不同血液净化方式对维持性血液透析患者矿物质及骨代谢异常的治疗效果

目的探讨3种血液净化方式联合骨化三醇注射液治疗尿毒症血液透析患者矿物质及骨代谢异常的差异。方法 60例维持性血液透析(MHD)患者,随机分为血液透析(HD)组、血液透析滤过(HDF)组、血液透析+血液灌流(HD+HP)组,每组患者20例,所有患者均使用骨化三醇注射液治疗,测定入选时及随访1个月和6个月后血钙、血磷、血甲状旁腺素(iPTH)。结果治疗前3组患者血清钙、磷、iPTH水平差异无统计学意义(P0.05)。治疗1个月及6个月后,患者血钙、血磷水平,3组间两两比较差异无统计学意义(P0.05)。3组患者血iPTH下降。HD组iPTH水平治疗1个月与治疗前比较差异无统计学意义(P0.05);治疗6个月与治疗前及治疗1个月比较,差异有统计学意义(P0.05)。HDF组和HD+HP组iPTH水平治疗1个月、6个月与治疗前比较明显下降,差异有统计学意义(P0.05)。HD+HP组iPTH水平治疗6个月和治疗1个月比较,差异有统计学意义(P0.05)。治疗6个月时,iPTH水平HD+HP组与HD组、HDF组比较,差异有统计学意义(P0.05)。结论对并发矿物质及骨代谢异常的维持性血液透析患者而言,血液透析滤过及血液透析+血液灌流联合骨化三醇注射液治疗更可有效控制矿物质及骨代谢异常,血液透析+血液灌流可以显著降低血iPTH和改善患者临床症状。     

六种血液净化单次治疗对尿毒症患者血磷和血甲状旁腺激素清除的比较

目的 探讨6种不同血液净化方法对尿毒症患者血磷及甲状旁腺激素(parathyroid hormone,PTH)的清除效果.方法 选取在我院维持性血液透析血磷的患者200例并采用数字表法随机分为6组:血液透析联合血液灌流(HD+ HP130)组、HD+ HP230组、血液透析滤过(HDF)组、血液透析(HD)组、床旁血液滤过(CVVH)组和高通量血液透析(HFHD)组.比较6组血液净化单次治疗前后血磷及血PTH清除率.结果 HD组治疗后血PTH值下降,但差异无统计学意义(P＞0.05);血磷治疗后下降且差异有统计学意义(P＜0.05).HDF组和HFHD组治疗后血PTH值及血磷值均下降,差异有统计学意义(P＜0.05).CVVH组治疗后血PTH下降明显,差异有统计学意义(P＜0.01),HD+ HP130和HD+ HP230组治疗后血PTH下降,差异有统计学意义(P＜0.05),且均显著高于HDF组(P＜0.05)和HFHD组,血磷值下降且差异有统计学意义(P＜0.05).结论 血液透析联合血液灌流、床旁血液滤过、高通量血液透析及血液透析滤过均能有效清除血磷及PTH,清除效果依次为CVVH组＞HD+ HP230组＞HD+ HP130组＞HDF组＞HFHD组.血液透析可以有效清除血磷但不能有效清除PTH.     

组合型人工肾对维持性血液透析患者矿物质代谢的影响

目的探讨组合型人工肾技术对维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢的影响。方法选择2012年1月至2013年8月在新乡市血液净化中心行MHD治疗3个月或以上的患者110例。按照随机数字表法将110例患者分为常规血液透析(hemodialysis,HD)组55例和组合型人工肾组55例。HD组患者每周行3次血液透析治疗,而组合型人工肾组患者每周行2次常规HD治疗加1次组合型人工肾治疗[将HD管路与血液灌流(hemoperfusion,HP)管路串联,选用透析模式,2 h后用盐水将灌流器及管路的血冲洗干净后迅速撤掉,再继续进行2 h的HD]。监测治疗前和治疗3个月后MHD患者外周血中血钙、血磷、血全段甲状旁腺素(intact parathyroid hormone,iPTH)及碱性磷酸酶(alkaline phosphatase,ALP)等矿物质代谢的评估指标。结果2组患者治疗前血钙、血磷、iPTH及ALP水平比较,差异无统计学意义(均P0.05)。治疗3个月后,HD组血钙、iPTH和血ALP与治疗前比较,差异无统计学意义(均P0.05);而血磷低于治疗前水平,差异有统计学意义(P0.05)。组合型人工肾组治疗后血磷、iPTH和血ALP较治疗前均明显下降(P均0.01),血钙明显上升(P0.05)。2组治疗后比较,组合型人工肾组的血钙水平较HD组明显升高(P0.05),ALP明显降低(P0.05),而血磷、iPTH明显降低(P0.01)。结论与常规血液透析比较,组合型人工肾治疗能有效清除血磷,降低血iPTH和ALP,升高血钙水平,从而改善MHD患者的矿物质代谢异常。     

