强直性脊柱炎患者骨密度的影响因素分析

目的:分析强直性脊柱炎（AS）患者腰椎和股骨颈骨密度（BMD）改变与年龄、性别、病程、髋关节病变及急性时相反应物之间的关联。方法:选取91例确诊AS患者,采用双能X线吸收法测定腰椎（L₂~L₄）、股骨颈BMD值,骨质疏松诊断标准用T值表示。结果:男性AS患者腰椎、股骨颈BMD均低于女性AS患者（P<0.05）。AS合并髋关节病变患者与无髋关节病变患者股骨颈BMD差异无统计学意义（P>0.05）。患者年龄与腰椎BMD T值呈负相关关系（P<0.05）,而患者病程、急性时相反应物与AS患者BMD均无相关关系（P>0.05）。结论:AS患者男性比女性更易发生骨量减少和骨质疏松,随着年龄的增加,腰椎骨质疏松发生增多。病程、髋关节病变以及急性时相反应物对AS患者BMD改变无显著影响。     

老年人髋部骨折与骨密度和跌倒的关系

目的探讨老年人髋部骨折与骨密度和跌倒的关系。方法 2012年5月至2014年4月均因平地跌倒而导致股骨颈部和粗隆间骨折入住我院骨科治疗的患者共41例,男性9例,女性32例,年龄61~91岁,平均(79±8)岁,所有患者均为初次骨折且第一次接受双能X线骨密度检查。使用美国GE Lunar公司生产的Prodigy型双能X线吸收法(DXA),进行骨密度测量,分别测量正位腰椎腰1至腰4(L1~4)及健侧股骨颈部骨密度(BMD)。根据所测骨密度值和T值(T-Score)评分进行回顾性总结。结果老年人平地跌倒后发生髋部骨折,虽然股骨颈部骨密度值低于腰椎骨密度,但二部位骨密度值比较,差异无统计学意义(t=0.842,P>0.05)。同样依据诊断骨质疏松的T值评分比较,股骨颈部T值评分低于腰椎T值评分,但二部位T值评分经统计学处理差异亦无统计学意义(t=1.893,P>0.05)。结论老年人腰椎和股骨颈部任一部位骨量低下跌倒后均易发生骨质疏松性髋部骨折,因此,预防老年人髋部骨折,临床医师不仅要重视提升骨密度,更应注重对老年人进行防止跌倒知识的宣传教育,有效预防老年人骨质疏松性髋部骨折的发生。     

2型糖尿病患者内脏脂肪与骨密度及骨折风险的相关性研究

背景肥胖与2型糖尿病关系密切,但2型糖尿病患者脂肪含量与骨密度及骨质疏松性骨折关系尚不十分明确。目的探究2型糖尿病患者内脏脂肪与骨密度及骨折风险的相关性。方法选取2019年7—12月在益阳市中心医院内分泌科住院的2型糖尿病患者202例。同期采用多阶段分层整群随机抽样的方法,抽取益阳市南县麻河口镇、南洲镇、乌嘴乡、茅草街镇非糖尿病者202例为对照,均于益阳市中心医院进行检查。使用双能X线检测腰椎、股骨颈、总髋骨密度;使用欧姆龙内脏脂肪检测仪测量皮下、内脏脂肪面积。采用骨折风险评估工具（FRAX问卷）评估未来10年主要部位及髋部骨质疏松性骨折风险。若为糖尿病人群,不纳入糖尿病作为骨质疏松风险因素所得结果用FRAX1表示;纳入糖尿病作为骨质疏松性骨折风险因素则将所得结果用FRAX2表示。结果2型糖尿病男性体质量、体质指数（BMI）高于非糖尿病男性,内脏脂肪面积、皮下脂肪面积大于非糖尿病男性,FRAX1（主要部位）低于非糖尿病男性（P<0.05）。2型糖尿病女性年龄、内脏脂肪面积大于非糖尿病女性,股骨颈骨密度、总髋骨密度低于非糖尿病女性,FRAX1（髋部）、FRAX2（主要部位）、FRAX2（髋部）高于非糖尿病女性（P<0.05）。校正年龄、体质量后,2型糖尿病女性总髋骨密度低于非糖尿病女性（P<0.05）。Pearson相关分析结果显示：在非糖尿病人群中,男性及绝经后女性内脏脂肪面积与体质量、BMI、皮下脂肪面积、腰椎骨密度、股骨颈骨密度、总髋骨密度均呈正相关（P<0.05）,女性内脏脂肪面积与体质量、BMI、皮下脂肪面积、总髋骨密度呈正相关（P<0.05）。在2型糖尿病患者中,男性内脏脂肪面积与体质量、BMI、皮下脂肪面积、腰椎骨密度、总髋骨密度均呈正相关（P<0.05）,女性、绝经后女性内脏脂肪面积与体质量、BMI、皮下脂肪面积、总髋骨密度呈正相关（P<0.05）。偏相关分析结果显示：校正年龄、体质量后,在2型糖尿病患者中,女性内脏脂肪面积与股骨颈骨密度、总髋骨密度呈负相关（P<0.05）,绝经后女性内脏脂肪面积与股骨颈骨密度呈负相关,与FRAX1（髋部）、FRAX2（髋部）呈正相关（P<0.05）。结论2型糖尿病患者较非糖尿病人群有较高的体质量、BMI及内脏脂肪面积。2型糖尿病女性患者股骨颈骨密度及髋部骨密度较低,其未来10年髋部骨质疏松性骨折风险较高。2型糖尿病女性患者内脏脂肪面积与股骨颈骨密度及总髋骨密度呈负相关,且随着内脏脂肪面积增加绝经后女性未来10年髋部骨质疏松性骨折风险增加。     

