绝经后女性外周骨超声速率与PINP的相关性研究

目的 观察绝经后女性指骨、桡骨、胫骨超声速率(SOS)随年龄变化的规律及其与骨代谢指标血清Ⅰ型前胶原氨基端前肽(PINP)、骨钙素(BGP)和甲状旁腺激素(PTH)的关系.方法 入选绝经后女性84例(42～85岁),其骨代谢生化指标血清PINP和PTH采用酶联免疫法测定,BGP采用放射免疫法测定;应用sunlight omnisense 7000TM型超声骨量测定系统测量研究对象的SOS.结果 绝经后女性桡骨、指骨和胫骨SOS指标值随年龄段递增而下降,但只有桡骨SOS在各年龄段之间差异存在统计学意义(P＜0.05);PINP、BGP和PTH随年龄段递增有变化但(P＞0.05),且与各部位超声骨量SOS的直线相关分析及多元线性回归均无统计学意义.结论 绝经后女性桡骨SOS能够反映绝经后女性骨密度随年龄的衰减,可能是超声骨量测定反映绝经后女性骨量变化的最佳部位.     

骨复生对家兔激素性股骨头坏死血清中甲状旁腺素的影响

目的:探讨中药骨复生治疗激素性股骨头缺血坏死的机制。方法:32只日本大耳白兔被随机分为空白对照组(n=12),造模组(n=20)。造模组肌注醋酸泼尼松龙(0.32mg.kg-1.d-1)8周,分别在第6周、第8周处死每组动物2只。8周后将造模组剩余动物随机分为两组:骨复生组(A组)及造模组(B组)。原空白对照组剩余动物组成空白组(C组)。A组给予骨复生煎液灌胃,B组和C组均给予生理盐水灌胃。治疗4周后,采血应用放射免疫法(R IA)测定血清中甲状旁腺素(PTH)水平,同时观察。结果:模型组PTH水平较空白组轻度升高(P<0.05);骨复生治疗组血清中PTH的含量明显降低(P<0.01),且股骨头的病理切片上空骨陷窝数开始减少。结论:中药骨复生能降低血清中PTH,抑制破骨细胞的骨吸收作用,限制骨吸收陷窝的增加与扩大;增强成骨细胞功能,提高骨密度。故对激素性股骨头坏死有良好的治疗作用。从而促进坏死组织的修复。     

更年乐水丸对去卵巢大鼠骨质疏松症的早期干预作用

目的:探讨更年乐水丸治疗摘除卵巢所致雌性大鼠骨质疏松的作用机理。方法:选用55只3月龄SD雌性大鼠随机分为假手术组、模型对照组、阳性对照组、更年乐水丸低剂量组、更年乐水丸高剂量组。后4组摘除双侧卵巢,于造模后第2天开始中药灌胃,连续45 d,处死动物后,取动物左侧股骨,测定骨密度;测定血清E2、PTH、IL-6、Alp、Acp的水平。结果:更年乐水丸能增加大鼠骨密度及提高血清E2水平,降低Alp、Acp、PTH、IL-6含量。结论:更年乐水丸可改变绝经后早期骨代谢高转换状态。     

老年人血浆维生素K和D水平的季节变化

目的了解老年人群血浆维生素K和维生素D水平的季节变化。方法对85名健康老年人用放射免疫分析法测定春秋两季血浆维生素D(25(OH)D)和甲状旁腺素(PTH)含量,用高压液相色谱法测定血浆维生素K含量。结果血浆维生素K水平女性在春秋两季均明显高于男性,而男性和女性各自无季节性差异。无论男女秋季血浆维生素(25(OH)D)水平明显高于春季,同一季节内男女间差异无统计学意义。维生素D缺乏率女性春季为63.4%,秋季为7.3%。男性春季为65.9%,秋季无缺乏者。春季维生素D缺乏率显著高于秋季(P<0.05)。男女秋季血浆PTH浓度明显低于春季。老年女性春季血浆25(OH)D浓度和血浆PTH浓度之间呈负相关(r=-0.426,P<0.001)。结论该人群血浆25(OH)D和PTH有明显的季节变化,春季血浆25(OH)D水平低。而血浆维生素K没有季节变化。     