不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病指标的影响及意义

目的 通过观察不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病指标的影响,探讨肾性骨病合适的治疗方案.方法 将60例符合标准的患者按随机数字表法分为3组,每组20例.所有患者采用骨化三醇冲击治疗,使用低钙透析液.普通透析组患者采用常规透析,血液透析滤过组患者采用血液透析滤过治疗,每周透析3次,其中血液透析滤过治疗每周1次.血液透析灌流组患者采用血液透析联合血液灌流治疗,每周透析3次,其中血液透析联合血液灌流治疗每周1次.结果 3组患者使用不同透析方式联合药物治疗3个月后发现,治疗前3组患者血钙、血磷、血甲状旁腺激素水平比较差异无统计学意义(P＞0.05),治疗后1个月血液透析灌流组患者血磷与普通透析组患者比较差异有统计学意义(P＜0.05),而血液透析滤过组患者的血磷与普通透析组比较差异无统计学意义(P＞0.05);治疗后3个月血液透析滤过组和血液透析组患者的血甲状旁腺激素、血磷、血钙水平与普通透析组比较差异也有统计学意义(P＜0.05),而血液透析滤过组和血液透析灌流组间血甲状旁腺激素、血磷、血钙水平比较差异无统计学意义(P＞0.05).结论 对于维持性血液透析的患者存在高磷血症以及继发性甲状旁腺激素的升高等肾性骨病的指标异常,可以应用血液透析滤过以及血液透析联合血液灌流治疗,且安全可行.     

碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常患者钙磷代谢的影响

目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P0.05);3组血磷及钙磷乘积较治疗前明显下降(P0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P0.05)。HD组门H在治疗前、后变化不大(P0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。     

血液透析滤过对维持性血液透析患者睡眠及生活质量影响的观察

目的观察血液透析滤过(hemodiafiltration,HDF)对维持性血液透析(maintenance hemodialysis,MHD)患者睡眠质量及生活质量的影响。方法选择MHD患者70例,分为常规血液透析治疗组(HD组)和On-line HDF治疗组(HDF组),每组各35例。HD组患者均调整为每周行3次血液透析治疗,HDF组患者每周行2次常规血液透析治疗,1次HDF,时间均为4 h。比较两组治疗前后匹兹堡睡眠质量指数量表(PSQI)、健康状况调查表(SF-36)改善情况。结果两组患者治疗后睡眠质量总评分、健康状况调查表分值较治疗前均有明显改善,其中HDF组患者入睡时间、睡眠时间、睡眠效率及PSQI总分值改善优于HD组治疗后(P0.05);肢体疼痛(BP)、总体健康(GH)、精力(VT)、情感职能(RE)及心理健康(MH)分值显著低于HD组治疗后(P0.05)。结论 HDF可更好的改善MHD患者的睡眠质量及生活质量。     

