CAJ | 학술논문

目的观察甲状腺功能亢进症患者治疗前后血清骨代谢指标变化，以了解甲状腺功能亢进症骨代谢及骨转换率特点。方法随机选取46例初诊原发性甲状腺功能亢进症患者，均用甲巯咪唑治疗，治疗前及治疗后2个月采集空腹静脉血，用电化学发光免疫分析法（ ECLIA）测定血清骨钙素（ OCN）、β-胶原特殊序列（β-CTx）及甲状腺功能指标，并与30例健康对照组进行比较。结果甲状腺功能亢进症患者治疗前后血清OCN、β-CTx均显著高于对照组（ P＜0.000），治疗前分别增加1.74倍、1.80倍，治疗后分别增加2.26倍、2.16倍；治疗前各指标相关分析显示，血清FT3水平与OCN浓度呈正相关（P＜0.05），FT4水平与OCN、β-CTx浓度呈正相关（ P＜0.05），血清OCN与β-CTx浓度呈正相关（ P＜0.01）。治疗早期（2个月）血清OCN、β-CTx水平较治疗前进一步升高，差异无统计学意义（ P＞0.05）。结论高骨转换速率是甲状腺功能亢进症患者骨代谢的显著特征。原发性甲状腺功能亢进症患者治疗前骨代谢可能以破骨细胞活动占优势，是甲状腺功能亢进症骨代谢异常的主要原因。甲状腺功能亢进症治疗早期骨吸收和骨形成指标较治疗前均增高，但骨形成指标增幅大于骨吸收指标，提示甲状腺功能亢进症治疗早期可能以成骨细胞活动占优势，有利于骨重建。
목적관찰갑상선공능항진증환자치료전후혈청골대사지표변화，이료해갑상선공능항진증골대사급골전환솔특점。방법수궤선취46례초진원발성갑상선공능항진증환자，균용갑구미서치료，치료전급치료후2개월채집공복정맥혈，용전화학발광면역분석법（ ECLIA）측정혈청골개소（ OCN）、β-효원특수서렬（β-CTx）급갑상선공능지표，병여30례건강대조조진행비교。결과갑상선공능항진증환자치료전후혈청OCN、β-CTx균현저고우대조조（ P＜0.000），치료전분별증가1.74배、1.80배，치료후분별증가2.26배、2.16배；치료전각지표상관분석현시，혈청FT3수평여OCN농도정정상관（P＜0.05），FT4수평여OCN、β-CTx농도정정상관（ P＜0.05），혈청OCN여β-CTx농도정정상관（ P＜0.01）。치료조기（2개월）혈청OCN、β-CTx수평교치료전진일보승고，차이무통계학의의（ P＞0.05）。결론고골전환속솔시갑상선공능항진증환자골대사적현저특정。원발성갑상선공능항진증환자치료전골대사가능이파골세포활동점우세，시갑상선공능항진증골대사이상적주요원인。갑상선공능항진증치료조기골흡수화골형성지표교치료전균증고，단골형성지표증폭대우골흡수지표，제시갑상선공능항진증치료조기가능이성골세포활동점우세，유리우골중건。
Objective To investigate the changes of bone metabolism markers in patients with hyperthyroidism before and after treatment and the characteristics of bone turnover rate .Methods Forty-six patients with hyperthyroidism and thirty healthy controls were included into this study .Electrochemical luminescence immunoassay(ECLIA)method was used to measure serum osteocalcin and β-cross laps levels in all the hyperthyroid patients before and after antithyroid ( methimazole ) therapy and thirty healthy volunteers .Results The mean concentrations of both osteocalcin and β-cross laps in hyperthyroid patients before and after treatment were significantly higher than those in the healthy subjects ( P <0.000 ) , increased by 1.74 folds and 1.80 folds respectively before treatment and 2.26 folds and 2.16 folds respectively after treatment .The correlation analysis showed that the serum FT3 was positively correlated with osteocalcin ( P<0.05 ) and FT4 was positively correlated with osteocalcin and β-cross laps ( P <0.05 ) before methimazole treatment .The serum osteocalcin was positively correlated with β-cross laps ( P <0.01 ) as well.Compared with the untreated hyperthyroidism group , serum osteocalcin and β-cross laps were further increased after methimazole treatment for 2 months ( P >0.05 ) . Conclusions High bone turnover rate characterizes the bone metabolism in the patients with hyperthyroidism .The activity of bone may dominant with osteoclast resulting in abnormal bone metabolism in the untreated hyperthyroidism patients.However, in the patients who under treatment , both bone resorption and bone formation were further increased and bone formation were more prominent ,which suggested that the osteoblast activity dominant the whole progress in favor of bone remodeling .