperthyroidism patients before treatment. Methods BMD was measured using DXA, the sex and age were matched with the normals of the control group. Results The levels of plasma ionized calcium and serum phosphorus were elevated (P<0.001, P<0.05) with increased urinary excretion of calcium and phosphorus as compared with the controls (P<0.001, P<0.05), indicating a negative calcium and phosphorus balance in hyperthyroidism patients. The serum levels of bone GLA protein (BGP), alkaline phosphotase, tartrate-resistant acid phosphotase, and the urinary excretion of hydroxyproline were also elevated. The BMD measurements revealed that, in the forearm the frequencies of bone mass loss were 82% for the distal one third portion and 58% for the distal one tenth portion, and in the lumbar vertebrae and hip the freq[1] [2] 下一页
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