Graves病患者维生素D营养状态及其与骨代谢指标的相关性研究

发布时间：2018-03-02 03:21

  本文关键词： Graves病 25-羟维生素D3 PTH PINP S-CTX　出处：《蚌埠医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨Graves病(Graves disease,GD)患者维生素D营养状态及其与骨代谢指标血清I型原胶原N-端前肽(procollagen type I N-terminal peptide,PINP)和I型胶原交联C-末端肽(C-telpeptide of type I collagen,S-CTX)水平的相关性。方法选取初诊或复发的GD患者178例,其中男74例,女104例,用放射免疫分析方法(Radioimmunoassay,RIA)测定所有受试者血清25-羟维生素D3[25-(OH)D3]、促甲状腺激素受体抗体(Thyrotropin receptor antibodies,TRAb);用酶联免疫吸附法(Enzyme-linked immunoassay,ELISA)测定血清PINP、S-CTX;采用自动生化分析仪检测血清钙(Calcium,Ca)、磷(Phosphorus,P);用电化学发光法检测血清三碘甲状原氨酸(Triiodothyronine,TT3)、甲状腺激素(Thyroxine,TT4)、促甲状腺激素(Thyroid stimulating hormore,TSH),甲状旁腺激素(Parathyroid hormore,PTH)。根据血清25-(OH)D3水平进行分组,比较各组间各项指标的差异。结果(1)178名GD患者中,维生素D水平缺乏、不足和充足者的比例分别为24.16%、29.21%、46.63%。(2)25-(OH)D312ng/ml组的血清PINP、S-CTX高于25-(OH)D312-20ng/ml组25-(OH)D320-30ng/ml组、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D312-20ng/ml组的血清PINP、S-CTX高于25-(OH)D320-30ng/ml组(P0.05)、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D320-30ng/ml组的血清PINP、S-CTX高于25-(OH)D3≥30ng/ml组(P0.05)。(3)25-(OH)D312ng/ml组的血清TT3、TT4高于25-(OH)D312-20ng/ml组、25-(OH)D320-30ng/ml组、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D312-20ng/ml组的血清TT3、TT4高于25-(OH)D320-30ng/ml组(P0.05)、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D320-30ng/ml组的血清TT3、TT4高于25-(OH)D3≥30ng/ml组(P0.05)。各组间血清TSH、TRAb差异无统计学意义(P0.05)。(4)25-(OH)D312ng/ml组的血清PTH、Ca高于25-(OH)D312-20ng/ml组(P0.05)、25-(OH)D320-30ng/ml组(P0.01)、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D312-20ng/ml组的血清PTH、Ca高于25-(OH)D320-30ng/ml组(P0.05)、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D320-30ng/ml组的血清PTH、Ca高于25-(OH)D3≥30ng/ml组(P0.05)。25-(OH)D312ng/ml组的血清P低25-(OH)D312-20ng/ml组、25-(OH)D320-30ng/ml组、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D312-20ng/ml组的血清P低于25-(OH)D320-30ng/ml组(P0.05)、25-(OH)D3≥30ng/ml组(P0.01),25-(OH)D320-30ng/ml组的血清P低于25-(OH)D3≥30ng/ml组(P0.05)。(5)Pearson相关分析显示25-(OH)D3与PINP、S-CTX、PTH、TT3、TT4、Ca呈负相关(P0.01),与P呈正相关(P0.01),与年龄、病程、TSH、TRAb均无明显相关性(P0.05);PINP、CTX分别与PTH、TT3、TT4、Ca呈正相关(P0.01),与25-(OH)D3、P呈负相关(P0.01),与年龄、病程、TSH、TRAb均无明显相关性(P0.05)。结论1、GD患者大多数存在维生素D的缺乏和不足;2、在GD患者中,维生素D水平与PINP、S-CTX呈负相关,可能提示随着维生素D的减少,骨形成、骨吸收增强,且骨吸收作用增强大于骨形成;3、GD患者血清维生素D水平与TT3、TT4水平呈负相关。与TSH、TRAb无相关性。
[Abstract]:Objective to investigate the effect of Graves disease (Graves disease, GD) the nutritional status of patients with vitamin D and bone metabolism index of serum type I procollagen terminal propeptide (procollagen type N- I N-terminal peptide, PINP) and type I collagen crosslinked C- terminal peptide (C-telpeptide of type I collagen, S-CTX). The relationship between the level of 178 patients with GD methods newly diagnosed or recurrent cases, 74 cases were male, 104 were female, radioimmunoassay (Radioimmunoassay, RIA) of all subjects were measured serum 25- hydroxyvitamin D3[25- D3] (OH), thyroid stimulating hormone receptor antibody (Thyrotropin receptor, antibodies, TRAb); enzyme linked immunosorbent assay (Enzyme-linked immunoassay, ELISA determination of serum PINP, S-CTX); the serum calcium was detected by automatic biochemical analyzer (Calcium, Ca), P (Phosphorus, P); three iodine thyroid original acid by chemiluminescence detection of blood (Triiodothyronine, TT3, thyroid hormone (Thyro) xine,TT4),淇冪敳鐘惰吅婵，

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