绝经后女性腰椎骨密度影响因素的研究

目的分析绝经后女性腰椎骨密度的相关影响因素,提高对绝经后女性骨质疏松症的预防,减少骨质疏松症的发生。方法随机抽取2012年1¹2月在武汉大学人民医院进行骨密度测量(采用美国生产的DEXA双能X线骨密度测量仪)的绝经后女性251例。测量记录251例自然绝经女性的年龄、绝经年龄、身高、体质量、第112月在武汉大学人民医院进行骨密度测量(采用美国生产的DEXA双能X线骨密度测量仪)的绝经后女性251例。测量记录251例自然绝经女性的年龄、绝经年龄、身高、体质量、第1⁴腰椎骨密度T值平均值,分析绝经后女性腰椎骨密度的相关影响因素。结果多元逐步回归分析结果显示:体质量和绝经年限为影响绝经后女性腰椎骨密度的主要因素(P<0.05)。绝经后14腰椎骨密度T值平均值,分析绝经后女性腰椎骨密度的相关影响因素。结果多元逐步回归分析结果显示:体质量和绝经年限为影响绝经后女性腰椎骨密度的主要因素(P<0.05)。绝经后1¹0年与绝经后10年以上腰椎骨密度T值比较差异均有统计学意义,绝经10年以后腰椎骨密度明显下降(P<0.05)。不同体质量组腰椎骨密度T值比较差异均有统计学意义(P<0.05),其中低体质量组最低,超体质量组最高,正常体质量组居中。结论女性绝经越早,绝经时间越长,体质量越低,绝经后的腰椎骨密度越低。体质量是腰椎骨密度的保护因素,绝经后女性保持适当的体质量有助于减少骨质疏松症的发生。     

股骨颈上部区域与腰椎及双侧股骨上端骨密度的相关性研究

目的:测量正常人群股骨颈上部1/2骨密度(Bonemineraldensity,BMD)值,分析其各性别年龄组BMD值的分布规律,并与腰椎、双侧股骨上端测量值进行对比分析。方法:通过双能X线吸收法(DualenergyX-rayabsorp-tiometry,DXA)测量285例正常汉族人群的正位腰椎(L2~L4)、双侧股骨近端以及股骨颈中段上部1/2的骨密度BMD值,统计出各年龄组BMD值,比较股骨颈上部1/2区域与传统的测量部位相关性差异。结果:股骨颈上部区域BMD峰值男、女均出现在21岁~29岁年龄组,女性55岁、男性70岁以后BMD值随年龄的增加而显著下降。结论:股骨颈上部区域与腰椎正位、双侧股骨近端的BMD值有良好的相关性,及良好的年龄相关性,股骨颈上部区域BMD的测量研究,是对OP筛查的新的敏感方法的有益探索。     

自然绝经后女性血清促甲状腺激素水平与骨密度的相关性

目的探讨女性自然绝经后血清促甲状腺激素(TSH)、T3、T4水平与骨密度的相关性。方法共选取149名45-72岁自然绝经2年以上的妇女,均由同一医师使用双能X射线吸收测定法(DEXA)同时扫描腰椎(腰1-腰4椎体)和股骨颈、Wards三角大粗隆、大粗隆进行标准BMD扫描。参与者按骨密度T值分为正常组(T–值≧-1.0)、骨量降低组(-2.5T–值-1.0)、骨质疏松组(T–值≦-2.5);比较各组间不同血清促甲状腺激素(TSH)、T3、T4。结果通过对正常组、骨量降低组、骨质疏松组所得数据的分析,发现在女性自然绝经后,血清TSH与骨密度有关,血清TSH较低的患者BMD低的风险较高;而血清TSH较高的患者BMD高,且体重和骨密度也存在一定的相关性,同等年龄间断的自然绝经后女性,体重较低的患者BMD低的可能性更大。结论自然绝经后女性,尤其是体重相对较低的、血清TSH值较低的,更可能是我们提前预防骨质疏松的早期指标的一部分。     

