骨质疏松症

原发性骨质疏松症的本质是骨组织的退化。造成这种退化的原因，一方面与增龄相关的机体自然衰老过程有关，另一方面与后天的生长、发育、营养、运动、疾病、生活习惯，以及生存环境等因素有关。     

废用性骨质疏松症的诊断分型与相关因素探讨

目的 研究废用性骨质疏松的诊断分型及其影响因素。方法 采用DEXA测定36例肱骨、股骨和胫骨骨折不愈合患者患肢与健肢3个部位的BMD值,测量部位位于患骨的上下干骺端及骨折远或近端5cm处,并进行统计学的分析比较,确定其诊断分类和讨论相关的影响因素。结果 患侧和健侧测定值,经统计学分析比较,有极显著差异P<0.01,按中国骨质疏松委员会制定的标准,废用性骨质疏松可分为骨量减少和骨质疏松两大类,分别占36.1％和41.7％,总计77.8％。并按年龄、性别、骨折不愈合类型和有无合并感染进行分析比较,结果仅合并感染者可加重骨质疏松,感染与无感染两组病例相比,P<0.05。结论 采用DEXA测定BMD值的方法,按骨量丢失的轻重程度进行诊断分类,可靠性强,临床应用价值大。感染是加重废用性骨质疏松的相关因素。     

护骨素在糖皮质激素性骨质疏松症诊断中的应用

糖皮质激素（glucocorticoid，GC）由于具有抗炎、抗毒素及抑制免疫等作用，而被广泛应用于临床。医生对其诸多不良反应虽早已熟知，但对于其诱发骨质疏松症（osteoporosis，OP）的问题却常常忽略，实际上糖皮质激素性骨质疏松症的发病率仅次于绝经后及老年性骨质疏松症而居第三位。服用糖皮质激素6个月以上的患，几乎50％都发生骨质疏松性变化，而高剂量糖皮质激素（〉10mg／d泼尼松）则使所有患都丢失相当大的骨量。糖皮质激素引起的骨量丢失是对钙动态平衡不利影响的多种因素作用的结果。     

μCT研究药物对骨结构的影响

以往人们一直都以增加骨密度或骨量作为对骨质疏松症疗效的主要衡量指针。20世纪80年代临床骨质评定的最终指针主要是骨质密度。对药物治疗效果的评价亦以骨密度为准,即遵循治疗期短,骨密度升高显著,则治疗效果好的原则。后来在对氟化物的研究中发现,氟化制剂能使骨密度显     

骨质量与骨量

骨强度同时反映骨量与骨质量的完整性。骨强度由骨材料、构筑、力学性能及骨量共同构成。骨质量能解释一些单纯用骨量或骨密度（BMD）不能解释的问题，诸如在正常BMD仍发生骨折；给予抗骨吸收制剂后，虽只有小的面积骨密度（aB—MD）变化也能减少骨折风险；应用氟化物虽能增加脊柱BMD，但并不能减少脊柱骨折风险；骨折风险早在BMD最大变化之前即可出现等。     

骨质疏松症的影像学诊断进展

骨质疏松症是一种最常见的骨代谢性疾病，以单位体积内骨量减少及骨组织微结构改变为特征，表现为骨的强度减弱，脆性增加，患者易发生骨折。目前该病的发病率、致残率、病死率日益提高，因此，越来越受到医学界的重视。影像检查作为骨质疏松症诊断的重要手段之一，其发展日新月异。现着重叙述骨质疏松症的各种影像学诊断方法的应用、优缺点及最新进展。     

SPA跟骨BMD检测判断绝经后脊柱骨质疏松症的价值

目的 探讨绝经后女性脊柱骨质疏松症的发病率，了解跟骨骨密度(bone mineral density，BMD)变化与脊柱骨质疏松症的相关性，分析跟骨骨量检测在判断脊柱骨折疏松症中的价值。方法 选择门诊，单纯性腰背疼痛、无外伤史、胸腰椎x线影像学显示有典型脊柱骨质疏松的绝经女性患者48例，年龄为29-84岁采用HK-I单光子骨密度仪(SPA)检测其跟骨的骨矿密度和骨量。结果 跟骨骨量112.82-486.42mg/cm^2，平均272.69mg/cm^2。其中，跟骨骨质疏松30例，平均骨量为201.85mg/cm^2；低骨量9例，平均273.13mg/cm^2；正常骨量9例，平均401.77mg/cm^2。与X线影像学相比较，脊柱骨质疏松的符合率为62.5％，大致符合率18.8％，有效符合率81.3％，不符合率18.8％。结论 SPA跟骨BMD仅可作为拟诊脊柱骨质疏松症的参考指标，临床参考价值为62.50％，其符合率与年龄递增相关。故诊断尚不能完全依赖跟骨密度检测参数，尤其75岁以下女性患者，仍需X线影像学的支持。非体力劳动者发病率相对较高，女性非体力劳动者尤其应注意预防。     

