石家庄市汉族初诊桥本甲状腺炎及Graves病患儿维生素D状况比较
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摘要
目的比较桥本甲状腺炎(Hashimoto thyroiditis,HT)及Graves病(Graves disease,GD)患儿的维生素D状况,探讨维生素D在两者内在联系中的作用。方法收集石家庄市汉族初诊HT患儿40例、GD患儿37例。采集清晨空腹静脉血4 mL,测定25羟维生素D(25 hydroxyvitamin D,25-OHD)、促甲状腺激素(thyrotropin,TSH)、总甲状腺素(total thyroxin,TT_4)、总三碘甲腺原氨酸(total triiodothyronine,TT_3)、游离甲状腺素(free thyroxine,FT_4)、游离三碘甲腺原氨酸(free triiodothyronine,FT_3)、促甲状腺激素受体抗体(thyrotropin receptor antibody,TRAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)、过氧化物酶抗体(thyroid peroxidase antibody,TPOAb);超声测定甲状腺左右两叶长、宽、厚度,计算甲状腺体积;电化学法测定晨起中段尿尿碘。结果 HT组FT_3、FT_4、TT_3、TT_4、TRAb显著低于GD组,TSH、TGAb显著高于GD组,差异均有统计学意义(P<0.05),2组25-OHD、TPOAb差异均无统计学意义(P>0.05)。有甲状腺体积结果的HT组TGAb显著高于GD组,TRAb显著低于GD组,差异均有统计学意义(P<0.05);2组甲状腺体积、25-OHD和TPOAb差异均无统计学意义(P>0.05)。有尿碘结果的HT组TGAb显著高于GD组,TRAb显著低于GD组,差异均有统计学意义(P<0.05);2组尿碘、25-OHD和TPOAb差异均无统计学意义(P>0.05)。HT组25-OHD水平与TSH、TRAb、TGAb、TPOAb均无相关性(P>0.05)。GD组25-OHD水平与TPOAb呈弱正相关(P<0.05),与TSH、TRAb、TGAb均无相关性(P>0.05)。结论 HT及GD患儿血清25-OHD水平差异无统计学意义。25-OHD可能不在HT与GD内在联系中发挥作用。
Objective To compare the vitamin D status in children with Hashimoto thyroiditis(HT) and Graves disease(GD),and to explore the role of vitamin D in the internal relationship between the two diseases. Methods Forty cases with HT and 37 cases with GD were collected from Shijiazhuang Han nationality. Four milliliter fasting venous blood samples of all the patients were collected in the morning to determine 25 hydroxyvitamin D(25-OHD), thyroid stimulating hormone(TSH), total thyroxine(TT_4), total triiodothyronine(TT_3), free thyroxine(FT_4), free triiodothyronine(FT_3), thyrotropin receptor antibody(TRAb), thyroid globulin antibody(TGAb) and thyroid peroxidase antibody(TPOAb). The lengths, widths and thicknesses of the left and right lobes of the thyroids were measured by ultrasound, and the thyroids volume were calculated. The iodine of the middle part urine in the morning was measured by electrochemical method. Results The levels of FT_3, FT_4, TT_3, TT_4 and TRAb in HT group were significantly lower than that of GD group, TSH and TGAb were significantly higher than those in GD group(P<0.05). There were no significant differences in 25-OHD and TPOAb levels between the 2 groups(P>0.05). TGAb in HT group with thyroid volume was significantly higher than that in GD group, and TRAb was significantly lower than GD group(P<0.05). There was no significant difference in thyroid volume, 25-OHD and TPOAb between the two groups(P>0.05). TGAb in HT group with the results of urine iodine was significantly higher than that in GD group, and TRAb was significantly lower than that in GD group(P<0.05). There was no significant difference in urinary iodine, 25-OHD and TPOAb between the two groups(P>0.05). There was no correlation between 25-OHD level and TSH, TRAb, TGAb, and TPOAb in HT group(P>0.05). There was a weak positive correlation between 25-OHD level and TPOAb in GD group(P<0.05), but no correlation with TSH, TRAb and TGAb(P>0.05). Conclusion There is no significant difference in serum 25-OHD levels between children with HT and GD. Serum 25-OHD level may not play a role in the internal relationship between the twodiseases.
