类风湿性关节炎的高钙血症与疾病活动和骨代谢的关系

通过双能X线吸收测定法测定类风湿性关节炎骨代谢参数以及腰椎骨密度和股骨颈骨密度研究离子钙和疾病间的关系。对146名类风湿性关节炎患者测定以下参数:血清钙离子水平、总钙、维生素D代谢产物25-羟基维生素D3和1,25-二羟基维生素D3、血清免疫活性甲状旁腺素、白细胞介素-6、骨钙素、红细胞沉降率和C反应蛋白,以及肾脏排泄物吡啶醚和脱氧吡啶醚交联物。共有30.1%的受试类风湿性关节炎患者血钙过高。高血钙的类风湿性关节炎患者红细胞沉降率值和C反应蛋白水平显著高于血钙正常的类风湿性关节炎患者,而血中血清免疫活性甲状旁腺激素和1,25-二羟基维生素D3水平以及腰椎骨密度显著低于血钙正常的类风湿性关节炎患者。研究结果显示,部分类风湿性关节炎患者血钙过高。疾病活动期伴随着血钙升高,并可能抑制甲状旁腺激素分泌和维生素D合成。高浓度离子钙可能反映了与疾病活动相关的全身骨丢失,并且可作为类风湿性关节炎中腰椎骨密度的预报因子。     

不同年龄段卵巢功能早衰患者骨质疏松症现状调查及钙片、骨化三醇、维生素D联合防治分析

目的调查分析不同年龄段卵巢功能早衰患者骨质疏松症发生现状及钙片、骨化三醇、维生素D联合防治效果,为临床治疗提供参考依据。方法选取2013年1月-2016年5月于该院就诊的200例卵巢功能早衰患者为研究对象,均接受骨转化标志物相关指标及骨密度检查,根据患者绝经年龄将其分为A组(绝经年龄36岁,65例)与B组(绝经年龄36~39岁,135例),比较两组甲状旁腺素(PTH)、25-羟基维生素D、骨钙素(BGP)、Ⅰ型胶原C端肽降解产物(CTX-Ⅰ)、骨密度及骨质疏松症发生率。同时对继发骨质疏松症患者行钙片、骨化三醇联合维生素D治疗,探讨其疗效。结果 A组骨质疏松症发生率为49.23%,B组为40.74%,差异无统计学意义(P0.05);A组水平显著低于B组,CTX-Ⅰ水平显著高于B组(P0.05);两组左髋部、腰椎BMD比较,差异无统计学意义(P0.05)。87例骨质疏松症患者治疗后PTH、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平较治疗前均显著下降,25-羟基维生素D、左髋部及腰椎骨密度均显著上升,差异有统计学意义(P0.05)。结论卵巢功能早衰患者骨质疏松症发生率较高,与其绝经年龄无关;钙片、骨化三醇、维生素D联合治疗能明显提高骨质疏松症患者骨密度及25-羟基维生素D水平,降低IL-6、TNF-α水平。     

老年2型糖尿病患者骨代谢标志物与骨密度的相关性

目的探讨老年(60岁以上)2型糖尿病患者骨代谢标志物与骨密度的相关性。方法选取2017年6月至2018年12月本院收治的老年2型糖尿病患者185例,根据骨密度测定结果分为骨量正常组(T≥-1.0)68例、骨量减少组(-2.5T-1.0)70例和骨质疏松组(T≤-2.5)47例。采集患者空腹外周静脉血,电化学发光免疫法检测空腹C肽、甲状旁腺激素、25-羟基维生素D、骨钙素、总骨Ⅰ型前胶原N端肽及Ⅰ型胶原羧基末端肽水平;全自动生化分析仪检测空腹血糖、血清钙及24 h尿蛋白;高效液相色谱法测定糖化血红蛋白水平。结果 3组患者年龄、体质量指数(BMI)、24 h尿蛋白定量、空腹C肽、甲状旁腺激素及糖化血红蛋白水平差异均有统计意义(均P0.05);骨质疏松组和骨量减少组患者年龄、病程、24 h尿蛋白定量、甲状旁腺激素及糖化血红蛋白水平明显高于骨量正常组,BMI和空腹C肽水平明显低于骨量正常组(25.69±2.04)kg/m~2、(2.25±0.31)nmol/L,其中骨质疏松组变化更明显,差异均有统计学意义(均P0.05)。3组患者25-羟基维生素D、骨钙素、总骨Ⅰ型前胶原N端肽及Ⅰ型胶原羧基末端肽水平差异均有统计意义(均P0.05);骨质疏松组和骨量减少组25-羟基维生素D、骨钙素及总骨Ⅰ型前胶原N端肽水平明显低于骨量正常组,Ⅰ型胶原羧基末端肽水平明显高于骨量正常组,其中骨质疏松组变化更明显,差异均有统计意义(均P0.05)。Pearson相关性分析显示,25-羟基维生素D、骨钙素、总骨Ⅰ型前胶原N端肽与骨密度呈正相关(均P0.05);25-羟基维生素D、骨钙素、总骨Ⅰ型前胶原N端肽与Ⅰ型胶原羧基末端肽呈负相关(均P0.05)。结论老年2型糖尿病患者骨代谢标志物与骨密度明显相关,25-羟基维生素D、骨钙素及总骨Ⅰ型前胶原N端肽水平下降,Ⅰ型胶原羧基末端肽水平升高,提示骨密度降低。     

