【摘要】 目的通过观察女性Grave病(GD)患者血清IGF-2的表达水平,探讨其在GD引起的骨量下降或骨质疏松发病机制中的作用。方法选择就诊于山西医科大学第二附属医院内分泌科的初发女性GD患者57例及同期健康体检者46例,根据1994年WHO骨质疏松诊断标准,以腰椎或股骨颈T/Z值将GD患者分骨质疏松、低骨量、骨量正常三个亚组。采用酶联免疫吸附法测定IGF-2水平,放免法检测FT3、FT4、TSH水平,电化学发光法检测骨转换指标N-MID OCN、t P1NP、β-Crosslaps水平,同时检测E2、FSH、LH及Ca、P、FPG、血脂水平。所有患者均于采血当天采用双能X线骨密度测定仪(DXA)测定腰椎(L1~L4)和股骨颈(Neck)及前臂1/3的骨密度。结果 (1)女性GD患者绝经前后组与相应对照组比,血IGF-2降低,差异有统计学意义(P<0.05,P<0.01);(2)女性绝经后与相应绝经前相比,无论是否患有GD,血IGF-2水平降低,差异有统计学意义(P<0.05,P<0.01);(3)按骨密度测定结果分组,女性GD患者无论绝经与否,骨量异常与骨量正常组相比,IGF-2水平降低,差异有统计学意义(P<0.05,P<0.01);骨质疏松组与骨量下降组比较,血IGF-2水平降低,差异有统计学意义(P<0.05);(4)在女性GD患者中,血IGF-2与血FT3、FT4、β-Crosslaps呈显著负相关(r=-0.422,r=-0.405,r=-0.504,P<0.05),与TSH、前臂1/3、Neck及L总的BMD呈正相关(r=0.423,r=0.412,r=0.435,r=0.479,P<0.05)。结论 (1)女性GD患者血IGF-2水平显著降低,与骨质疏松症的发生相关;(2)绝经后妇女无论是否患有GD血清IGF-2水平均降低,且在骨质疏松症组中降低更为显著,可能参与绝经后骨质疏松的发生与发展。更多还原

【Abstract】 Objective By observing serum level of IGF-2 in female patients with Grave disease(GD) and its relationship with bone mass, to probe if it participates the occurring of osteoporosis caused by GD and the possible mechanism. Methods Selecting 57 cases female patients which were new diagnozed GD in endocrinology clinic of The Second Hospital of Shanxi Medical University as experimental group, 46 cases of healthy women were chosen as control group. According to the WHO criteria of osteoporosis(1994), divided the patients with hyperthyroidism osteoporosis group, low bone mass group and the bone mass normal group. Using enzyme-linked immunosorbent to measure the serum levels of IGF-2, and detected FT3, FT4, TSH by radioimmunity method, the levels of N-MID OCN, t P1 NP, β-Crosslaps were detected by electrochemical luminescence method, and meanwhile detected E2, FSH, LH, Ca, P, FPG, TC, TG, HDL and LDL. Using dual-energy X-ray absorptiometry(DXA) to measure bone mineral density of the lumbar spine(L1-L4), femoral neck(neck) and the third of forearm of all patients. Results In GD patients before and after menopause compared with the corresponding control group, serum IGF-2 level were lower(P<0.05, P<0.01); Compared with the corresponding premenopausal, postmenopausal women, regardless of whether suffering from GD, serum IGF-2 level were lower(P<0.05, P<0.01); According to the bone mineral density determination results, female GD patients no matter if menopause or not, compared with the normal bone mass group, abnormal bone mass group patients serum IGF-2 reduced(P<0.05, P<0.01); Compared with the low bone mass group, serum IGF-2 level of the patients with osteoporosis reduced(P<0.05); In female GD patients, serum IGF-2 and FT3, FT4, β-Crosslaps were significantly negative correlation(r=-0.422, r=-0.405, r=-0.504, P<0.05), in opposite to TSH, BMD of 1/3 forearm, Neck, and the total lumbar spine they had positively correlationship(r=0.423, r=0.412, r=0.435, r=0.479, P<0.05). Conclusions The serum IGF-2 level in female patients with GD were significantly reduced, and may have relationship with the occurrence of OP caused by GD; In postmenopausal women, regardless of whether suffering from GD or not, the level of serum IGF-2 were reduced, and more significantly in the patients who merged with OP, it hinted that IGF-2 may involve in the occurrence and development of PMOP.更多还原