不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病的治疗效果

目的 观察不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病的疗效,探讨治疗肾性骨病的最佳方案.方法 将45例符合标准的患者按数字表法随机分为3组,每组15例.普通透析组接受血液透析治疗;血液透析滤过组接受血液透析滤过治疗,每2周1次;血液透析灌流组接受血液透析联合血液灌流治疗,每2周1次.所有患者均使用骨化三醇冲击治疗.检测治疗0、1、3个月血清钙、磷、甲状旁腺素水平.结果 治疗前3组患者血清钙、磷、甲状旁腺素水平差异无统计学意义(P＞0.05).治疗1个月及3个月后,血液透析组患者血钙、血磷下降水平,三组间两两比较差异无统计学意义(P＞0.05).血液透析组甲状旁腺素水平治疗1个月及3个月与治疗前比较差异无统计学意义(P＞0.05);治疗3个月与治疗前及治疗1个月比较差异有统计学意义(P＜0.05).血液透析滤过组和血液透析灌流组甲状旁腺素水平治疗1个月、3个月与治疗前比较明显下降,差异有统计学意义(P＜0.05),治疗3个月与治疗1个月比较,差异有统计学意义(P＜0.05).血液透析灌流组甲状旁腺素水平治疗3个月和治疗1个月比较,差异无统计学意义(P＞0.05).治疗3个月时,甲状旁腺素水平血液透析滤过组与血液透析灌流组比较差异有统计学意义(P＜0.05).结论 对维持性血液透析肾性骨病的患者而言,血液透析滤过及血液透析灌流联合骨化三醇冲击治疗可以有效控制肾性骨病.     

老年尿毒症患者血液透析滤过临床疗效观察

目的探讨血液透析滤过(hemodiafiltration,HDF)对老年尿毒症患者不同分子量物质的清除率、患者耐受性及临床疗效。方法选择38例行维持性血液透析(maintenance hemodialysis,MHD)的老年尿毒症患者,依经济状况随机分为HDF组和血液透析(hemodialysis,HD)组。HDF组行前稀释HDF 1次/周,HD 2次/周;HD组患者行HD 3次/周。2组HD方案一样,且观察时间均为3个月;观察2组尿素清除指数(Kt/V)、血清肌酐(SCr)、尿素氮(BUN)、血尿酸(uric acid,UA)、β2-微球蛋白(β2-microglobulin,β2-MG)、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血钾、血钙、血磷、二氧化碳结合力(carbon dioxide combining power,CO_2-CP)下降率及治疗中的并发症和不良反应发生率。结果老年尿毒症患者对HDF治疗效果和耐受性显著优于HD,HDF组的HD并发症和不适症状发生率显著低于HD组(P0.01),HDF治疗后血清β2-MG、iPTH水平显著降低,Kt/V明显增高。治疗前后2组血清BUN、SCr、UA均明显下降,但下降幅度差异无统计学意义。治疗前后2组血钾、血钙、CO_2-CP及酸碱平衡失调均明显改善或纠正(P0.01),但2组间比较其变化幅度差异无统计学意义。结论前稀释HDF、结合HD的方案与单纯HD治疗相比,能有效清除尿毒症患者血中大、中、小分子物质,透析效果显著提高。患者对该法治疗的耐受性明显提高,适用于易出现HD并发症及不适症状的老年尿毒症患者。     

不同血液净化方式对维持性血液透析患者骨骼肌营养状况的影响

目的:探讨血液透析(HD)和血液透析滤过(HDF)对维持性血液透析(MHD)患者肌肉营养状况的影响。方法:随机选取潍坊医学院附属医院血液净化室门诊维持性血液透析的患者40例,随机分为两组,HD组(n=20)和HDF组(n=20)。HD组进行常规HD治疗,每周3次,HDF组每周行HD治疗2次,HDF治疗1次。分别于治疗前和治疗6个月后测量两组患者的C反应蛋白(CRP)、血清白蛋白(Alb)、前白蛋白(PA),肱三头肌皮褶厚度(TSF)、中臂围(MAC)、肌肉质量和肌力。结果:HD组治疗后的Alb、PA均较前升高,与治疗前比较差异均无统计学意义(P0.05),CRP、TSF、MAC均较前降低,与治疗前比较差异均无统计学意义(P0.05),肌肉质量、肌力均较前降低,与治疗前比较差异均有统计学意义(P0.05)。HDF组治疗后的Alb、PA均较前升高,与治疗前比较差异均有统计学意义(P0.05),CRP、肌肉质量、肌力均较前降低,与治疗前比较差异均有统计学意义(P0.05),TSF、MAC均较前降低,与治疗前比较差异均无统计学意义(P0.05)。治疗6个月后,HDF组的Alb、PA均高于HD组,CRP低于HD组,差异均有统计学意义(P0.05)。两组的TSF、MAC、肌力、肌肉质量治疗后均下降,但HDF组下降的百分比均低于HD组,差异均有统计学意义(P0.05)。结论:HDF能明显减轻MHD患者的肌肉消耗状况。     