老年骨质疏松症患者骨代谢指标变化、生长分化因子15及其炎症因子水平分析

目的研究老年骨质疏松症患者骨代谢指标变化、GDF15及其炎症因子水平,为患者的诊疗提供临床指导。方法选取2017年1月-2019年6月本院接收的165例老年骨质疏松症患者作为观察组,选择同期在本院体检的健康老年人100例作为对照组。测量比较患者腰椎L2～4正位和股骨颈骨密度,采集患者空腹静脉血,检测患者骨代谢指标骨钙素N段中分子片段(N-MID)、I型胶原羧基端肽β特殊系列(β-CTX)、I型前胶原氨基端延长肽(P1NP)、血清25羟维生素D3[25-(OH) D_3],生长分化因子-15(GDF15)以及炎症因子IL-1β、IL-6、TNF-α。结果观察组腰椎L2～4、股骨颈的骨密度低于对照组;观察组N-MID、β-CTX、PINP水平高于对照组;观察组25-(OH) D3水平低于对照组观察组GDF15水平高于对照组观察组IL-1β、IL-6、TNF-α水平高于对照组,上述差异均有统计学意义(P 0.05)。结论骨质疏松患者骨密度显著降低,N-MID、β-CTX、PINP水平显著上升,25-(OH) D3水平显著下降,GDF15、IL-1β、IL-6、TNF-α水平显著上升,对于老年骨质疏松症的筛查以及治疗有重要意义。     

个体化维生素D补充治疗绝经后妇女骨质疏松症的临床应用

目的 探讨绝经后骨质疏松症患者血清25-羟维生素D的水平,在患者中进行个体化维生素D补充的临床应用价值与意义。方法 回顾性分析2021年6月至2023年6月于河南科技大学第一附属医院诊断为骨质疏松症并接受地舒单抗治疗的绝经后妇女患者的临床数据。86例初次诊断为绝经后骨质疏松症的患者纳入研究。根据维生素D补充方式将患者分为两组,对照组45例(固定剂量组)和观察组41例(个体化剂量组：依据患者血清维生素D水平,以≥30ng/mL为目标进行补充)。观察并对比两组患者骨密度值及骨代谢情况。结果 治疗前两组患者在年龄、身高、体重、血清25(OH)D浓度、BMI和腰椎股骨颈的骨密度方面均无显著性差异(P>0.05)。治疗后观察组β-1型胶原交联羧基端肽(β-CTX)、1型原胶原氨基端前肽(P1NP)水平降低较对照组更显著,25羟维生素D水平高于对照组,差异有统计学意义(t值分别为2.052,2.608和9.167,P<0.05);观察组股骨颈、腰椎L2节段骨密度水平均高于对照组,差异有统计学意义(t值分别为2.275,2.560,P<0.05)。结论 接受地舒单抗药物治疗的绝经后...     

