甲亢患者血清瘦素脂联素水平与甲状腺激素和骨代谢指标的关系

doi:10.3969/j.issn.1006-6233.2020.01.007

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Abstract Objective: To compare and analyze the changes of serum leptin and adiponectin levels in patients with hyperthyroidism and their relationships with thyroid hormone levels and bone metabolism. Methods: 78 patients with hyperthyroidism from April 2018 to March 2019 were selected as hyperthyroidism group, and 56 healthy volunteers were selected as control group. At the same time, patients with hyperthyroidism were divided into osteoporosis group (21 cases) and non-osteoporosis group (57 cases) according to whether they had osteoporosis. Serum leptin level was detected by radioimmunoassay and serum adiponectin level was detected by enzyme-linked immunosorbent assay (ELISA). The levels of serum thyroid hormone indexes such as triiodothyronine (T3), tetraiodothyronine (T4), free triiodothyronine (FT3), free thyroxine (FT4), parathyroid hormone (PTH), thyrotropin (TSH) were detected by chemiluminescence. The levels of bone metabolism-related cytokines such as interleukin-6 (IL-6), tumor necrosis factor (TNF), calcitonin (CT) and insulin-like growth factor-II (IGF-II) were measured by ELISA. The levels of osteocalcin (BGP) and bone specific alkaline phosphatase (BAP) were measured by radioimmunoassay. The levels of N-terminal osteocalcin (N-MID) and bone-derived alkaline phosphatase (ABAP) were measured by chemiluminescence. Bone mineral density (BMD) of femoral neck was measured. Pearson method was used to analyze serum leptin and adiponectin in patients with hyperthyroidism and their correlations with each index; the diagnostic value of serum leptin and adiponectin in hyperthyroidism-induced osteoporosis was analyzed by receiver operating characteristic curve (ROC). Results: The levels of serum leptin and adiponectin in hyperthyroidism group were significantly higher than those in control group (P < 0.05); the levels of T3, T4, FT3, FT4 and PTH in thyroid hormone indexes of hyperthyroidism group were significantly higher than those of control group (P < 0.05), and TSH level was significantly lower (P < 0.05); the levels of bone metabolism-related cytokines TNF, CT and IGF-II in hyperthyroidism group were significantly lower than those in control group (P < 0.05). The level of IL-6 was significantly higher than that of the control group (P < 0.05). The levels of ALP, BGP, BAP, N-MID and ABAP in hyperthyroidism group were significantly higher than those in control group (P < 0.05), while BMD in femoral neck was significantly lower (P < 0.05). Pearson analysis showed that serum leptin was positively correlated with adiponectin (P < 0.05), and positively correlated with T3, T4, FT3, FT4 and PTH (P < 0.05), negatively correlated with TSH (P < 0.05); Pearson analysis showed that leptin and adiponectin were positively correlated with ALP, BGP, BAP, N-MID, ABAP and IL-6 (P < 0.05), but negatively correlated with BMD, TNF, CT and IGF-II of femoral neck (P < 0.05). The serum leptin and adiponectin levels in osteoporosis group were significantly higher than those in non-osteoporosis group (P < 0.05). ROC analysis showed that the AUC of leptin in the diagnosis of osteoporosis caused by hyperthyroidism was 0.806, the sensitivity was 74.36%, the specificity was 76.79%, and the truncation value was 7.31ng/mL. The AUC of adiponectin in the diagnosis of osteoporosis caused by hyperthyroidism was 0.849, the sensitivity was 71.79%, the specificity was 85.71%, and the truncation value was 249.86 mg/dL. Conclusion: Serum leptin and adiponectin levels are abnormally increased in patients with hyperthyroidism. It is closely related to thyroid hormone level and bone metabolism index. It can also be used as an important index for early diagnosis of osteoporosis caused by hyperthyroidism.

Key words： Hyperthyroidism Leptin Adiponectin Thyroid hormone Bone metabolism

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2020.01.007 OR http://www.hbyxzzs.cn/EN/Y2020/V26/I1/28

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