高通量透析对维持性血液透析患者钙磷代谢的影响

目的探讨高通量血液透析对维持性血液透析患者钙磷代谢的影响,为临床维持性血液透析合并有钙磷代谢紊乱的患者提供新的血液透析治疗思路。方法纳入2013年1月至2015年1月于我院门诊行维持性透析治疗且合并有高磷血症及继发性甲状旁腺功能亢进的患者80例,将其随机分为高通量血液透析组(甲组)和普通血液透析组(乙组);比较透析前及透析后3个月、6个月患者血磷、血钙、骨密度、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血红蛋白(hemoglobin,Hb)、C反应蛋白(C-reactive protein,CRP)透析充分性及患者的生活质量(如皮肤瘙痒、骨痛、关节痛)的变化。采用SPSS 20.0软件进行数据分析,P0.05表示差异有统计学意义。结果治疗3个月后甲组患者的血磷、iPTH、CRP水平较治疗前有降低,血钙及Hb较治疗前有升高,但治疗前后差异无统计学意义(P0.05);乙组患者治疗3个月后患者的血磷、iPTH、CRP水平较治疗前升高,血钙及Hb较治疗前有降低,差异无统计学意义(P0.05);治疗3个月后2组间比较,血磷、血钙、iPTH和CRP无差异(P0.05)。治疗6个月后甲组患者的血磷、iPTH、CRP水平较治疗前明显降低,血钙及Hb较治疗前明显升高,治疗前后差异有统计学意义(P0.05);乙组患者治疗6个月后患者的血磷、iPTH水平较治疗前明显升高,差异有统计学意义(P0.05);血钙及Hb较治疗前有升高,差异无统计学意义(P0.05);治疗6个月后2组间比较,甲组血磷、iPTH、CRP较乙组降低(P0.05),血钙较乙组升高(P0.05)。随着治疗时间的延长,甲组患者皮肤瘙痒、骨痛、关节痛的症状逐渐减轻,乙组患者的上述症状无明显改善;2组间比较,甲组关节痛和皮肤瘙痒较乙组明显缓解(P0.05)。2组患者治疗前后骨密度检测、透析充分性无明显差异(P0.05)。结论高通量血液透析对于维持性血液透析患者钙磷代谢紊乱、继发性甲状旁腺功能亢进、减轻皮肤瘙痒程度、贫血及生活质量有较好的改善作用。     

血清半胱氨酸蛋白酶抑制剂C在慢性肾脏病肾功能中的应用

目的以放射性核素99Tcm-DTPA清除率测定的肾小球滤过率为标准,比较血清胱抑素C和肌酐评价GFR的准确性和特异性。方法以99Tcm-DTPA清除率法测定38例慢性肾脏病患者GFR,并同时测定Scr浓度和Cys-C浓度。运用ROC分析曲线分析SCysC和Scr评价GFR的准确性、敏感性和特异性。结果 38例慢性肾脏病患者SCys-C浓度为（1.67±0.25）mg/L,Scr浓度为（198.77±98.01）μmol/L,GFR为（50.55±35.62）mL/（min.1.73m2）。SCys-C与Scr、GFR呈明显负相关,相关系数分别为-0.74和-0.6（1P〈0.05）;分别以GFR〈90mL（/min.1.73m2）、GFR〈60mL（/min.1.73m2）和GFR〈30mL/（min.1.73m2）为界点,Cys-C的Roc曲线下面积（AUC）分别为0.822、0.857、0.920;Scr的Roc曲线下面积分别为0.775、0.801和0.922。结论在慢性肾病患者中与Scr比较,Cys-C是评价GFR的一个良好内源性指标,且能更好地反映GFR的早期改变。     