唑来膦酸治疗2型糖尿病骨质疏松的临床疗效

目的探讨唑来膦酸治疗2型糖尿病骨质疏松的临床疗效。方法选取阜新市某医院2015年1月-2016年1月收治的128例2型糖尿病骨质疏松患者为研究对象,随机分为对照组(58例)和研究组(70例)。对照组患者给予常规治疗,研究组患者在对照组的基础上给予唑来膦酸治疗,比较2组患者治疗前后视觉模拟评分法(VAS)评分、骨密度及血清降钙素(CT)、骨钙素(BGP)、25-羟维生素D、Ⅰ型前胶原羧基端前肽(PICP)水平变化情况。结果治疗后,2组患者VAS评分均低于治疗前,且研究组低于对照组,差异有统计学意义(P0.05);治疗后,2组患者腰椎L2-4、股骨颈、大转子内侧及华氏三角区骨密度均高于治疗前,且研究组高于对照组,差异有统计学意义(P0.05);治疗后,研究组患者血清CT,BGP,25-羟维生素D,PICP水平均高于对照组,差异均有统计学意义(P0.05)。结论唑来膦酸治疗2型糖尿病骨质疏松临床疗效较好,能够有效减轻患者疼痛,同时增加患者骨密度,提高患者治疗依从性,值得临床推广应用。     

儿童血清中25羟-维生素D_3水平与骨密度及脂代谢异常发生的关系

目的观察血清中25羟-维生素D3水平与患者骨密度及脂代谢异常发生的关系。方法选择民航总医院2015年11月～2017年11月门诊健康体检的儿童200例,所有儿童均抽血检测血脂、25羟-维生素D3水平。并根据25羟-维生素D3水平分为25羟-维生素D3缺乏组(25羟-维生素D320μg/L)25例,25羟-维生素D3偏低组(25羟-维生素D320～30μg/L)45例,25羟-维生素D3正常组(25羟-维生素D3 30μg/L)130例。行骨密度检测,探讨儿童血清中25羟-维生素D3水平与患者骨密度的关系,采用logistics回归分析探讨血清中25羟-维生素D3水平与脂代谢异常发生的关系。结果 25羟-维生素D3缺乏组儿童腰椎、股骨颈、股骨粗隆、Ward三角区骨密度水平分别为(0.95±0.19)、(0.94±0.24)、(0.75±0.13)、(0.87±0.24)g/cm2明显低于偏低组、正常组儿童,差异有统计学意义(P 0.05);25羟-维生素D3缺乏组儿童TG、TC、LDL-C水平分别为(2.45±0.32)、(5.37±1.23)、(3.12±0.25)mmol/L明显高于偏低组、正常组,HDL-C水平(0.35±0.12)mmol/L明显低于偏低组、正常组,差异有统计学意义(P 0.05);25羟-维生素D3缺乏组儿童超重、肥胖的人数分别为8、15例,明显高于其他组,差异有统计学意义(P 0.05)。结论 25羟-维生素D3水平与骨密度及脂代谢密切相关可能是儿童肥胖的危险因素。     

老年男性2型糖尿病25羟维生素D状况及其与糖代谢和骨密度的相关分析

目的 探讨25羟维生素D在老年男性2型糖尿病(T2DM)患者中的状况,分析其与糖代谢和骨密度的关系.方法 收集老年男性T2DM患者53例(T2DM组),老年男性非糖尿病(NDM)患者51例(NDM组),测定两组患者血生化指标及25羟维生素D水平,双光能X线检测T2DM患者腰椎(L2-4)和左侧股骨近端骨密度.结果 T2DM组血清25羟维生素D水平为(12.38±5.12) μg/L,显著低于NDM组的(17.35±5.52) μg/L,差异有统计学意义(P＜0.05);老年男性T2DM患者血清25羟维生素D水平与空腹血糖、糖化血红蛋白呈负相关(r=-0.225、-0.499,P＜0.05),而与空腹胰岛素、稳态模型胰岛素抵抗指数无明显相关性(r=-0.050、-0.082,P＞0.05);T2DM组骨质疏松患病率(30.19％,16/53)明显高于NDM组(11.76％,6/51),差异有统计学意义(P＜0.05);25羟维生素D与股骨颈、股骨大转子、Ward三角区骨密度呈明显正相关(r=0.773、0.762、0.812,P＜0.05),与腰椎(L2～4)骨密度不相关(r=0.116,P＞0.05).结论 老年男性T2DM患者普遍存在维生素D缺乏.维生素D缺乏或不足不仅影响血糖控制,还增加骨质疏松发生风险.因此,对T2DM患者,尤其是老年患者,应进行常规维生素D检测,对维生素D不足及缺乏的患者及时给予维生素D补充可能对改善糖代谢和防治骨质疏松有益.     

