维生素D缺乏与Graves病及其并发症关系的临床研究

Clinical research on the deficiency of vitamin D with autoimmune thyroid disease

摘要:

目的：研究弥漫性甲状腺肿伴甲亢（Graves disease，GD）、甲亢性眼病（Graves’ ophthalmopathy，GO）、甲亢性心脏病（hyperthyroid heart disease，HHD）患者血清25-（OH）D3水平与甲状腺功能、病程、甲状腺大小等的相关性。方法：选取符合试验标准的对象150例，分为：GD组（n=50），GO组（n=50），HHD组（n=50），同期与实验组匹配的50例体检正常者为正常对照组（n=50），检测所有对象的free triiodothyronine（FT3）、free thyroxine（FT4 ）、thyroid stimulating hormone（TSH）、thyroid peroxidase antibody（TPOAb）、thyrotrophin receptor antibody（TRAb）及25-（OH）D3水平。血清25-（OH）D3水平参照国际标准：＜20 ng/mL视为缺乏，20～30 ng/mL视为不足，≥30 ng/mL视为充足。结果使用SPSS 17.0统计软件进行分析。结果：①与正常组相比，GD组、GO组和HHD组血清 FT3、FT4、TPOAb、TRAb均明显升高（P=0.000），TSH、25-（OH）D3均明显降低（P=0.000）；GD组、GO组和HHD组血清 FT3、FT4、TPOAb、TRAb和TSH差异均无统计学意义（P＞0.05）；血清25-（OH）D3水平GO组和HHD组均明显低于GD组（P=0.000），而GO组和HHD组间差异（P=0.320）无统计学意义。②GO组25-（OH）D3水平与FT4（r=0.40，P=0.004）、FT3（r=0.39，P=0.006）呈显著正相关，与TSH未见统计学相关性（P＞0.05）；其余组未见统计学相关性（P＞0.05）。结论：低25-（OH）D3血症可能与GD及相关并发症的出现密切相关，25-（OH）D3水平缺乏还可能参与了GO和HHD的发生和进展。

Abstract:

Objective：To study the correlation among serum 25-（OH）D3 level and thyroid function，thyroid disease duration，size in patients with Graves disease（GD） or Graves’ ophthalmopathy（GO） or hyperthyroid heart disease. Methods：Totally 150 cases of pa－tients diagnosed with the corresponding diagnosis were selected. All the cases were divided into GD group（n=50），GO group（n=50），HHD group（n=50），and the other 50 cases of healthy people at the same age were selected as the control group（n=50）. Then all the cases were taken the morning fasting venous blood，in which the FT3 and FT4，TSH，TRAb，TPOAb，serum 25-（OH）D3 were tested. The study of 25-（OH）D3 level takes the rule of the international consensus for references：serum 25-（OH）D3 level< 20 ng/mL means vitamin D deficiency，and serum 25-（OH）D3 level 20-30 ng/mL means vitamin D is not enough，when the level ≥30 ng/mL suggests vitamin D is sufficient. All the data were analyzed by SPSS 17.0 statistical software,and the significant inspection standards is P＜0.05. Results：①Compared with the control group，serum FT3，FT4，TPOAb，TRAb levels were significantly increased（P=0.000），and TSH，25-（OH）D3 levels were significantly decreased in GD group，GO group and HHD group（P=0.000）. There was no significant difference in serum FT3，FT4，TPOAb，TRAb and TSH among GD group，GO group and HHD group（P>0.05）. Serum 25-（OH）D3 level was sig－nificantly lower in GO group and HHD group than in GD group（P=0.000），and no statistical significant difference was ob－served between GO group and HHD group（P=0.320）. ②The serum 25-（OH）D3 levels in group GO were significantly positively correlated with FT3（r=0.390，P=0.006） and FT4（r=0.40，P=0.004），but there was no statistically significant corre－lation with TSH（P>0.05）. There was no statistical correlation between the remaining groups（P>0.05）. Conclusion：The low level of 25-（OH）D3 maybe closely related with the pathogenesis of Graves disease and its complications，and the deficiency of serum 25-（OH）D3 may also be involved in the development and progression of GO and HHD.