骨质疏松症与抑郁症关系的研究进展

本综述论述了骨质疏松症与抑郁症之间密切的关联性,国内外的研究表明,骨质疏松症和抑郁症可能是两个互为因果的慢性常见疾病,这种合并发病的机制可能来源于内分泌激素、药物、行为习惯等原因.     

钙剂，维生素D与骨质疏松症

充足的钙和维生素D摄入可以导致正钙平衡并且减少骨丢失的比率,联合服用钙剂和维生素D制剂可以减少骨折的风险,对于饮食摄入过低以及骨质疏松症的患者,推荐补充钙剂和维生素D是应该而且必须的。     

亚洲人群维生素D受体基因多态性和骨质疏松症相关性研究进展

骨质疏松症（osteoporosis,OP）是一种随年龄增加患病率不断提高的全球性骨骼疾病,主要受遗传因素与环境因素双重作用的控制,它所引起的最恶性的结果是出现骨质疏松性骨折,危害老年群体的身心健康,增加此人群的死亡风险。维生素D受体（Vitamin D receptor,VDR）基因在调节骨代谢和调控钙稳态方面发挥至关重要的作用。迄今为止,有许多研究对VDR基因多态性和OP之间的联系进行了探究,但研究结果往往具有较大争议。因此,该文以探究亚洲人群VDR基因多态性与发生OP的联系为目的,从ApaⅠ位点多态性、BsmⅠ位点多态性、TaqⅠ位点多态性以及FokⅠ位点多态性与OP相关性4个方面作综述,并根据国内外各研究结果以及相关位点的位置特征进行总结,对进一步研究进行展望,以期为如何筛查亚洲OP易感人群及制定相关预防、治疗OP的策略提供思路。     

广州地区骨质疏松症患者冬季维生素D水平现状分析

目的调查广州地区冬季骨质疏松症患者体内维生素D(Vit D)水平的状况。方法随机选取2014年12月至2015年2月我院299例年龄≥50岁骨质疏松症患者,采集其清晨空腹静脉血,所有研究对象均采用Cobase 6000型电化学发光仪(瑞士,罗氏诊断)检测血清25-羟维生素D(25(OH)D)和甲状旁腺激素(PTH)水平,日立7180型自动生化分析仪测定钙(Ca)、磷(P)及碱性磷酸酶(ALP)水平。双能X线吸收仪检测腰椎和股骨近端骨密度(BMD),SPSS 16.0软件进行数据分析。结果299例骨质疏松症患者,其中男性患者63例,25(OH)D平均水平为(52.75±17.30)nmol/L,女性患者236例,25(OH)D平均水平(53.97±16.11)nmol/L。其中Vit D正常者仅占3.3%,缺乏者占47.6%,不足者占44.8%,严重不足者占4.3%。这些患者普遍存在着25(OH)D水平不足现象,其中Vit D缺乏和不足所占比例较大,且男女两组的25(OH)D水平无统计学差异。结论本研究显示广州地区冬季骨质疏松症患者25(OH)D不足和缺乏现象较普遍,且无性别差异,补充足量Vit D,需要重视及积极治疗,定期监测25(OH)D水平,为临床骨质疏松症的防治提供一定的数据参考。     

老年男性骨质疏松症与血清痩素水平关系的研究

目的 探讨瘦素和老年男性骨质疏松的关系.方法 选择86例老年男性原发骨质疏松患者和50例正常对照者,采用放免法检测血清瘦素(Lep)浓度,骨钙素(BGP)、I型胶原前胶原氨基端前肽(PINP),采用双能X线吸收法测定腰椎及髋部骨密度,同时计算体重指数(body mass index, BMI),并分析瘦素与其他各项指标的关系.结果 老年男性骨质疏松组血清瘦素水平(4.137±2.439 μg/L)明显低于正常对照组(5.142±2.869 μg/L),两组有显著性差异,P<0.05.血清瘦素水平与BMI显著正相关(Pearsons 相关系数r=0.470, P<0.001),亦与L_(1-2), L_4的BMD 及BGP正相关(r分别为0.356,0.315,0.307,0.241, P<0.05),但在校正BMI后,瘦素与L_2的BMD及BGP的正相关关系消失,与L_1(r=0.193,P<0.05)和L_4(r=0.212, P<0.05)BMD的正相关关系亦有所减弱.结论 老年男性骨质疏松患者血清瘦素水平下降,推测瘦素可能通过外周局部作用影响骨代谢.     