Objective To compare the vitamin D status in children with Hashimoto thyroiditis(HT) and Graves disease(GD),and to explore the role of vitamin D in the internal relationship between the two diseases. Methods Forty cases with HT and 37 cases with GD were collected from Shijiazhuang Han nationality. Four milliliter fasting venous blood samples of all the patients were collected in the morning to determine 25 hydroxyvitamin D(25-OHD), thyroid stimulating hormone(TSH), total thyroxine(TT_4), total triiodothyronine(TT_3), free thyroxine(FT_4), free triiodothyronine(FT_3), thyrotropin receptor antibody(TRAb), thyroid globulin antibody(TGAb) and thyroid peroxidase antibody(TPOAb). The lengths, widths and thicknesses of the left and right lobes of the thyroids were measured by ultrasound, and the thyroids volume were calculated. The iodine of the middle part urine in the morning was measured by electrochemical method. Results The levels of FT_3, FT_4, TT_3, TT_4 and TRAb in HT group were significantly lower than that of GD group, TSH and TGAb were significantly higher than those in GD group(P<0.05). There were no significant differences in 25-OHD and TPOAb levels between the 2 groups(P>0.05). TGAb in HT group with thyroid volume was significantly higher than that in GD group, and TRAb was significantly lower than GD group(P<0.05). There was no significant difference in thyroid volume, 25-OHD and TPOAb between the two groups(P>0.05). TGAb in HT group with the results of urine iodine was significantly higher than that in GD group, and TRAb was significantly lower than that in GD group(P<0.05). There was no significant difference in urinary iodine, 25-OHD and TPOAb between the two groups(P>0.05). There was no correlation between 25-OHD level and TSH, TRAb, TGAb, and TPOAb in HT group(P>0.05). There was a weak positive correlation between 25-OHD level and TPOAb in GD group(P<0.05), but no correlation with TSH, TRAb and TGAb(P>0.05). Conclusion There is no significant difference in serum 25-OHD levels between children with HT and GD. Serum 25-OHD level may not play a role in the internal relationship between the twodiseases.
引文
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[13] Xu MY,Cao B,Yin J,et al.Vitamin D and Graves′ disease:a meta-analysis update[J].Nutrients,2015,7(5):3813-3827.
[14] Zhang H,Liang L,Xie Z.Low vitamin D status is associated with increased thyrotropin-receptor antibody titer in Graves disease[J].Endocr Pract,2015,21(3):258-263.
[15] 王娟娟,贾清珍,张向东,等.尿碘与甲状腺疾病相关性的研究[J].中华地方病学杂志,2013,32(4):359-361.
[2] 蔡雪蜂,欧阳晓光.甲状腺上动脉血流速度在Graves病和桥本氏甲状腺炎诊断中的应用价值[J].中国实用医药,2018,13(14):27-28.
[3] Inoue N,Watanabe M,Ishido N,et al.The functional polymorphisms of VDR,GC and CYP2R1 are involved in the pathogenesis of autoimmune thyroid diseases[J].Clin Exp Immunol,2014,178(2):262-269.
[4] Bizzaro G,Shoenfeld Y.Vitamin D and thyroid autoimmune diseases:the known and the obscure[J].Immunol Res,2015,61(1/2):107-109.
[5] Vondra K.Vitamin D and autoimmune thyroid diseases[J].Vnitr Lek,2016,62(9 Suppl 3):121-125.
[6] Kim D.The Role of Vitamin D in Thyroid Diseases[J].Int J Mol Sci,2017,18(9).pii:E1949.
[7] Muscogiuri G,Tirabassi G,Bizzaro G,et al.Vitamin D and thyroid disease:to D or not to D?[J].Eur J Clin Nutr,2015,69(3):291-296.
[8] Bozkurt NC,Karbek B,Ucan B,et al.The association between severity of vitamin D deficiency and Hashimoto′s thyroiditis[J].Endocr Pract,2013,19(3):479-484.
[9] D′Aurizio F,Villalta D,Metus P,et al.Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases?[J].Autoimmun Rev,2015,14(5):363-369.
[10] 阎雪,徐佳琛,韩笑,等.石家庄地区儿童血清25羟VD水平的季节和年龄变化[J].营养学报,2017,39(1):37-40.
[11] 刘向辉,阎雪,田旭,等.夏季高海拔地区儿童血清25羟维生素D水平分析[J].中国儿童保健杂志,2016,24(10):1113-1115.
[12] 韩笑,阎雪,张亚男,等.石家庄市夏季汉族4月龄至14岁健康儿童血清25-羟维生素D和甲状旁腺素的关系[J].中国循证儿科杂志,2015,10(3):202-205.
[13] Xu MY,Cao B,Yin J,et al.Vitamin D and Graves′ disease:a meta-analysis update[J].Nutrients,2015,7(5):3813-3827.
[14] Zhang H,Liang L,Xie Z.Low vitamin D status is associated with increased thyrotropin-receptor antibody titer in Graves disease[J].Endocr Pract,2015,21(3):258-263.
[15] 王娟娟,贾清珍,张向东,等.尿碘与甲状腺疾病相关性的研究[J].中华地方病学杂志,2013,32(4):359-361.