初发Graves病对骨代谢的影响

发布时间：2018-05-13 21:17

本文选题：甲状腺功能亢进症 + 骨钙素　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:观察初发Graves病患者骨代谢指标的变化情况,了解初发甲状腺功能亢进症对骨代谢的影响,为纠正骨代谢异常提供临床依据。方法:选择2014年4月—2014年9月河北北方学院附属第二医院门诊和住院治疗的初发甲状腺功能亢进症患者45例作为实验组,选择年龄、性别相对应的健康人44例作为对照组。在相同季节采用化学发光微粒子免疫检测法测定甲状腺功能(FT3、FT4、TSH)及相关抗体(TPOAb);TRAb测定采用电化学发光法;应用离子选择电极法测定血钙终点法测定血磷;应用电化学发光法测定骨形成指标骨钙素(OST)及骨吸收指标β-胶联降解产物(β-CTX);采用化学发光法测定调节钙磷代谢的甲状旁腺激素(PTH);应用高效液相色谱串联质谱法测定25-羟维生素D3。采用SPSSl6.0软件包对所得结果进行统计学分析,计量资料分析使用t检验及Mann-Whitney U非参数检验,P0.05有统计学意义。结果:1甲状腺功能检查:实验组FT3及FT4较对照组明显升高,TSH较对照组明显降低。实验组FT3平均值为(23.51±14.63)pmol/L、FT4平均值为(41.08±14.03)pmol/L,对照组FT3平均值(4.32±0.51)pmol/L、FT4平均值(15.71±1.82)pmol/L,P值0.001;实验组TSH(0.003±0.013)u IU/ml,对照组TSH(2.132±1.027)u IU/ml,P值0.001;2甲状腺相关抗体检查:实验组TRAb及TPOAb较对照组明显增高。实验组TRAb平均值(12.99±8.39)IU/L、TPOAb平均值(558.46±420.14)IU/ml,对照组TRAb平均值(0.95±0.31)IU/L、TPOAb平均值(11.52±9.74)IU/ml,P值0.001;3血钙磷检查:实验组血钙磷较对照组明显增高。实验组游离钙平均值(1.25±0.07)mmol/L,对照组游离钙平均值(1.18±0.08)mmol/L,P值0.001;实验组血磷平均值(1.26±0.19)mmol/L,对照组血磷平均值(1.22±0.12)mmol/L,P值0.05;4成骨及破骨细胞的指标:实验组OST及β-CTX较对照组明显增高。实验组OST平均值(48.62±19.92)ng/ml,对照组OST平均值(14.02±3.75)ng/ml,P值0.001;实验组β-CTX平均值(0.981±0.418)ng/ml,对照组β-CTX平均值(0.445±0.268)ng/ml,P值0.001;5 PTH测定结果:实验组较对照组明显降低。实验组PTH平均值(2.64±1.36)pmol/L,对照组PTH平均值(3.12±1.37)pmol/L,P值0.05;6 25-羟维生素D3测定结果:实验组较对照组明显降低。实验组25-羟维生素D3平均值(17.60±7.85)ng/ml,对照组25-羟维生素D3平均值(23.55±7.87)ng/ml,P值0.05。结论:1甲状腺功能亢进症患者较健康对照人群相比游离血钙及血磷明显增高;2甲状腺功能亢进症患者的骨形成及骨吸收均较健康人群活跃;3甲状腺功能亢进症患者PTH及25-羟维生素D3水平较健康人群明显降低。
[Abstract]:Objective: to observe the changes of bone metabolism in patients with primary Graves disease, and to understand the effect of primary hyperthyroidism on bone metabolism, and to provide clinical basis for correcting abnormal bone metabolism. Methods: from April 2014 to September 2014, 45 patients with primary hyperthyroidism were selected from outpatient and inpatient treatment in the second affiliated Hospital of Hebei North University as experimental group, and 44 healthy persons corresponding to age and sex were selected as control group. In the same season, the thyroid function FT3FT _ 4T _ 4T _ (SHH) and the relative antibody TPO _ (Ab) TRAB were detected by chemiluminescence microparticle immunoassay, and the serum phosphorus was determined by ion selective electrode method by the end point method of blood calcium, and by electrochemiluminescence (ECL). Bone formation index osteocalcin (OST) and bone resorption index 尾 -gel degradation product (尾 -CTX) were determined by electrochemiluminescence (ECL), parathyroid hormone (PTH), a parathyroid hormone (PTH), which regulates calcium and phosphorus metabolism, and 25-hydroxyvitamin D _ (3) was determined by high performance liquid chromatography tandem mass spectrometry (HPLC / MS). The results were analyzed by SPSSl6.0 software package, and the data were analyzed by t test and Mann-Whitney U nonparametric test (P0.05). Results: FT3 and FT4 in