燃煤型氟骨症早期大鼠血清PTH、CT的变化

目的研究燃煤型氟骨症早期血清甲状旁腺激素(PTH)、降钙素(CT)的变化。方法将SD大鼠随机分为6组:对照、低氟、中氟加营养、中氟、高氟加营养、高氟组,每组34只,雌雄各半。各染毒组喂饲含不同比例的燃煤型病区煤烘玉米的饲料复制氟中毒动物模型。分2批以股动脉放血法处死动物,检查氟斑牙,测尿、骨、肾氟,骨密度(BMD),骨Ca、尿Ca,血清PTH、CT。结果(1)建成氟中毒动物模型:各染毒组均出现氟中毒,对照组正常。中毒严重程度随氟剂量增加而加重;氟剂量相同时,营养好,中毒程度轻。(2)燃煤型氟中毒对骨代谢相关激素的影响:高氟组血清PTH后期高于早期,差异有统计学意义(P<0.01)。说明染氟大鼠成骨活动增强,该指标变化较晚。血清CT各组早期无变化,后期低氟组和中营组升高,差异有统计学意义(P<0.05或0.01);低氟组高于高氟组,差异有统计学意义(P<0.05)。结论(1)骨转换活跃可能是燃煤型氟中毒骨病变发生发展的一个重要环节并且早期以成骨活跃为主;(2)尚不能认为血清PTH、CT是反映燃煤型氟骨症病情的早期指标;(3)降低摄氟量及改善营养状况,可缓解氟中毒病情。     

Calcium absorption and bone mineral density in celiacs after long term treatment with gluten-free diet and adequate calcium intake

Calcium malabsorption, hypocalcemia and skeletal demineralization are well-recognized features of untreated celiac disease. This study investigates calcium absorption and bone mineral density (BMD) after a prolonged, over 4 years, treatment with a gluten-free diet. Twenty-four adult females with treated celiac disease and twenty age- and sex-matched control subjects were studied. Mean body mass index (MBI), energy intake, serum calcium, and serum 25(OH)D concentrations in treated celiacs did not differ from controls. However, while both dietary calcium and protein intake were significantly higher in celiacs (P<0.012), fractional calcium absorption was lower (mean percentage±SD; treated 39.8±12 versus controls 52.3±10, P<0.001). Thus, after adjusting for calcium intake, the estimated amount of calcium absorbed daily was similar in both groups. Whole body, spine and trochanter BMD were significantly lower in treated celiac patients compared with controls (P<0.05). There were significant inverse correlations between: serum parathyroid hormone (PTH) and femoral neck or total body BMD (P<0.01), PTH and duration of gluten-free diet (P=0.05), and fractional calcium absorption and alkaline phosphatase (P=0.022). Increased calcium intake could potentially compensate for the reduced fractional calcium absorption in treated adult celiac patients, but may not normalize the BMD. In addition, the inverse correlation between PTH and time following treatment is suggestive of a continuing long-term benefit of gluten withdrawal on bone metabolism in celiac patients.     

Differences between ‘intact’ PTH and 1–84 PTH assays in chronic renal failure and dialysis

Intact parathyroid hormone (iPTH) assays overestimate actual PTH as they cross-react with non (1–84) PTH fragments (C-PTH) that accumulate in renal failure. New assays that measure just 1–84 PTH (CAP-PTH) are now available. It has been suggested that there is a linear relationship between the two assays; however, increased C-PTH levels are found as glomerular filtration rate (GFR) declines and in patients on dialysis. We investigated the relationship between iPTH and CAP-PTH in children with chronic renal failure (CRF) managed conservatively and on dialysis. We investigated 241 children, 156 with a GFR <60 ml/min per 1.73 m² managed conservatively, 49 post renal transplant (and GFR <60 ml/min per 1.73 m²) and 36 on dialysis, by measuring PTH levels by iPTH and CAP-PTH assays. Multiple regression analysis comparing differences between PTH levels in each patient group was performed. Correlation slopes between iPTH and CAP-PTH assays differed between CRF and dialysis patients (P=0.001). These assays perform differently in CRF and dialysis patient groups. Studies investigating the correlation between newer assays and bone histology are required to determine whether these more-specific PTH assays are superior surrogate markers of bone turnover.     

Calciphylaxis in pediatric end-stage renal disease

Calciphylaxis is a rare, but life-threatening complication of end-stage renal disease (ESRD) that has been reported mostly in adult patients. The exact etiology is unknown, but the disease is commonly associated with a high calcium-phosphorus product and elevated levels of parathyroid hormone (PTH). We herein review the published reports on calciphylaxis in ESRD patients less than 18 years old and report the case of a patient with severe calciphylaxis who presented with lower extremity pain, muscle tenderness and difficulty in walking. The serum PTH was low, and the calcium-phosphorus product was normal. The diagnosis of calciphylaxis was confirmed by a muscle biopsy. Treatment with low calcium peritoneal dialysate and substitution of calcium-based phosphorus binders with sevelamer (Renagel) was unsuccessful. The patients clinical condition progressed to extensive soft tissue calcification and ulcerating skin lesions. Nine months after the onset of symptoms, the patient died of cardiopulmonary arrest.