亚临床甲状腺功能减退症与骨密度及骨代谢指标的相关性研究

目的观察亚临床甲状腺功能减退患者骨密度及骨代谢指标的变化，探讨甲状腺功能对骨密度及骨代谢指标的影响。方法纳入符合亚临床甲状腺功能减退症标准的患者122例（亚临床甲减组），应用双能X线测定仪（DEXA）检测其骨密度（BMD），并检测其血清游离三碘甲状腺原氨酸（FT3），游离甲状腺素（FT4），促甲状腺素（TSH），血钙（Ca）、血磷（P）、碱性磷酸酶（ALP），按性别、绝经情况分层，同时纳入与其年龄和性别相匹配的健康志愿者153例（对照组），比较两组间骨密度及骨代谢指标的差异。结果亚临床甲减组骨量丢失高于对照组(P<0.005)。亚临床甲减组血钙值均较对照降低，差异有统计学意义（P<0.05）,亚临床甲减组男性血磷、骨密度指标T值、Z值高于对照组，差异有统计学意义（P<0.05）,绝经前妇女Z值高于对照组，差异有统计学意义（P<0.01）,而绝经期前妇女和绝经期后妇女T值、血磷较对照组差异均无统计学意义（P>0.05）。亚临床甲减组ALP较对照组差异均无统计学意义（P>0.05）。多元线性回归分析, 性别(B=0.543，P<0.000 1)与T值正相关，即与男性相比女性的T值更低；T值与绝经(B=-0.274，P=0.001)，年龄(B=-0.161，P<0.000 1)，TSH(B=-0.108，P<0.000 1)负相关。结论亚临床甲状腺功能减退患者存在血钙下降，骨密度降低。

英文摘要:

Objective?To investigate the change of bone mineral density and bone metabolism biochemical markers in subclinical hypothyroidism. Methods?This study included total 122 patients with subclinical hypothyroidism and 153 healthy age and gender matched people as control. All the patients and controls were subjected to the measurements of bone density by dual energy X-ray absorptiometry (DEXA), and serum free triiodothyronine (FT3), free thyroxine （FT4）,thyroid stimulating hormone (TSH), Ca²⁺, PO4³⁺, alkaline phosphatase （ALP) levels. All the data was analyzed statistically with the stratification of gender and menopause status. Results?Compared to the control, the patients with subclinical hypothyroidism had significantly higher incidence of bone mass loss (P<0.005) and lower level of Serum Ca²⁺ (P<0.05) and higher levels of serum PO4³⁺, T-value and Z-value (P<0.05). Furthermore, premenopausal women had higher Z-value (P<0.01) , but no significantly differences of T-value, serum PO4³⁺ was found either in pre-menopause or post-menopause women when compared to the control. Multiple linear regression analysis showed gender (B=0.543，P<0.000 1) was positive correlation with T value, female had lower T values. Moreover, T value was negative correlated to menopausal status (B=-0.274，P=0.001), age (B=-0.161，P<0.000 1) and TSH(B=-0.108，P<0.000 1). Conclusion?Subclinical hypothyroism appears decreased serum calcium and low bone density.

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