骨质疏松症患者血清25-羟维生素D水平的研究

目的：调查了解西安地区骨质疏松症患者体内维生素D 水平的状况。方法随机选取2012年12月－2013年11月我科440例骨质疏松症患者,采集其清晨空腹静脉血,用Cobase 6000型电化学发光仪（瑞士罗氏诊断）检测血中25（OH）D的水平,按照2012年12月－2013年5月为冬春季和2013年6月－2013年11月为夏秋季进行分组,用SPSS13．0软件进行数据分析。结果共调查了440例骨质疏松症患者,其中女性患者数量远大于男性患者,这些患者普遍存在着维生素D水平不足现象,其中维生素D严重缺乏和缺乏所占比例较大,男女两组在年龄和血清25（ OH） D水平上均无统计学差异,而且冬春季患者体内维生素D的水平要低于夏秋季的患者。结论本研究显示西安地区骨质疏松症患者维生素D不足现象比较普遍,男性女性之间无明显差别,而且体内维生素D水平与季节的变化有关,为骨质疏松症的防治提供一定的数据参考。     

血清维生素D和K水平和慢性胰腺炎患者骨质疏松症相关性研究

目的探索血清维生素D和K水平和慢性胰腺炎患者骨质疏松症相关性。方法通过双能X射线吸收测定法检测骨密度和粪弹性蛋白酶检测评估胰腺功能;检测患者血清维生素D和维生素K的水平;通过逻辑回归分析研究变量与骨密度之间的关联。结果共有211名CP患者,其中男性142例。有18%的患者有晚期CP,患有胰腺外分泌功能不全为43%。维生素D和K缺乏分别为56%和32%。骨量减少的诊断率为42%,骨质疏松症的诊断率为22%。在多变量分析中,女性、年龄和较高BMI与骨质疏松症存在相关性。在男性患者中,与骨质疏松症相关的唯一因素是维生素K缺乏症。结论 CP患者的骨病发生率很高,且维生素K缺乏作为男性骨质疏松症患者唯一的危险因素。     

维生素K2防治骨质疏松症的研究进展

维生素K2是一种与骨形成和骨吸收有关的药物,具有促进骨形成和抑制骨吸收的双重作用。本文着重论述维生素K2对骨代谢的影响和维生素K2预防和治疗骨质疏松症的临床应用研究等方面的研究新进展。     

老年骨质疏松症患者25羟维生素D3水平的季节变化

目的：本文通过测定我院就诊的老年骨质疏松症患者体内25羟维生素D3水平,分析目前维生素D治疗状况并评价其与季节的关系。方法50例老年骨质疏松症患者（均符合1994年WHO关于骨质疏松症的诊断标准）,其中男性28名,平均年龄75．6±1．5岁,女性22名,平均年龄69．3±2．6岁,用放射免疫分析法测定冬夏两季25（ OH） D3、钙、磷、碱性磷酸酶、甲状旁腺素含量。结果所有患者夏季25（OH）D3水平明显高于冬季（男性高42．5％,女性高54．6％,P＜0．05）。维生素D缺乏情况：女性夏季为13．64％,冬季为36．36％,男性夏季为7．14％,冬季35．71％,冬季维生素D缺乏明显高于夏季（ P＜0．05）,男女两组钙、磷、碱性磷酸酶、甲状旁腺素含量均在正常范围。结论老年骨质疏松症患者在不同季节存在着不同程度的维生素D缺乏,冬季25（OH）D3水平更低。建议老年人科学合理应用维生素D,应该将定期监测25（OH）D3水平作为骨质疏松症治疗的常规实验室检查,并为临床合理应用维生素D提供科学的理论依据。     