骨质疏松性骨折的新认识

骨质疏松症防治的根本目的在于降低人群中骨折的发病率。这种防治要根据骨密度(BMD)、骨转换生化指标,以及一系列骨质量测量指标的了解而进行。那么“为什么骨折会发生?如何发生?谁是骨折最危险的人?临床治疗能否降低骨折危险?”等,都是近些年来讨论的热点问题。     

PTH治疗骨质疏松症的研究进展

甲状旁腺素(PTH)是由甲状旁腺分泌的含84个氨基酸的单链多肽蛋白质，它是调节钙、磷代谢及骨转换的最为重要的肽类激素之一。传统认为PTH是刺激骨分解的骨代谢调节激素。它直接作用于骨和肾，靶细胞为成骨细胞及肾小管细胞，促进骨钙动员和肾对钙的重吸收，通过促进1-α羟     

骨疏康冲剂与钙剂联合应用治疗绝经后骨质疏松症的临床研究

目的 观察骨疏康冲剂与钙剂联合应用治疗绝经后骨质疏松症的效果。方法 对年龄为50～75岁、绝经5～30年确诊为骨质疏松症的妇女62例,随机分为骨疏康冲剂加钙剂联合用药组和单用骨疏康冲剂组和单用钙剂组。分别于治疗前、治疗后3个月和6个月观察患者临床症状,用DEXA监测髋部骨密度,测定血清碱性磷酸酶(ALP)、血钙、血磷。结果 骨疏康冲剂加钙剂联合用药组服药后6个月,临床症状改善明显优于单用骨疏康冲剂组(P<0.01),其骨密度也高于单用骨疏康冲剂组(P<0.05),但骨代谢指标各组间无显著差异(P>0.05)。结论 骨疏康冲剂与钙剂联合应用治疗绝经后骨质疏松症较单用骨疏康冲剂有着较好的疗效。     

IVIg to prevent tumor metastases (Review)

Intravenous gamma globulin (IVIg) is produced from a pool of precipitated IgG from over 3,000 healthy donors. IVIg was originally given to subjects with Igs deficiencies. Later on its beneficial effects on a diverse autoimmune clinical conditions were revealed. Based on large experimental studies in mice as well as limited clinical experience, we consider IVIg useful in preventing metastatic spread. In mice, the employment of IVIg reduced significantly metastatic spread of melanoma, carcinoma and sarcoma. The effect of IVIg was achieved following i.v. or s.c. administration at high dose (2 g/kg body weight) and at 100 times lower doses. The effect of IVIg on the prevention of metastases are diverse and achieved via enhancement of IL-12 secretion and increased NK activity as well as inhibition of matrix metalloproteinase-9 (MMP-9). The lack of serious side effects with the remarkable decrease in metastatic spread make IVIg a suitable adjuvant therapy in early and advanced cancer conditions.     

Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy

BACKGROUND: Androgen deprivation therapy (ADT) is a strong risk factor for osteoporosis. The current study identified physician practices in preventing or treating osteoporosis during ADT. The practices of interest are the uses of dual-energy X-ray absorptiometry (DXA) scans, bisphosphonates, calcium or vitamin D supplement, calcitonin, or estrogen. METHODS: A retrospective medical record review was conducted. Patients were included if they had received ADT with goserelin injection for >/= 1 year. Multivariable logistic regression analysis was performed to identify independent predictors of receiving at least one intervention. RESULTS: Analyses included 184 patients. Most were the elderly with multiple risk factors for osteoporosis. Only 8.7% (95% confidence interval [CI], 4.6-13.0%) of patients received a DXA scan at least once during the past 3 years. Oral and intravenous bisphosphonates were prescribed in 4.9% (95%CI, 1.8-8.0%) and 0.5% (95%CI, 0-2.0%) of patients, respectively, during the past year. Overall, 14.7% of patients (95%CI, 9.5-20.0%) received at least one intervention. Concurrent risk factors for osteoporosis, including smoking, alcoholism, advanced age, low body mass index, long duration of ADT, multiple comorbidities, history of fractures, and steroid use, were not independent predictors of having received interventions. However, bone metastasis was, with a hazard ratio of 5.6 (95%CI, 1.99-15.6%). Primary care physicians provided the greatest number of interventions and cancer-related specialists provided the fewest. CONCLUSIONS: The majority of patients with prostate carcinoma undergoing ADT did not receive interventions to prevent or treat osteoporosis. Having other concurrent risk factors for osteoporosis was not predictive of receiving these few interventions.     

Novel therapies targeting hypoxia mechanism to treat pancreatic cancer

Pancreatic cancer (PC) is one of the deadliest malignancies. The high mortality rate of PC largely results from delayed diagnosis and early metastasis. Therefore, identifying novel treatment targets for patients with PC is urgently required to improve survival rates. A major barrier to successful treatment of PC is the presence of a hypoxic tumor microenvironment, which is associated with poor prognosis, treatment resistance, increased invasion and metastasis. Recent studies have identified a number of novel molecules and pathways in PC cells that promote cancer cells progression under hypoxic conditions, which may provide new therapy strategies to inhibit the development and metastasis of PC. This review summarizes the latest research of hypoxia in PC and provides an overview of how the current therapies have the capacity to overcome hypoxia and improve PC patient treatment. These findings will eventually provide guidance for future PC management and clinical trials and hopefully improve the survival of patients with PC.     