年龄、体质量及体质量指数对中老年女性骨密度的影响

目的探讨年龄、体质量及体质量指数对中老年妇女骨密度的影响。方法统计2000年1月至2003年12月间,在广东省人民医院骨质疏松防治中心就医的277例中老年妇女各年龄组骨密度值及骨质疏松的发病情况,分析年龄、体质量及体质量指数与骨密度的关系。结果中老年妇女的腰椎正位、腰椎侧位、股骨颈、股骨大转子和Ward’s三角的骨密度与年龄呈负相关(P<0.01),与身高及体质量呈正相关(P<0.01或P<0.05),而与体质量指数无相关性。骨质疏松的发生率随年龄升高逐渐增加。相对于低体质量组妇女(体质量指数<19),超体质量组(体质量指数>25)的腰椎、大转子及Ward’s区骨密度值明显升高(P<0.05)。结论高龄、低身高及低体质量是影响中老年妇女骨密度的重要因素,是中老年妇女患骨质疏松的易感指标。     

重庆市2805例健康女性DXA法骨密度现况分析

目的：通过测量重庆市2 805人次健康女性骨密度,初步建立重庆地区各年龄段骨密度数据库及骨峰值,并探讨年龄、体质量指数对骨密度变化的影响。方法：选取2011年6月至2015年11月在重庆市妇幼保健院体检的健康女性,采用双能X线骨密度仪测量腰椎1~4和股骨颈骨密度。结果：2 805例健康女性骨质疏松症发生率为11.44%;随着年龄增长,骨质疏松症比例增加（趋势卡方检验： χ2=403.800,P=0.000）;50岁以上骨质疏松症发生率为26.04%,50岁前后的正常骨量和骨质疏松症比例均有统计学差异（P=0.000）;35~39岁达到腰椎1~4骨密度峰值（1.116±0.120） g/cm2,17~19岁达到股骨颈骨密度峰值（0.935±0.146） g/cm2。结论：本研究建立了重庆市经DXA法测量腰椎及股骨颈骨密度的大数据。     

CT定量评价2型糖尿病患者腰椎骨密度及影响因素

目的调查研究2型糖尿病患者腰椎骨密度以及影响因素。方法以2012-2014年入住我院的76例2型糖尿病患者以及76例健康体检人员为研究对象,且以2型糖尿病患者为观察组,健康体检人员为对照组,比较两组实验对象在不同年龄、性别、病程、绝经时间等的骨密度以及骨质疏松发病率情况。结果两组受试人员各年龄段骨密度值以及骨质疏松的发病率无明显差异(P0.05);2型糖尿病患者腰椎骨密度各病程之间无明显差异(P0.05)。2型糖尿病患者的腰椎骨密度与年龄呈负相关,与体质量指数呈正相关。将年龄作为控制因子,女性2型糖尿病患者腰椎骨密度与绝经年限负相关(r=-0.22,P0.05),与绝经年龄无相关性。结论2型糖尿病患者随着年龄的增长其腰椎的骨密度下降,骨质疏松发病率增加,但还是和正常人群相仿。而对于女性患者来说随着绝经年限的延长,其腰椎的骨密度下降趋势明显。     

茂名地区绝经后女性骨密度调查及不同部位检出率研究

目的:调查分析茂名地区绝经后女性骨密度情况及骨质疏松发病率,同时确定DXA法测量不同部位诊断骨质疏松的检出率。方法:回顾性分析2015年4月-2016年6月于本院行骨密度检查的1884例患者临床资料,严格按照纳入排除标准进行筛选后纳入绝经后女性591例。比较绝经后女性各部位骨密度的不同及各部位骨密度与年龄、绝经年限的关系,同时计算不同部位骨密度对骨质疏松诊断的检出率。结果:随着年龄和绝经年限的增长,绝经后女性各部位骨密度值均呈下降趋势,骨质疏松发病率呈上升趋势。纳入研究的绝经后女性骨质疏松总患病率为62.6%,其中腰椎患病率为50.3%,髋部患病率为51.3%。各年龄段及绝经年限组,腰2~4骨密度值明显高于髋部各部位骨密度值,差异均有统计学意义(P0.05)。单独检测髋部骨密度,其骨质疏松检出率为81.9%;单独检测腰椎骨密度,其骨质疏松检出率为80.3%。结论:茂名地区绝经后女性腰椎骨密度高于髋部骨密度,随着年龄和绝经年限增长,各部位骨密度均下降,骨质疏松发病率升高,腰椎与髋部骨密度扫描诊断骨质疏松的检出率分别为80.3%和81.9%。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.