大庆市城区部分居民血清维生素D水平评估

目的了解大庆市居民血清维生素D水平,为骨质疏松症(osteoporosis,OP)防治提供依据。方法 2014年3月至2016年4月招募大庆市城区居民4874名,其中0～10岁864人,11～20岁298人,21～30岁155人,31～40岁580人,41～50岁888人,51～60岁927人,61～70岁750人,70岁以上412人。采集受试者清晨空腹静脉血,应用酶联免疫法测定血清25-羟基维生素D[25 hydroxy vitamin D,25(OH)D]浓度。以血清25(OH)D<30 nmol/L为维生素D缺乏;血清25(OH)D在30～49.9 nmol/L之间为维生素D不足;血清25(OH)D≥50 nmol/L为维生素D充足。评估大庆城区居民血清维生素D水平。结果大庆城区部分居民血清25(OH)D平均水平为(16.89±11.92)nmol/L,0～10岁组血清25(OH)D平均水平为(27.44±14.90) nmol/L;11～20岁组血清25(OH)D平均水平为(13.86±8.51)nmol/L;21～30岁组血清25(OH)D平均水平为(15.40±13.41) nmol/L;31～40岁组血清25(OH)D平均水平为(17.57±12.31) nmol/L;41～50岁组血清25(OH)D平均水平为(13.01±8.08)nmol/L;51～60岁组血清25(OH)D平均水平为(14.31±9.20)nmol/L;61～70岁组血清25(OH)D平均水平为(14.94±9.33)nmol/L;70岁以上组血清25(OH)D平均水平为(14.32±9.58)nmol/L。不同年龄组相比较(完全随机方差分析one way ANOVA检验),差异有统计意义(F=152.67,P<0.01)。经独立样本t检验,不同性别间差异有统计意义(t=3.05,P=0.002),男性高于女性。结论大庆市部分居民普遍存在维生素D缺乏,女性维生素D水平低于男性。     

肌肉减少症研究进展

人口老龄化使得肌肉减少症(sarcopenia)（简称肌少症）的患病率逐年增加,流行病学调查显示该疾病会带来严重的致残率和致死率,受到国内外学者的诸多关注,对于肌少症的发病机制、危险因素、诊断评估以及治疗均有大量研究,但目前国内外对于该疾病的认识仍然存在差异。我国对于肌少症的研究尚处于探索阶段,肌少症作为脆性骨折的一个独立危险因素,及时诊治肌少症对降低骨折与跌倒风险具有重要意义,研究肌少症与骨质疏松症的相关性也是目前预防跌倒性骨折的重要研究方向。本文将从概述、流行病学、发病机制、诊断和治疗干预等方面对肌少症的新进展进行综述。     

Epinephrine and clonidine do not improve intrathecal sufentanil analgesia after total hip replacement

Background. We compared analgesia after intrathecal sufentanilalone, sufentanil with epinephrine 200 µg and sufentanilwith clonidine 30 µg in patients after total hip replacement,the endpoints being onset and duration of action. Methods. We performed a randomized double-blind study of 45patients for elective total hip arthroplasty using continuousspinal anaesthesia. As soon as a pain score higher than 3 ona 10 cm visual analogue scale was reported, sufentanil 7.5 µgalone, sufentanil 7.5 µg + epinephrine 200 µg orsufentanil 7.5 µg + clonidine 30 µg in 2 ml normalsaline was given intrathecally. Pain scores, rescue analgesia(diclofenac and morphine) and adverse effects (respiratory depression,postoperative nausea and vomiting, itching) were observed for24 h after surgery. Results. Time to a pain score of <3 [6 (SD 1) vs 6 (1) vs5 (1) min], time to the lowest pain score [7 (2) vs 8 (2) vs8 (2) min] and time to the first dose of systemic analgesicfor a pain score >3 [281 (36) vs 288 (23) vs 305 (30) min]were similar in all three groups. Adverse effects and analgesicrequirements during the first 24 h were also similar. Conclusion. After total hip replacement, all three analgesicregimens gave good analgesia with comparable onset and durationof action, and minor adverse effects. Br J Anaesth 2002; 89: 562–6     

