摘要
目的研究桥本甲状腺炎(HT)合并甲状腺功能减退(甲减)采用骨化三醇[1,25(OH)2D3]治疗对患者甲状腺激素及自身抗体的影响。方法选择2013年1月至2014年3月内科门诊诊治的62例HT合并甲减患者,随机分为联合组32例及单纯组30例。两组均常规给予甲状腺激素替代治疗,联合组加用骨化三醇[1,25(OH)2D3]0.25μg,1次/d口服。治疗24周后观察两组血清25羟维生素[25(OH)D2、25(OH)D3]及游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、血清甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)的变化,另检测20例健康人(健康对照组)的血清25(OH)D2、25(OH)D3。对上述指标进行对比分析。结果62例患者25(OH)D3及总25(OH)D水平较健康对照组显著降低(P<0.01)。治疗24周后,联合组和单纯组FT3、FT4明显上升,TSH、TGAb、TPOAb下降(P均<0.01),且以联合组改善更明显(P均<0.01)。单纯组25(OH)D3水平无明显改变(P>0.05),联合组明显上升(P<0.01),且高于单纯组(P<0.01)。两组25(OH)D2水平治疗前后组间及自身对照差异无统计学意义(P均>0.05)。HT合并甲减患者血清25(OH)D3水平与TGAb(r=-0.426,P<0.01)、TPOAb(r=-0.675,P<0.01)、TSH(r=-0.438,P<0.01)呈负相关;与FT3(r=0.382,P<0.05)、FT4(r=0.370,P<0.05)呈正相关。结论 HT合并甲减患者存在低25-(OH)D3血症,可能与其发病相关;应用活性维生素D3有助于改善甲状腺自身免疫调节,对HT合并甲减具有一定的治疗作用。
Objective To study the influence of calcitriol [1,25（OH）2D3] treatment on thyroid hormones and thyroid autoantibodies in patients with Hashimoto’ s thyroiditis（HT） combined with hypothyroidism.Methods Sixty-two HT complicated with hypothyroidism patients were selected who were diagnosed and treated in outpatient department of internal medicine between January 2013 and May 2014.The patients were randomly divided into combined treatment group（n =32） and simple thyroid hormone treatment group（n = 30）.The replacement therapy of thyroid hormones was all given in two groups,and 1,25（OH）2D3（0.25 μg,qd） was added in combined treatment group.The changes of serum 25（OH） D2,25（OH） D3,free triiodothyronine（FT3）,free thyroxine（FT4）,thyroid stimulating hormone（TSH）,thyroglobulin antibody（TGAb） and thyroid peroxidase antibody（TPOAb） 24 weeks after treatment were observed.In addition,20 healthy subjects were selected as control group.Results The serum 25（OH） D3 and total 25（OH） D levels in 62 patients were all significantly lower than those in control group（all P 〈 0.01）.Twenty 24 weeks after treatment,25（OH） D3 level in simple thyroid hormone treatment group remained unchanged（P 〉 0.05）,while it in combined treatment group significantly elevated compared with before treatment（P 〈 0.01） and with simple thyroid hormone treatment group（P 〈 0.01）.The 25（OH） D2 levels before treatment in two treatment groups were similar and remained unchanged after treatment in two treatment groups（all P 〉 0.05）.In two treatment groups,the FT3,FT4 levels increased significantly,while the TSH,TGAb,TPOAb levels decreased significantly（all P 〈 0.01）,and the aforementioned changes in combined treatment group were more obvious than those in simple thyroid hormone treatment group（all P 〈 0.01）.In 62 cases of HT combined with hypothyroidism,25（OH） D3 was negatively correlated with TGAb（r =-0.426,P 〈 0.01）,TPOAb（r =-0.675,P 〈0.01）,TSH（r =-0.438,P 〈 0.01） and was positively correlated with FT3（r = 0.382,P 〈 0.05）,FT4（r = 0.370,P 〈0.05）.Conclusions HT combined with hypothyroidism patients exist low 25-（OH） D3 viremia,and this might be associated with the pathogenesis.The application of activated Vitamin D3 contributes to the improvement of thyroid autoimmune regulator and has a certain therapeutic effect in HT combined with hypothyroidism patients.
出处
《中国临床研究》
CAS
2015年第1期17-19,23,共4页
Chinese Journal of Clinical Research
基金
广东省医学科学技术研究基金面上项目(WSTJJ201112034401061970081018249)