马鞭草防治放射性口腔炎的临床观察

目的：研究马鞭草对放射性口腔炎的预防与治疗作用.方法：将102例头颈部肿瘤放射治疗患者用计算机随机平均分为观察组和对照组.对观察组进行放射治疗并给其含服马鞭草煎剂;对照组放疗并含服生理盐水.每组患者从放疗疗程起,在第2周末、第4周末、第6周末、第8周末时评价口腔黏膜情况.结果：全部患者均出现不同程度的放射性口腔黏膜炎,放疗开始至第2周末两组发生放射性口腔黏膜炎的分级比较无统计学差异（P＞0.05）,放疗第4周末、第6周末、第8周末,两组比较有显著性差异（P＜0.05）,但实验组患者口腔黏膜的损伤程度明显低于对照组.结论：马鞭草煎水含服可以延缓放疗口腔黏膜反应发生的时间,改善患者临床症状,提高生活质量,防治鼻咽癌引起的放射性口腔黏膜炎安全有效,值得临床推广应用.     

Targeted molecular therapies for ovarian cancer: an update and future perspectives (Review)

Identification of the potential gene expression profiles of epithelial ovarian cancer and the arrival of newly targeted therapies have advanced the strategies used for treatment of this disease. This review focuses on the design of ongoing and planned clinical trials and offers a synopsis of the English-language literature for preclinical and clinical targeted therapies for epithelial ovarian cancer. Among many targeted agents, a promising, novel class of targeted drugs for special patient populations expected to improve the effectiveness of current therapy include inhibitors of angiogenesis, poly (ADP ribose) polymerase (PARP) and DNA repair mechanisms. Inhibition of PARP or homologous recombination (HR) repair mediated by Chk1 (checkpoint kinase?1) would selectively sensitize p53 mutation, BRCAness phenotype (serous type ovarian cancer) or HNF (hepatocyte nuclear factor)-1β-overexpressing tumor cells (clear cell type ovarian cancer) to chemotherapeutic agents. The therapeutic response is likely to be limited to a targeted patient, but not to the broad population. This review discusses some of the key current developments and existing challenges.     

云南白药合剂防治放射性食管炎的临床观察

目的探讨减轻胸部肿瘤患者放射治疗所致的食管黏膜反应、进食梗阻等副反应的防治方法,保证放射治疗的顺利进行.方法将120例颈胸部肿瘤需行放射治疗的患者随机分为3组,试验1组从放疗开始即口服云南白药合剂,试验2组于放疗过程中出现放射性食管炎时口服云南白药合剂,对照组于放疗过程中出现放射性食管炎时口服利氟庆合剂.结果试验1组与试验2组、对照组比较,放射性食管炎发生率明显减少,说明云南白药合剂对放射性食管炎有显著的治疗作用.结论云南白药合剂能促进食管黏膜组织的再生修复,服用方便,经济实用,药疗与食疗结合,能增加营养,提高机体免疫力,安全无任何不良影响,防治放射性食管炎效果显著,可协助患者顺利完成放疗疗程.     

芦荟多糖防治皮肤放射反应的临床研究

为了总结芦荟多糖(AP)对皮肤放射防护效果,回顾性分析2007-08-01—2008-08-01我院放疗的初治鼻咽癌(NPC)患者185例,用AP油膏2 mg/mL作为皮肤放射保护剂,从放疗开始至结束予左颈照射野涂抹防护剂,右颈照射野不涂防护剂(空白)对照观察皮肤放射反应.全部患者鼻咽及颈部照射野采用直线加速器8 MVX射线照射,辅以电子线照射颈后三角区.颈预防量Dr 50 Gy/25次,根治量60～64 Gy/30～32次.鼻咽68～72 Gy/34～36次,5次/周.皮肤反应采用RTOG皮肤急性放射损伤分级标准评级.185例患者全部按计划完成放疗,用药组与对照组出现皮肤Ⅰ级放射反应分别为58.9％和71.4％,Ⅱ级分别为37.8％和25.9％,Ⅲ级分别为3.2％和2.7％,x2=6.388,P=0.041；用药组与对照组出现皮肤Ⅰ级放射反应中位剂量分别为30和36 Gy,Ⅱ级分别为50和54 Gy,Ⅲ级分别为58和58 Gy,x2 =0.350,P=0.839.初步研究结果提示,临床试用该药剂后Ⅱ级、Ⅲ级皮肤反应较高,提示该制剂对皮肤急性放射损伤无保护效果,须予以剂量或剂型改进.