Transient hyperaemic response to assess vascular reactivity of skin: effect of locally iontophoresed acetylcholine,bradykinin, epinephrine and phenylephrine

Background. Recently, the transient hyperaemic response (THR)to brief compression (20 s) of the brachial artery has beendescribed as a way to assess vascular reactivity of the forearmskin. We studied the effects of locally iontophoresed vasoactiveagents on this response in 20 male volunteers. Methods. An iontophoresis chamber attached to the anterior forearmpermitted simultaneous administration of drugs by iontophoresisand measurement of skin blood flow-flux by laser Doppler probe.Three THR tests were performed before and after iontophoresisby compressing the brachial artery with digital pressure for20 s and then releasing. The following were iontophoresed: saline0.9% (iontophoresis vehicle control), acetylcholine, bradykinin,epinephrine and phenylephrine. The THR ratio (THRR) was calculatedas F2/F1 where F1 was baseline blood flow-flux immediately beforecompression and F2 was peak blood flow-flux after release. Results. When compared with saline 0.9%, acetylcholine and bradykininincreased median F1 from 9.2 (range 5.2–23.8) to 22.1(8.7–61.5) and from 4.8 (3.0–23.2) to 15.0 (2.5–31.8),respectively, and reduced THRR from 1.26 (1.07–2.2) to0.99 (0.93–1.04) and from 1.63 (1.06–2.58) to 1.09(0.93–1.19), respectively. Epinephrine, but not phenylephrine,caused a significant reduction in F1 from 9.2 (5.2–23.8)to 4.0 (1.5–22.3). Neither epinephrine nor phenylephrinehad significant effect on THRR. Conclusions. Iontophoresed acetylcholine and bradykinin significantlyincrease the flow-flux and impair THR in forearm skin, furthervalidating the concept that THR represents true vasodilatationduring arterial occlusion. In addition, iontophoresis of vasoconstrictorsdoes not appear to have any consistent effect. Br J Anaesth 2003; 90: 446–51     

Selective effect of sufentanil on Group III (A delta) and Group IV (C) somatosympathetic reflexes

The effect of sufentanil on somatosympathetic reflexes and the subsequent reversal of its effects by naloxone have been observed in dogs anaesthetised with alpha-chloralose, paralysed with suxamethonium and artificially ventilated. When the drug was infused at a rate of 2.5 micrograms kg-1 min-1 the late long latency response evoked by Group IV (C) fibres was totally abolished at a mean dose of 6.40 micrograms kg-1 (+/- 0.99 microgram kg-1) (s.e. mean), while retaining a substantial part of the early short latency response evoked by group III (A delta) fibres; subsequently, during the infusion, this response was also totally abolished at a mean dose of 26.2 micrograms kg-1 (+/- 3.2 mg kg-1). The administration of naloxone (2 mg i.v.) completely reversed the effects of sufentanil within 3-5 min in different preparations. Some of the implications of these results are discussed.     

Bone mineralization defects and vitamin D deficiency: Histomorphometric analysis of iliac crest bone biopsies and circulating 25‐hydroxyvitamin D in 675 patients