Effect of menopause and aging on serum total and ionized calcium and protein concentrations

Summary The effects of menopause and aging on serum total and ionized calcium concentrations were evaluated in 402 healthy women (aged 18–71 years), of whom 83 were premenopausal and 319 postmenopausal. Serum albumin and globulin concentrations and serum pH were also measured in most of these women. Serum total but not ionized calcium concentration increased significantly at menopause. This increase in the protein-bound component of total calcium in postmenopausal women was associated with increases in mean serum globulin concentration (P=0.03) and in serum pH (P=0.03). Serum total calcium declined with age within the pre- and postmenopausal groups (r=−0.225,P=0.04 and r=−0.121,P=0.03, respectively). This was associated with an age-related decrease in serum albumin concentration in all women (r=−0.47,P<0.0001). Neither serum globulin concentration or pH varied with age. Thus, menopause and aging affect serum total, but not ionized calcium concentration.     

持续非卧床腹膜透析患者血清肌酐水平的影响因素分析

目的：探讨影响持续非卧床腹膜透析（CAPD）患者血清肌酐水平的因素。方法：选取北京大学第三医院腹透中心200名临床情况稳定的CAPD患者为研究对象。同时收集患者人口学特征、血清肌酐（Scr）及其他生化资料,评估腹膜透析充分性,采用简单相关及多元回归分析探讨影响Scr水平的因素。结果：所有患者平均年龄（61.02±14.81）岁,平均Scr（893±293）μmol/L;简单相关分析显示Scr水平与年龄、总尿素清除指数（TKt/V）、残肾尿素清除指数（RKt/V）、总肌酐清除率（Tccr）及残肾肌酐清除率（Rccr）呈负相关,而与透析剂量、体质指数（BMI）、透析龄呈正相关,差异均具有统计学意义;逐步多元回归分析提示在矫正透析剂量、透析龄及糖尿病等因素后,性别、年龄、Tccr、RKt/V、透析液肌酐浓度/血肌酐浓度（D/PCr）及BMI是影响Scr水平的独立因素（R2=0.659,P〈0.05）。结论：本研究提示在剂量、透析龄及糖尿病等因素后,性别、年龄、营养状况、残余肾功能及腹膜转运功能仍能独立地影响CAPD患者血清肌酐水平。     

The impact of serum albumin and serum protein levels on POSSUM score of patients with proximal femur fractures

BackgroundPOSSUM was developed to predict risk-adjusted mortality and morbidity rates for surgical procedures. We evaluated the impact of serum albumin and serum protein levels on POSSUM scores.MethodsMedical files of 2269 patients operated for proximal femur fractures were reviewed. Preoperative serum albumin levels were available for 387 patients (mean 35.1 g/l, range 22–49) and serum protein levels for 279 patients (mean 61.6 g/l, range 40–86).ResultsSerum albumin and protein levels were inversely associated with mortality in multivariate models (albumin, OR = 0.89, p = 0.009; protein, OR = 0.92, p = 0.009) and in composite outcome models as well (albumin, OR = 0.955, p = 0.219, protein, OR = 0.94, p = 0.014). The area under the curve (AUC) for POSSUM prediction of mortality (n = 1770) was 0.632 (95% CI: 0.580–0.684, p < 0.001). The AUC for a model including serum protein levels was 0.742 (95% CI: 0.649–0.834, p < 0.001). Hospitalisation time was longer for patients with lower serum proteins levels (p = 0.045), with an inverse correlation (Pearson correlation −0.164, p = 0.011).ConclusionsLower preoperative serum albumin and serum protein levels were associated with increased risk for mortality, increased hospitalisation time and poorer outcomes in patients operated for proximal femoral fractures. Including those values to POSSUM scores would increase their predictive power.     

