CAJ | 학술논문

目的：探讨中青年毒性弥漫性甲状腺肿(甲亢)患者血清Ⅰ型前胶原氨基端前肽( PINP)及Ⅰ型胶原羧基端肽(β-CTx)的变化及其与甲状腺激素水平和骨密度( BMD)的关系。方法选择中青年甲亢患者150例为甲亢组,60例年龄匹配的正常者为对照组。使用双能 X 线骨密度仪( DXA)分别测定受试者前臂(桡骨全部)、腰椎( L2~4)及股骨颈BMD；用ELISA法测定受试者PINP及β-CTx。用化学发光法测定甲亢患者的游离三碘甲腺原氨酸( FT3)、游离甲状腺激素(FT4)及促甲状腺激素(TSH)。用自动生化分析仪测定钙( Ca)、磷( P)。根据国际骨质疏松基金会( IOF)对伴有影响骨代谢疾病的中青年骨质疏松诊断定义,按BMD T值将甲亢组分为骨量正常组( ON组)、骨量减少组( OD组)及骨质疏松组( OP组),比较3组间上述各项指标的差异。结果与对照组比较,甲亢组PINP、β-CTx、Ca显著升高( P<0．01),前臂、L2~4及股骨颈BMD均降低(P<0．05)。甲亢患者中,OP组与 ON 组比较, PINP、β-CTx、FT3、FT4明显升高,TSH明显降低( P<0．01), OP组与OD组比较, PINP、β-CTx、FT3及TSH差异有统计学意义( P<0．01),而OD组与ON组比较, PINP、β-CTx、TSH 差异有统计学意义( P <0．01)。相关分析显示,中青年甲亢患者PINP、β-CTx分别与FT3、FT4呈正相关( P<0．05),与TSH及前臂BMD呈负相关(P<0．05)。结论中青年甲亢患者骨转换加快,破骨细胞功能增强伴成骨细胞活性增加。 PINP及β-CTx联合BMD检测可更准确的反映中青年甲亢患者骨代谢情况。
목적：탐토중청년독성미만성갑상선종(갑항)환자혈청Ⅰ형전효원안기단전태( PINP)급Ⅰ형효원최기단태(β-CTx)적변화급기여갑상선격소수평화골밀도( BMD)적관계。방법선택중청년갑항환자150례위갑항조,60례년령필배적정상자위대조조。사용쌍능 X 선골밀도의( DXA)분별측정수시자전비(뇨골전부)、요추( L2~4)급고골경BMD；용ELISA법측정수시자PINP급β-CTx。용화학발광법측정갑항환자적유리삼전갑선원안산( FT3)、유리갑상선격소(FT4)급촉갑상선격소(TSH)。용자동생화분석의측정개( Ca)、린( P)。근거국제골질소송기금회( IOF)대반유영향골대사질병적중청년골질소송진단정의,안BMD T치장갑항조분위골량정상조( ON조)、골량감소조( OD조)급골질소송조( OP조),비교3조간상술각항지표적차이。결과여대조조비교,갑항조PINP、β-CTx、Ca현저승고( P<0．01),전비、L2~4급고골경BMD균강저(P<0．05)。갑항환자중,OP조여 ON 조비교, PINP、β-CTx、FT3、FT4명현승고,TSH명현강저( P<0．01), OP조여OD조비교, PINP、β-CTx、FT3급TSH차이유통계학의의( P<0．01),이OD조여ON조비교, PINP、β-CTx、TSH 차이유통계학의의( P <0．01)。상관분석현시,중청년갑항환자PINP、β-CTx분별여FT3、FT4정정상관( P<0．05),여TSH급전비BMD정부상관(P<0．05)。결론중청년갑항환자골전환가쾌,파골세포공능증강반성골세포활성증가。 PINP급β-CTx연합BMD검측가경준학적반영중청년갑항환자골대사정황。
Objective To explore the changes in serum type I procollagen N-terminal propeptide ( PINP) and c-terminal telopeptide region of collagen type 1 (β-CTx) and their relationship with thyroid hormone levels and bone mineral density ( BMD) in adult patients under 50 years old with hyperthyroidism. Methods 150 adult patients under 50 years old with hyperthyroidism and 60 healthy adults in the same age range ( comparison group) were re-cruited to participate in the study. Subjects ’ BMD was assessed using the dual-energy X-ray absorptiometry (DXA) at forearm (whole radius), lumbar spine (L2~4), and femoral neck. The free triiodothyronine (FT3), free thyroxine ( FT4 ) and thyroid stimulating hormone ( TSH) in patients with hyperthyroidism were determined by chemiluminescence. The hyperthyroidism group was further divided into normal bone mass group ( ON group) , os-teopenia group ( OD group) and osteoporotic group ( OP group) based on T scores of BMD. Subjects’ PINP andβ-CTx levels were measured with ELISA, and their calcium ( Ca) and phosphorus ( P) were measured using an auto-matic biochemical analyzer. The levels of PINP,β-CTx, Ca and P were compared between the hyperthyroidism and comparison groups and among the three hyperthyroidism subgroups. Results When compared with comparison group, the hyperthyroidism group had significantly higher levels of PINP,β-CTx and Ca (P<0. 01), and signifi-cantly lower BMD at forearm, L2~4 and femoral neck ( P<0. 05 ) . Among patients with hyperthyroidism, the OP group had significantly higher PINP,β-CTx, FT3 and FT4 levels (P<0. 01) and significantly lower TSH level (P<0. 01) than the ON group had, and the OP group had significantly higher PINP,β-CTx, FT3 levels (P<0. 01) and significantly lower TSH level ( P <0. 01 ) than the OD group had. Besides, the OD group had significantly higher PINP, β-CTx levels ( P <0. 01 ) and significantly lower TSH level ( P <0. 01 ) than the ON group had. PINP and β-CTx levels were positively correlated with FT3 and FT4 levels ( P <0. 05 ) and negatively correlated with TSH and forearm BMD ( P<0. 05 ) in patients with hyperthyroidism. Conclusion Adult patients under 50 years old with hyperthyroidism have accelerated bone turnover, enhanced osteoclast function and increased osteo-blast activity. PINP and β-CTx in combination with BMD measurements can more accurately reflect the bone me-tabolisms in patients with hyperthyroidism.