老年女性股骨颈骨折、股骨粗隆骨折患者性激素水平、骨密度特点及相关性研究

目的分析老年女性股骨颈骨折、股骨粗隆骨折患者性激素水平、骨密度特点及相关性,为制定合理的护理方案提供依据。方法选取2018年1月-2019年1月该院诊治的老年女性股骨颈骨折和股骨粗隆骨折患者130例为骨折组,另选取同期该院诊治的非骨折老年女性患者100例为非骨折组,两组均测定血清雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)水平及腰椎、髂骨、股骨上段骨密度并进行比较。将老年女性股骨颈骨折和股骨粗隆骨折患者根据骨密度水平分为基本正常组、下降组,比较两组患者血清E2、FSH、LH水平,并分析老年女性股骨颈骨折和股骨粗隆骨折患者性激素水平与骨密度的相关性。结果骨折组患者血清E2水平显著低于非骨折组,而血清FSH、LH水平显著高于非骨折组,差异均有统计学意义(均P<0. 05)。骨折组患者腰椎、髂骨、股骨上段骨密度均显著低于非骨折组,差异均有统计学意义(均P<0. 05)。骨密度下降组患者的血清E2水平显著低于骨密度基本正常组,血清FSH、LH水平显著高于骨密度基本正常组,差异均有统计学意义(均P<0. 05)。Pearson相关性分析结果显示,老年女性股骨颈骨折、股骨粗隆骨折患者腰椎、髂骨、股骨上段骨密度与血清E2水平呈显著正相关关系(P<0. 05),与血清FSH、LH水平呈显著负相关关系(P<0. 05)。结论老年女性股骨颈骨折、股骨粗隆骨折患者性激素水平显著变化,骨密明显下降,临床护理工作者可以通过针对性护理方案改善老年女性性激素水平和骨密度,预防骨折的发生。     

妊娠糖尿病伴亚临床甲减对孕妇骨密度及骨钙素、25-羟基维生素D的影响

目的:探讨妊娠糖尿病伴亚临床甲减对孕妇骨密度及骨钙素、25-羟基维生素D的影响。方法:以本院内分泌科确诊的妊娠期糖尿病伴亚临床甲减孕妇120例为观察组,同期产前检查健康孕妇120例为对照组,检测两组孕妇骨密度(BMD)及骨钙素(OC)、25-羟基维生素D3(25-OH-VD3),并观察母婴妊娠结局。结果:观察组骨量正常率(72.5%)低于对照组(85.0%),骨量减少发生率(20.0%)和OC(9.86±0.13μg/L)高于对照组(5.0%、7.21±0.15μg/L),25-OH-VD(16.09±5.34μg/L)和跟骨BMD水平(0.91±0.18 g/cm2)低于对照组(18.96±6.36μg/L、1.14±0.21g/cm2)(均P<0.05);观察组新生儿低出生体质量(20.0%)和新生儿窒息发生率(10.0%)高于对照组(5.0%、1.7%)。结论:妊娠糖尿病伴亚临床甲减可降低孕妇的骨密度,影响骨钙素、25-羟基维生素D表达水平,增加新生儿窒息、低体重风险,应引起临床重视。     

骨髓活检在诊断骨髓转移瘤中的价值

目的探讨骨髓活组织检查在诊断骨髓转移瘤中的价值。方法骨髓转移瘤患者行一步法骨髓抽吸取材,活检塑料包埋切片行HGF、Gomori染色,骨髓涂片行瑞特氏染色。结果骨髓活检检出率为97.1%,骨髓涂片检出率为60.9%,骨髓活检与骨髓涂片诊断相符率为57.9%;骨髓活检检出率明显高于骨髓涂片(P<0.01)。结论骨髓活检可作为诊断骨髓转移瘤的常规检测手段。     

