Changes Of The Level Of IGF-1 And IGF-2 In Female Patients Which Were New Diagnosised Graves Disease With Bone Metabolism Abnormal

Objective:By observing expression level of serum IGF-1 and IGF-2 in female patients with Graves disease, the relationship between these indexes and bone mass decline or osteoporosis caused GD and their possible pathogenesis were discussed.Methods:Collecting 57 cases female patients which were new diagnosised GD in endocrinology clinic of our hospital from October 2013 to August 2014 of with incipient wome, which were divided into two subgroup:31 pre-menopause patients aged 24 ~ 48 years old, the average age of(35.1± 8.1)years old, 26 post-menopause patients aged 44 ~61 years old, the average age of(53.0±6.8)years old. 46 healthy women of age, gender,all match the case group were chosed as control group, 18 pre-menopausal healthy women aged 22 to 49 years old, the average age of( 34.4 ±7.6) years old, 28post-menopause healthy women aged 46~58 years old, the average age of(52.0-6.7)years old. According to the WHO criteria for the diagnosis of osteoporosis, 1994, in the lumbar spine and femoral neck T/Z value judgment(for postmenopausal women with T score standard, the standard for premenopausal women with Z score), divide the patients with hyperthyroidism osteoporosis group(T/Zvalue≤-2.5), low bone mass group(-2.5<T/Z value<-1.0), the bone mass normal group(-1≤T/Zvalue≤+1)three subgroups.Height, weight of all subjects were measured and body mass index was calculated. BMI,age, menopausal years of all subjects were record carefully. Using enzyme-linkedimmunosorbent to measure the levels of IGF-1 and IGF-2, measure the levels of FT3,FT4, TSH by radioimmunity method, the levels of N-MID OCN, t P1 NP, β-Crosslaps were detected by electrochemical luminescence method, using chemilumin-escence to detect the levels of E2, FSH, LH, the levels of serum Ca, P, FPG, TC, TG, HDL and LDL were tested by sautomatic biochemical analyzer. Using dual-energy X-ray absorptiometry to measure bone mineral density of the lumbar spine(L1-4) and femoral Neck(Neck)and a third of the forearm of all patients on the date of blood(DXA) determination.Results:1. GD patients before and after menopause compared with the corresponding control group, no obvious difference was found between age, body mass index, menopause period; Women GD patients compared with healthy physical examination before and after menopause, Serum IGF-1significantly rised, Serum IGF-2 dropped, the difference was statistically significant(P < 0.05, P < 0.01); Serum N-MID OCN, t P1 NP, β-crosslaps significantly increased, the difference was statistically significant(P < 0.05, P< 0.01);Serum FT3, FT4 significantly rised, TSH decreased significantly, the difference was statistically significant(P < 0.01); GD patients after menopause compared with controls,Serum FSH, LH, E2 rised, the difference was statistically significant(P < 0.05); The level of FPG dropped, there was no statistically significant difference(P > 0.05); Serum TC, TG, LDL, HDL reduced, the difference was statistically significant(P < 0.05, P <0.01); Serum Ga are no obvious change. Women GD patients compared with healthy physical examination before and after menopause, femoral Neck Neck, 1/3 forearm BMD decreased, and the forearm one-third was lower more obvious(P < 0.05, P < 0.01),while L1-4 BMD in postmenopausal women with GD patients reduced significantly, the difference was statistically significant(P < 0.05), Compared with the control group,L1-4BMD of premenopausal women with GD patients was no significant change.2. Compared with the corresponding premenopausal, postmenopausal women,regardless of whether suffering from GD, body mass index was rised, the difference wasno statistical significant(P < 0.05), Serum β- Crosslaps, N-MID OCN, t P1 NP rised,Serum IGF-1, IGF-2, E2 dropped, the difference was statistically significant(P < 0.05, P< 0.01); Serum TC, TG, LDL rised, the difference was statistically significant(P<0.05);Compared with premenopausal GD group, Serum HDL are no significant differences in postmenopausal patients with GD, in the healthy physical examination, Serum HDL declined in postmenopausal women, the difference was statistically significant(P < 0.01);Postmenopausal GD patients serum FSH, LH levels higher than the control group, the difference was statistically significant(P < 0.05); Neck, L1-4, a third of the forearm BMD decreased, the difference was statistically significant(P < 0.05, P < 0.01).3. In female GD patients according to the bone mineral density determination results T/Z score group, compared with the normal bone mass group, no matter before and after menopause, Serum IGF-1, N-MID OCN, t P1 NP, β-Crosslaps of the osteoporosis and the low bone mass groups were elevated, Serum IGF-2 reduced, the difference was statistically significant(P < 0.05, P < 0.01); Compared with the low bone mas group,Serum IGF-1, N-MID OCN, t P1 NP, β-Crosslaps of the osteoporosis group rised, IGF-2reduced, the difference was statistically significant(P < 0.05).4. In female GD patients, serum IGF-1 and serum P1 NP, FT3, FT4 were significantly positive correlation(r=0.543, r=0.547, r=0.523, P<0.05),and TSH, 1/3forearm, Neck, and the total lumbar spine BMD showed a negative correlation(r=-0.385,r=-0.353, r=-0.444, r=-0.384, P<0.05); Serum IGF-2 and serum β-Crosslaps, FT3,FT4 were significantly negative correlation(r=-0.422, r=-0.405, r=-0.504, P<0.05)and TSH, 1/3 forearm, Neck, and the total lumbar spine BMD positively correlated(r= 0.423,r= 0.412, r=0.435, r=0.479, P<0.05).Conclusion:1. Female patients with GD, serum IGF-1 rised significantly, positively correlated with serum FT3, FT4, and negatively correlated with TSH, may participate in the regulation of thyroid function, and was positively correlated with serum t P1 NP, noobvious correlation with β-crosslaps,these all showed that IGF-1 mainly affected the bone metabolism of GD patients through adjusting osteoblast, but it was negative correlation with all the parts of BMD, we considered that IGF-1, s role contributing to bone may is not enough to resist bone loss caused GD, eventually lead to patients,BMD decreased, and the forearm 1/3 falled more obvious;2. Female patients with GD,serum IGF-2 significantly reduced, and positively correlated with serum TSH, and negatively correlated with serum FT3, FT4, considering the high serum level of FT3, FT4 may inhibit the secretion of IGF-2, negative correlation with the serum β-crosslaps, and it was no obvious correlation with serum t P1 NP, N-MID OCN, but it significantly positively related with all the parts of the BMD, it suggested that low levels of IGF-2 main influence osteoclast, due to GD patients itself exist high bone transform, on the basis of the low level of serum IGF-2 by increasing osteoclast activity, promoted bone absorption, accelerated bone transformation, increased the occurrence of osteoporosis;3. Postmenopausal women, regardless of whether suffering from GD, the level of serum IGF-1 and IGF-2 was reduced, and decreased significantly in the OP group,showed that IGF-1 and IGF-2 were involved in the occurrence and development of PMOP.