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目的了解甲亢病人治疗1年前、后骨生化指标和骨密度的变化,提高对甲亢性骨代谢异常的认识。方法对136例甲亢病人经抗甲状腺药物治疗或加用维生素D(或活性维生素D)和钙剂治疗1年前、后的骨生化代谢指标血钙、磷、碱性磷酸酶、24h尿钙、尿磷以及骨密度进行测定和分析。结果与正常对照组比较,甲亢患者FT3、FT4、ALP和24h尿钙均明显升高,而TSH和骨密度均明显降低;其骨量减少和骨质疏松发生率亦明显增高。治疗1年后,随着甲亢的控制,甲亢患者的血ALP和24h尿钙水平恢复正常;骨密度明显升高,但仍低于正常对照组;其骨量减少与骨质疏松发生率也有不同程度降低;进一步分析发现,加用维生素D(或活性维生素D)和钙剂治疗的患者上述指标改善较单纯抗甲状腺药物治疗者明显。结论甲亢性骨代谢异常是一种高骨转换状态,可以引起骨量减少和骨质疏松。及早并有效地控制甲亢,尤其加用维生素D(或活性维生素D)和钙剂治疗可以纠正这一异常,并有助于改善骨质量。
Objective To understand the changes of biochemical markers and bone mineral density in patients with hyperthyroidism treated one year ago and to improve their understanding of the abnormalities of hyperthyroidism. Methods 136 patients with hyperthyroidism were treated with antithyroid drugs or with vitamin D (or active vitamin D) and calcium for 1 year before and after treatment. The indexes of bone biochemical metabolism such as serum calcium, phosphorus, alkaline phosphatase, 24h urinary calcium, Urine phosphorus and bone mineral density were measured and analyzed. Results Compared with the normal control group, the FT3, FT4, ALP and 24 h urinary calcium in patients with hyperthyroidism were significantly increased, while the TSH and BMD were significantly decreased; the incidence of osteopenia and osteoporosis were also significantly increased. After 1 year of treatment, with the control of hyperthyroidism, blood ALP and 24h urinary calcium levels returned to normal in patients with hyperthyroidism; bone mineral density increased significantly, but still lower than the normal control group; its osteopenia and the incidence of osteoporosis are also different The degree of reduction; further analysis found that with vitamin D (or vitamin D) and calcium treatment in patients with these indicators improved than the anti-thyroid drug treatment were obvious. Conclusions Hyperthyroidism with abnormal bone metabolism is a state of high bone turnover that can cause osteopenia and osteoporosis. Early and effective control of hyperthyroidism, especially with vitamin D (or active vitamin D) and calcium treatment can correct this anomaly and help to improve bone quality.