Chondroblastoma of bone

Background: Chondroblastoma is a rare and benign cartilaginous tumor of bone often localized in the epiphysis of long bones and affecting young persons between 10 and 20 years. Aim: To study the epidemiological, clinical and radiological aspects of bone chondroblastoma, to assess the outcome of chirurgical treatment and factors associated with recurrence. Methods: It's a retrospective study, concerning 13 patients with chondroblastoma of bone, attending the orthopedic department of Sahloul hospital between 1991 and 2007. The patients' age, sex, clinical features, radiological aspects, treatment and evolution were recorded. After initial clinical examination, all patients have had plane radiographs. Twelve patients were explored by Computed tomography. The treatment was surgical in every case: curettage of the lesion in 11 cases associated with bone grafting in 5 cases and cementation in one case, one in-bloc resection and one simple biopsy. Histology confirmed the diagnostic in all cases. Résultats: The average age of patients was 18, 2 years and sex ratio was 2, 3. the long bones are the most commonly involved. The main presenting symptoms were pain in all cases and local swelling in 8 cases. Radiographs showed a lytic geographic well-defined lesion in 7 cases. Computed tomography showed better calcifications and soft tissue extension. The mean follow-up of our patients was 8 years (6 mois-18 ans). Two recurrences were noted. Functional results were good in 11 cases. Conclusion: Chondroblastoma is a rare and benign cartilaginous tumor of bone which usually involves the epiphysis of long bones. Plane radiographs are sufficient for diagnostic in typical cases. MRI is interesting in unusual presentations and localizations. Curettage and grafting constitute the treatment of choice. Prognosis depends basically on a relatively high rate of recurrence. Aggressive feature of the lesion and incomplete curettage are the most important predictive factors of recurrence.     

Effect of dietary calcium deficiency on bone matrix-induced ectopic bone

The effect of dietary depletion of calcium on collagenous bone matrix-induced ectopic bone was studied, following thirty days of deficiency. While the molar ratio of phosphorus and calcium did not exhibit any significant differences between the control and experimental groups, individual concentrations of these minerals showed significant reduction in the ossicles derived from experimental rats. A concomitant decrease and increase in urinary excretion of calcium and phosphate was noted in the calcium deficient group; the serum levels of these parameters, however, were not affected. Both hexosamine and hydroxyproline levels appeared higher in calcium deficient ossicles. A significant elevation of alkaline and acid phosphatase as well as aryl sulfatase was observed in calcium deficient ossicles. There appeared to be no difference between control and experimental rats in the rate of calcification as measured by ⁴⁵Ca uptake. These results suggest that dietary deficiency induces significant resorption of ectopic bone without altering mineralization capacity. It is suggested that matrix-induced ectopic bone may be used as a suitable experimental model to study pathophysiology of bone loss under various experimental conditions.     

Correlates of forearm bone mass among women during maximal bone mineralization

The distribution and correlates of bone mass among women ages 20-35 were studied. During young adulthood, bone mass reaches its maximum level and appears to stabilize. Factors that establish the individual's relative position in this plateau period may influence the ultimate expression of bone loss with aging. Mid-distal radial bone mass was measured in a geographically defined population of 86 women in two rural, demographically similar communities in Iowa. The water supplies provided 55 and 375 mg/liter of elemental calcium, generating significantly different mean community dietary calcium intakes of 871 and 1,233 mg/day, respectively. Bone mass was measured by single-beam photon densitometry and correlated with data from physical measurements, medical history, and reported nutritional intake. In evaluating the joint effect of variables in a multiple regression procedure, forearm bone mass was negatively and significantly associated with alcohol consumption (P = 0.0327) and with a first pregnancy prior to age 20 (P = 0.0250). There was a trend for current calcium intake estimated from 24-hr recall to be positively associated with bone mass (P = 0.0816). Because the 24-hr recall is characterized by significant error due to daily variability of an individual's intakes, a more general calcium intake was estimated from food frequency. Women whose estimated intake of calcium from food frequency was greater than 800 mg/day, the Recommended Daily Allowance, had significantly greater bone mass than women whose intake was estimated to be less than 800 mg/day (P = 0.0053). No relationship was observed with oral contraceptive use, parity, breastfeeding practices, smoking behavior, or measures of physical activity.     

Treatment of postsurgical jaw bone defects by bone filling material.

The aim of this study was to analyse the clinical application of some bone filling materials (DFDBA, Osteovit, ATR-24) during the treatment of limited postsurgical defects of jaw bones in 108 patients. The results indicated a significant decrease of the mean time needed for bone regeneration within the area of the defect as assessed by Ro-densitometry and videodensitometry during the follow-up period.