CAJ | 학술논문

目的：分析中青年甲状腺功能亢进（甲亢）患者骨密度特点及其与病程、病情严重程度的关系。方法使用双能X线骨密度仪分别测定340例中青年甲亢患者及160名年龄匹配的正常对照者的前臂、腰椎及股骨颈骨密度，用化学发光法测定甲亢患者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），用自动生化仪检测血清钙（Ca）、血清磷（P）、碱性磷酸酶（ALP），比较2组间骨密度及Ca、P、 ALP的差异。根据国际临床骨密度学会（ISCD）和国际骨质疏松基金会（IOF）对中青年骨质疏松诊断的不同定义分别将甲亢患者分为骨量正常组（ ON1）和骨质疏松组（ OP1）、骨量正常组（ ON2）、骨量减少组（OD2）、骨质疏松组（OP2），比较使用2种诊断方法得出的骨质疏松检出率，比较各组甲状腺激素（TH）及TSH的差异。结果与正常对照组相比，甲亢患者桡骨全部、腰椎L2-4及股骨颈骨密度均明显降低（均P＜0.05）。根据ISCD定义得出的骨质疏松检出率为46.8％，根据IOF定义得出的骨质疏松检出率为27.1％，前臂较腰椎、股骨颈骨密度降低更明显。甲亢患者骨质疏松组较骨量正常组的 FT3、 FT4明显升高（ P＜0.05）， TSH明显降低（P＜0.05）。多元线性回归分析显示桡骨骨密度与 FT4、 Ca呈负相关，与TSH呈正相关。结论中青年甲亢患者骨质疏松患病率高，骨量丢失较明显的部位为桡骨，过量甲状腺激素及低TSH均可导致骨代谢紊乱。
목적：분석중청년갑상선공능항진（갑항）환자골밀도특점급기여병정、병정엄중정도적관계。방법사용쌍능X선골밀도의분별측정340례중청년갑항환자급160명년령필배적정상대조자적전비、요추급고골경골밀도，용화학발광법측정갑항환자유리삼전갑선원안산（ FT3）、유리갑상선격소（ FT4）급촉갑상선격소（TSH），용자동생화의검측혈청개（Ca）、혈청린（P）、감성린산매（ALP），비교2조간골밀도급Ca、P、 ALP적차이。근거국제림상골밀도학회（ISCD）화국제골질소송기금회（IOF）대중청년골질소송진단적불동정의분별장갑항환자분위골량정상조（ ON1）화골질소송조（ OP1）、골량정상조（ ON2）、골량감소조（OD2）、골질소송조（OP2），비교사용2충진단방법득출적골질소송검출솔，비교각조갑상선격소（TH）급TSH적차이。결과여정상대조조상비，갑항환자뇨골전부、요추L2-4급고골경골밀도균명현강저（균P＜0.05）。근거ISCD정의득출적골질소송검출솔위46.8％，근거IOF정의득출적골질소송검출솔위27.1％，전비교요추、고골경골밀도강저경명현。갑항환자골질소송조교골량정상조적 FT3、 FT4명현승고（ P＜0.05）， TSH명현강저（P＜0.05）。다원선성회귀분석현시뇨골골밀도여 FT4、 Ca정부상관，여TSH정정상관。결론중청년갑항환자골질소송환병솔고，골량주실교명현적부위위뇨골，과량갑상선격소급저TSH균가도치골대사문란。
Objective To investigate the effect of the course and condition of hyperthyroidism on the change of bone mineral density ( BMD) in young adult patients .Methods BMDs at forearm , lumbar vertebrae , and femoral neck were measured using dual-energy X-rays absorptiometry (DEXA) in young adult patients (n=340) and normal subjects (n=60).Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels were measured using chemiluminescence method . Alkaline phosphatase ( ALP ) , calcium ( Ca ) , phosphorus ( P ) were measured using automatic biochemical analyzer .ALP, Ca, P, BMD at forearm, lumbar vertebrae and femoral neck were compared between patients amd and normal subjects .According to the different definitions of osteoporosis in the young from International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF), patients were divided into normal group1 (ON1) and osteoporosis group1 (OP1), normal group2 (ON2), Osteopenia group2 (OD2) and osteoporosis group2 (OP2).Compared the incidence of osteoporosis in two different diagnostic criteria .Be-sides, thyroid hormone (TH) and TSH were compared among all groups of patients .Results The BMD at forearm (to-tal radius), lumbar vertebrae 2-4, and femoral neck in the patients were significantly lower than those of normal subjects ( P<0.05 ) .Ca, ALP in the patients were significantly higher than those of normal subjects ( P<0.05 ) .Osteoporosis was found in 46.8%of patients according to definition of ISCD , and in 27.1%of patients according to definition of IOF . Among the three measurement sites , forearm had the highest rate of osteoporosis .. The multiple regression analysis showed that there was an independent negative correlation between BMD of forearm and FT 4, Ca, and an independent positive correlation between BMD of forearm and TSH .Conclusion The rate of osteoporosis in patients with hyperthy-roidism is high and the forearm bone is more obrious .High level of FT3 and FT4 and low level of TSH can cause abnormal bone metabolism .