骨外膜素在Graves病致骨代谢异常患者诊疗中的价值
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摘要
目的探讨骨外膜素(periostin)与传统骨代谢标记物在Graves病(GD)致骨代谢异常患者诊断和治疗中的价值和意义。方法选取2015年1月—2018年9月本院收治的GD致骨代谢异常患者32例作为研究组,另选择同期健康成人32名作为对照组,所有受试者检测骨密度(BMD)、血清甲状腺功能(FT_4、FT_3)、Periostin、骨钙素(BGP)、骨特异性碱性磷酸酶(B-ALP)、I型前胶原羧基末端前肽(PICP),然后研究组经抗甲亢药物(ATD)治疗6个月后重复骨密度及上述各项血清血指标检测。结果 GD致骨代谢异常患者治疗前与对照组比较,BMD水平较对照组下降,血清FT_4、FT_3、Periostin、BGP、B-ALP、PICP水平较对照组升高,差异具有统计学意义(P<0.01),经抗甲亢药物治疗6个月后,与对照组比较,差异无统计学意义(P>0.05),而治疗后与治疗前比较,BMD水平较治疗前升高,血清FT_4、FT_3、Periostin、BGP、BALP、PICP水平较治疗前下降,差异具有统计学意义(P<0.01)。GD致骨代谢异常患者BMD与血清FT_4、FT_3呈负相关(P<0.05),而血清Periostin、BGP、B-ALP、PICP与FT_4、FT_3呈正相关(P<0.05)。结论Periostin作为一种新型骨代谢转换标记物,在GD致骨代谢异常患者的诊断和治疗中具有一定的临床价值,能为骨量减少严重程度和疗效评价提供判断依据。
Objective To investigate the value and significance of periostin and conventional bone metabolism markers in the diagnosis and treatment of bone metabolism disorders caused by Graves disease( GD).Methods From January 2015 to September 2018,thirty-two GD patients with abnormal bone metabolism admitted to the department of endocrinology were randomly chosen and thirty-two healthy adults during the period were selected as the control group. Bone mineral density( BMD),serum free triiodothyronine( FT3),free thyroxine( FT4),periostin,bone Gla protein( BGP),bone specific alkaline phosphatase( B-ALP),carboxy terninal propeptide of type I proeollagen( PICP) levels were detected,then the study group was treated with antithyroid drugs( ATD) for six months to detect above indicators again.Results Before the treatment,BMD level of patients with GD caused abnormal bone metabolism were lower than those of the control group,however,the concentrations of serum FT4,FT3,periostin,BGP,B-ALP,and PICP were higher than those of the control group,the differences were statistically significant( P < 0. 01),after six months of treatment with ATD,there were no statistically significant differences between the two groups in the above indexes( P > 0. 05). After the treatment,the level of BMD was higher than that before treatment,the levels of serum FT4,FT3,Periostin,BGP,B-ALP,and PICP were lower than those before treatment,the differences were statistically significant( P < 0. 01). In the patients with abnormal bone metabolism caused by GD,BMD was negatively correlated with serum FT4 and FT3( P < 0. 05),while serum periostin,BGP,B-ALP and PICP levels were positively correlated with FT4 and FT3( P < 0. 05).Conclusions As a new type of bone metabolism marker in GD,periostin has certain clinical value in the diagnosis and treatment of the patients with abnormal bone metabolism and could provide the basis for judging the severity of osteopenia and the evaluation of therapeutic effect.
