Siddiqi A, Burrin J M, Noonan K, James I, Wood D F, Price C P, Monson J P
Department of Endocrinology, St. Bartholomew's and the Royal London Hospital, England.
J Clin Endocrinol Metab. 1997 Mar;82(3):753-9. doi: 10.1210/jcem.82.3.3804.
Whether biochemical markers can predict improvement in reduced bone mineral density (BMD) associated with thyrotoxicosis in unclear. We investigated the relationship between serum osteocalcin (OC), bone-specific alkaline phosphatase (b-ALP), serum deoxypyridinoline (Sdpd) and pyridinoline (Spyr), 24-hour urinary deoxypyridinoline (Udpd), and BMD in 17 thyrotoxic patients during 1 yr of treatment. Coinciding with euthyroidism at 4-8 weeks, there was a peak in b-ALP and OC and a prompt fall into the normal range in Udpd and Sdpd, but not Spyr, levels. Mean b-ALP continued to be raised at week 52 when it was inversely correlated with BMD. Mean BMD rose approximately 6%, P < 0.01, over 1 yr. Coupling indices were calculated as a measure of bone balance and, at diagnosis, was [minus4.26 in favor of bone resorption and rose with treatment in favor of bone formation: weeks 2: -0.23; 4: +4.01; 8: +4.37; 12: +4.44; 24: +2.32; and 52: +1.56. Bone turnover is balanced within 2 weeks of starting treatment for thyrotoxicosis. Udpd accurately indicates thyrotoxic bone resorption. Serum b-ALP indicates continuing bone formation and, at 1 yr, may provide a marker for low BMD. OC, Sdpd, and Spyr are less sensitive in documenting bone remodeling during treatment of thyrotoxicosis.
目前尚不清楚生化标志物能否预测甲状腺毒症相关的骨矿物质密度（BMD）降低情况的改善。我们研究了17例甲状腺毒症患者在1年治疗期间血清骨钙素（OC）、骨特异性碱性磷酸酶（b-ALP）、血清脱氧吡啶啉（Sdpd）和吡啶啉（Spyr）、24小时尿脱氧吡啶啉（Udpd）与BMD之间的关系。在4 - 8周达到甲状腺功能正常时，b-ALP和OC出现峰值，Udpd和Sdpd水平迅速降至正常范围，但Spyr水平未下降。在第52周时，平均b-ALP持续升高，此时它与BMD呈负相关。平均BMD在1年中上升了约6%，P < 0.01。计算耦合指数作为骨平衡的指标，在诊断时为[ - 4.26，有利于骨吸收，随着治疗有利于骨形成而上升：第2周： - 0.23；第4周： + 4.01；第8周： + 4.37；第12周： + 4.44；第24周： + 2.32；第52周： + 1.56。甲状腺毒症治疗开始后2周内骨转换达到平衡。Udpd准确指示甲状腺毒症性骨吸收。血清b-ALP指示持续的骨形成，在1年时可能为低BMD提供一个标志物。在甲状腺毒症治疗期间，OC、Sdpd和Spyr在记录骨重塑方面不太敏感。