Parathyroid hormone (PTH) is only one measurable index of skeletal health, and we reasoned that a histomorphometric analysis of iliac crest biopsies would be another and even more direct approach to assess bone health and address the required minimum 25‐Hydroxyvitamin D [25(OH)D] level. A cohort from the northern European population with its known high prevalence of vitamin D deficiency therefore would be ideal to answer the latter question. We examined 675 iliac crest biopsies from male and female individuals, excluding all patients who showed any signs of secondary bone diseases at autopsy. Structural histomorphometric parameters, including osteoid indices, were quantified using the Osteomeasure System according to ASBMR standards, and serum 25(OH)D levels were measured for all patients. Statistical analysis was performed by Student's t test. The histologic results demonstrate an unexpected high prevalence of mineralization defects, that is, a pathologic increase in osteoid. Indeed, 36.15% of the analyzed patients presented with an osteoid surface per bone surface (OS/BS) of more than 20%. Based on the most conservative threshold that defines osteomalacia at the histomorphometric level with a pathologic increase in osteoid volume per bone volume (OV/BV) greater than 2% manifest mineralization defects were present in 25.63% of the patients. The latter were found independent of bone volume per trabecular volume (BV/TV) throughout all ages and affected both sexes equally. While we could not establish a minimum 25(OH)D level that was inevitably associated with mineralization defects, we did not find pathologic accumulation of osteoid in any patient with circulating 25(OH)D above 75 nmol/L. Our data demonstrate that pathologic mineralization defects of bone occur in patients with a serum 25(OH)D below 75 nmol/L and strongly argue that in conjunction with a sufficient calcium intake, the dose of vitamin D supplementation should ensure that circulating levels of 25(OH)D reach this minimum threshold (75 nmol/L or 30 ng/mL) to maintain skeletal health. © 2010 American Society for Bone and Mineral Research     

Osteomalacia in Fractures of the Proximal Femur

The occurrence of osteomalacia was studied in 58 hip fracture patients who were admitted to the University Central Hospital of Kuopio for operative treatment. Findings indicating osteomalacia were frequent in the series. Hypocalcaemia was found in 70 per cent and an increase in serum alkaline phosphatase in 22 per cent of the patients. Urinary calcium excretion was decreased in 45 per cent and urinary hydroxyproline excretion was increased in 70 per cent of the cases. The serum levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D were significantly decreased in the patients compared with the controls. Histomorphometric analysis revealed no difference in the amount of trabecular bone in the patients compared with the controls, but the amount of osteoid and resorption surfaces was increased in the patients. Histological osteomalacia was found in 12 out of 50 patients (24 per cent). In 10 of these 12 cases the diagnosis of osteomalacia was supported by biochemical changes.

There was only one patient, a 29-year-old man with glutein enteropathy who had an evident reason for osteomalacia. The most obvious cause of osteomalacia was the lack of vitamin D due to a deficient diet and lack of exposure to sunlight. The conclusion drawn was that osteoporosis was the main cause and osteomalacia was an important aggravating factor in the bone fragility in these hip fracture patients.     

Osteomalacia in Fractures of the Proximal Femur

The occurrence of osteomalacia was studied in 58 hip fracture patients who were admitted to the University Central Hospital of Kuopio for operative treatment. Findings indicating osteomalacia were frequent in the series. Hypocalcaemia was found in 70 per cent and an increase in serum alkaline phosphatase in 22 per cent of the patients. Urinary calcium excretion was decreased in 45 per cent and urinary hydroxyproline excretion was increased in 70 per cent of the cases. The serum levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D were significantly decreased in the patients compared with the controls. Histomorphometric analysis revealed no difference in the amount of trabecular bone in the patients compared with the controls, but the amount of osteoid and resorption surfaces was increased in the patients. Histological osteomalacia was found in 12 out of 50 patients (24 per cent). In 10 of these 12 cases the diagnosis of osteomalacia was supported by biochemical changes.

There was only one patient, a 29-year-old man with glutein enteropathy who had an evident reason for osteomalacia. The most obvious cause of osteomalacia was the lack of vitamin D due to a deficient diet and lack of exposure to sunlight. The conclusion drawn was that osteoporosis was the main cause and osteomalacia was an important aggravating factor in the bone fragility in these hip fracture patients.     

Drugs affecting the autonomic nervous system

The autonomic nervous system (ANS) is a complex system of nervous and humoral mechanisms that modulates the function of the autonomous or visceral organs. Autonomic control of organs aims to maintain homoeostasis in health. Many drugs used in clinical practice can have either primary or secondary effects on the function of autonomic nervous system.