Alcohol decreases serum osteocalcin in a dose-dependent way in normal subjects

Summary The acute effect of 25 and 50 g of alcohol on the variation in serum osteocalcin, a specific and sensitive marker of bone formation, and on serum cortisol and serum parathyroid hormone (PTH)(1–84) was calculated in 6 normal young adults. They were studied during three periods, each lasting from 4 p.m.–7:30 a.m. Alcohol was ingested between 4:15 and 5 p.m. during period two and three. Blood was taken at 4 p.m. and every 15 minutes from 4:30 til 6 p.m., followed by hourly sampling until 12 p.m. The last blood sample was taken after an overnight fast at 7:30 a.m. Initial and end values before and after alcohol ingestion did not differ significantly from control values. Repeated measures analysis of variance showed that 50 g of ethanol decreased serum osteocalcin significantly (P<0.02) and increased serum cortisol (P<0.05) during the 4–12 p.m. interval. The interaction of 50 g of ethanol on the variation in serum osteocalcin was already significant during the first 2 hours (P<0.02), where no significant effect on serum cortisol could be detected. Although insignificant, the same pattern was observed after 25 g of alcohol. There was no significant change in the variation of serum iPTH(1–84) during the 4–6 p.m. after alcohol intake. We conclude that 3–4 drinks of alcohol taken over 45 minutes decreases serum osteocalcin in a dose-dependent way. The time lag between changes in serum osteocalcin and cortisol indicates that the decrease in serum osteocalcin is not related to the increase in serum cortisol.     

血清铁蛋白与血清铁调素在老年原发性高血压合并骨质疏松中作用的研究

目的探讨血清铁蛋白(serum ferritin,SF)与血清铁调素(hepcidin,Hep)的表达在老年原发性高血压(senile essential hypertension,SEH)合并骨质疏松(osteoporosis,OP)的意义。方法以SEH患者255例为研究对象,按照双能X线检测骨密度(bone mineral densily BMD)的检查结果分为骨质疏松组83例,骨量减少组91例,骨量正常组81例。ELISA法检测SF、Hep,进行各组间比较并分析相关因素与骨量的关系。结果 1.与骨量正常组比较,骨量减少组与OP组中的SF高于骨量正常组(P0.05);与骨量减少组相比,OP组中的SF高于减少组,差异有统计学意义(P0.05)。与骨量正常组比较,骨量减少组与OP组中的Hep低于骨量正常组(P0.05);与骨量减少组相比,OP组中的Hep低于减少组,差异有统计学意义(P0.05)。2.相关分析显示:股骨颈BMD与碱性磷酸酶、铁调素成正相关(P0.05);BMD与铁蛋白成负相关(P0.05)。结论 SEH患者SF、Hep的水平与OP密切相关,监测SF、Hep,有助于指导SEH合并OP患者的预防和治疗。     

The effects of menopause and estrogen replacement therapy on the renal handling of calcium

Mineral metabolism was studied in 99 premenopausal and 80 postmenopausal women both before and after 9–14 months of treatment with 50 µg/day transdermal estradiol. In estrogen-repleted subjects (premenopausal women and postmenopausal women on estrogen replacement therapy) total serum calcium was significantly lower (0.065 mmol/l;p<0.001) than in those who were estrogen-depleted (untreated postmenopausal women). This difference was smaller but still significant for calculated ultrafiltrable calcium (UFCa: 0.02–0.03 mmol/l;p<0.001). However, ionized calcium (both calculated and measured) was not different in the two groups of women. This finding explains why estrogen repletion does not induce changes in the serum level of intact parathyroid hormone (PTH), despite lower total or ultrafiltrable serum calcium. In a parallel study we have shown that intravenous administration of aminobutane bisphosphonate, a powerful inhibitor of bone resorption, produces similar decreases in serum calcium which were associated with significant increases in intact PTH.Estrogen-depleted women had, on the one hand, significantly higher serum levels of bicarbonate, anion gap, complexed calcium, pH, phosphate and alkaline phosphatase, and higher rates of tubular reabsorption of phosphate and urinary excretion of calcium and hydroxyproline. On the other hand they had lower serum chloride levels and lower rates of tubular reabsorption of calcium.Altogether these findings might indicate that estrogen deficiency decreases renal sensitivity to PTH. This is responsible for the higher serum phosphate and bicarbonate levels, the resulting mild metabolic alkalosis leading to higher serum levels of complexed ultrafiltrable calcium and higher rates of urinary excretion of calcium, but unchanged serum levels of ionized calcium and PTH.     