the experimental group were significantly higher than those in the control group. The average FT3 of experimental group was 23.51 卤14.63 渭 mol / L FT _ 4 = 41.08 卤14.03 渭 mol 路L ~ (-1), FT3 of control group was 4.32 卤0.51 渭 mol / L ~ (-1) 渭 mol / L ~ (-1) FT _ 4 = 15.71 卤1.82 渭 mol / L ~ + P = 0.001, TSH(0.003 卤0.013 渭 mol / L ~ (-1) 渭 mol / L ~ (-1) TSH(0.003 of control group and control group (TSH(2.132 卤1.027 U 路ml ~ (-1) 路L ~ (-1); TRAb and TPOAb in the experimental group were significantly higher than those in the control group. The average value of TRAb in the experimental group was 12.99 卤8.39 渭 mol / L, the mean value of TRAb was 558.46 卤420.14 渭 mol / ml, and the average value of TRAb in the control group was 0.95 卤0.31. The mean value of serum calcium and phosphorus was 11.52 卤9.74U / ml / ml P 0.001g / ml: the blood calcium and phosphorus in the experimental group was significantly higher than that in the control group. The mean value of free calcium in the experimental group was 1.25 卤0.07 mmol / L, in the control group was 1.18 卤0.08 mmolL / L P 0.001, in the experimental group was 1.26 卤0.19 mmol / L, and in the control group, the mean value of serum phosphorus was 1.22 卤0.12 mmol / L / L, 0.054 mmol-1 / L, respectively. The levels of OST and 尾 -CTX in the experimental group were significantly higher than those in the control group. The average value of OST was 48.62 卤19.92 ng / ml in the experimental group and 14.02 卤3.75 ng / ml / ml in the control group (P = 0.001), while the average value of 尾 -CTX in the experimental group was 0.981 卤0.418 ng / ml, and the average value of 尾 -CTX in the control group was 0.445 卤0.268 ng / ml respectively. The results showed that the average value of 尾 -CTX in the experimental group was significantly lower than that in the control group. The average value of PTH was 2.64 卤1.36 mmol / L in the experimental group and 3.12 卤1.37 mmol / L in the control group. The results showed that the mean value of PTH in the experimental group was 0.05 卤1.36 渭 mol / L, and the value of hydroxyvitamin D3 in the experimental group was significantly lower than that in the control group. The mean value of 25-hydroxyvitamin D _ 3 was 17.60 卤7.85 ng / ml in the experimental group and 0.05 in the control group (23.55 卤7.87 ng / ml, P < 0.05). Conclusion the bone formation and bone resorption in hyperthyroidism patients with 1 / 1 hyperthyroidism were significantly higher than those in healthy controls, compared with free blood calcium and serum phosphorus in hyperthyroidism patients with hyperthyroidism, both bone formation and bone resorption in hyperthyroidism patients were more active than those in healthy controls. The levels of PTH and 25-hydroxyvitamin D 3 were significantly lower than those of healthy subjects.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R581.1

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