Objective To investigate the value and significance of periostin and conventional bone metabolism markers in the diagnosis and treatment of bone metabolism disorders caused by Graves disease( GD).Methods From January 2015 to September 2018,thirty-two GD patients with abnormal bone metabolism admitted to the department of endocrinology were randomly chosen and thirty-two healthy adults during the period were selected as the control group. Bone mineral density( BMD),serum free triiodothyronine( FT3),free thyroxine( FT4),periostin,bone Gla protein( BGP),bone specific alkaline phosphatase( B-ALP),carboxy terninal propeptide of type I proeollagen( PICP) levels were detected,then the study group was treated with antithyroid drugs( ATD) for six months to detect above indicators again.Results Before the treatment,BMD level of patients with GD caused abnormal bone metabolism were lower than those of the control group,however,the concentrations of serum FT4,FT3,periostin,BGP,B-ALP,and PICP were higher than those of the control group,the differences were statistically significant( P < 0. 01),after six months of treatment with ATD,there were no statistically significant differences between the two groups in the above indexes( P > 0. 05). After the treatment,the level of BMD was higher than that before treatment,the levels of serum FT4,FT3,Periostin,BGP,B-ALP,and PICP were lower than those before treatment,the differences were statistically significant( P < 0. 01). In the patients with abnormal bone metabolism caused by GD,BMD was negatively correlated with serum FT4 and FT3( P < 0. 05),while serum periostin,BGP,B-ALP and PICP levels were positively correlated with FT4 and FT3( P < 0. 05).Conclusions As a new type of bone metabolism marker in GD,periostin has certain clinical value in the diagnosis and treatment of the patients with abnormal bone metabolism and could provide the basis for judging the severity of osteopenia and the evaluation of therapeutic effect.
引文
[1]马文杰,易茜璐,于明香.甲状腺疾病与骨质疏松关系的研究进展[J].复旦学报(医学版),2012,39(4):418-421,432.
[2]邱明琪,胡美华.甲状腺功能亢进症患者骨密度变化的临床分析[J].实用临床医学,2012,13(6):16-17,20.
[3]李丽,蔡妹群,孙平,等.甲状腺功能亢进患者骨密度与骨代谢指标的临床观察[J].黑龙江医学,2013,37(8):675-676.
[4]吴自强,汤春波.骨膜蛋白及其在牙周膜中的生物学作用[J].国际口腔医学杂志,2016,43(2):168-171.
[5]张建明,朱锋,牟华明,等.缺血性心力衰竭患者血浆periostin检测的临床意义[J].中国老年学杂志,2013,3(20):5114-5115.
[6]孙其恺,吕阳,王伟.Periostin与肿瘤相关研究进展[J].中华外科杂志,2013,51(7):659-661.
[7]吕琳琳,李纾.骨膜蛋白与牙周组织再生[J].国际口腔医学杂志,2014,41(2):224-227.
[8]伊亚婷,官秋明,韩向龙.Periostin在骨矿化过程中的生物学功能研究进展[J].国际生物医学工程杂,2013,36(5):294-298.
[9] Merle B,Gamero P. The muItiple facets of periostin in bone metabolism[J].Osteopoms Int,2012,23:1199-1212.
[10] Rousseau JC,Somay-Rendu E,Bertholon C,et al.Serum periostin is associated with fracture risk in postmenopausal women:A 7 years prospective analysis of the OFELY Study[J]. J Clin Eudocrinol Metab,2014,99(7):2533-2539.
[2]邱明琪,胡美华.甲状腺功能亢进症患者骨密度变化的临床分析[J].实用临床医学,2012,13(6):16-17,20.
[3]李丽,蔡妹群,孙平,等.甲状腺功能亢进患者骨密度与骨代谢指标的临床观察[J].黑龙江医学,2013,37(8):675-676.
[4]吴自强,汤春波.骨膜蛋白及其在牙周膜中的生物学作用[J].国际口腔医学杂志,2016,43(2):168-171.
[5]张建明,朱锋,牟华明,等.缺血性心力衰竭患者血浆periostin检测的临床意义[J].中国老年学杂志,2013,3(20):5114-5115.
[6]孙其恺,吕阳,王伟.Periostin与肿瘤相关研究进展[J].中华外科杂志,2013,51(7):659-661.
[7]吕琳琳,李纾.骨膜蛋白与牙周组织再生[J].国际口腔医学杂志,2014,41(2):224-227.
[8]伊亚婷,官秋明,韩向龙.Periostin在骨矿化过程中的生物学功能研究进展[J].国际生物医学工程杂,2013,36(5):294-298.
[9] Merle B,Gamero P. The muItiple facets of periostin in bone metabolism[J].Osteopoms Int,2012,23:1199-1212.
[10] Rousseau JC,Somay-Rendu E,Bertholon C,et al.Serum periostin is associated with fracture risk in postmenopausal women:A 7 years prospective analysis of the OFELY Study[J]. J Clin Eudocrinol Metab,2014,99(7):2533-2539.