男性骨特异性碱性磷酸酶、骨钙素、I型胶原氨基末端肽与骨密度的关系

目的探讨男性人群血清骨特异性碱性磷酸酶(BAP)、血清骨钙素(sOC)和血清Ⅰ型胶原氨基末端肽(sNTX)与BMD的相互关系。方法用ELISA方法测定309名20~80岁男性志愿者的血清骨特异性碱性磷酸酶(sBAP)、血清骨钙素(sOC)和血清Ⅰ型胶原氨基末端肽(sNTX),用DEXA(双能X线吸收法)测定腰椎正位(AP)L1-L4总体、腰椎侧位、股骨颈、Wards区(华氏区)及髋部总体的面积BMD。结果(1)直线相关分析显示,sOC、sNTX与腰椎正位总体BMD呈负相关,r分别为-0.007,-0.100。BAP与腰椎正位总体、腰椎侧位、髋部总体、股骨颈及Wards区BMD均负相关,r分别为-0.190、-0.087、-0.175、-0.128、-0.128(P<0.05)。(2)校正年龄、体重指数和吸烟的影响后,sOC和各部位BMD相关性消失;sNTX与腰椎正位总体BMD;BAP与腰椎正位总体、髋部总体、股骨颈及Wards区BMD相关性仍存在,r分别为-0.164、-0.171、-0.148、-0.191、-0.105(P<0.05)。(3)以50岁为切点,将所有样本按年龄分两段,偏相关分析显示50岁以前sOC、sNTX和BAP与各部位BMD无显著相关;50岁以后除腰椎侧位外,BAP与腰椎正位总体、髋部总体、股骨颈及Wards区BMD负相关,偏相关系数分别为-0.206、-0.256、-0.183、-0.126(P<0.05)。sOC与各部位BMD无显著相关,sNTX与腰椎正位总体显著负相关,偏相关系数为-0.202(P<0.05)。(4)按BMD分组,方差分析显示50岁以上年龄匹配男性骨质疏松组BAP高于正常对照组与低骨量组,NTX高于正常对照组(P<0.05)。(5)分别以各部位BMD为应变量,年龄、BMI、吸烟(每日吸烟数量×烟龄)、BAP、sOC和sNTX为自变量,进行多元逐步线性回归分析。年龄、体重指数为各部位BMD的独立决定因子;吸烟为腰椎正位总体、髋部总体及Wards区BMD的独立决定因子。BAP为腰椎正位总体,髋部总体,股骨颈及Wards区BMD的独立决定因子,解释其BMD变化的百分数分别为16.5%、18.0%、13.4%、10.8%。(P均<0.05);sNTX为腰椎正位总体BMD的独立决定因子,解释腰椎正位总体BMD变化的15.7%。结论(1)校正年龄、体重指数和吸烟后,50岁以上男性BAP与腰椎正位总体、髋部总体、股骨颈及Wards区BMD,sNTX与腰椎正位总体BMD均呈负相关,BAP与sNTX均为50岁以上男性BMD的独立决定因子。(2)50岁以上男性骨质疏松组BAP显著高于正常对照组与低骨量组,NTX高于正常对照组,较高的骨代谢转换水平与较低的BMD相关联。(3)年龄、体重指数与吸烟均为各部位BMD的独立影响因素。     

血清钴离子浓度升高对小鼠肝、肾、心脏功能与形态的影响

目的 探讨血清钴离子浓度升高对小鼠肝、肾、心脏功能与形态的影响.方法 将断乳1周的40只雄性ICR小鼠(美国癌症研究所Institute of Cancer Researcch分送各国饲养实验,各国称为ICR小鼠)随机分成4组,即低剂量组、中剂量组、高剂量组和空白对照组,每组10只.实验组小鼠每天腹腔内分别注射剂量为0.82 mg/kg、1.64 mg/kg和3.28 mg/kg氯化钴溶液(CoCl2);空白对照组腹腔注射灭菌双蒸水.分别于注射后第4天、1、2、3周从每组小鼠眼球采血测定血清中钴离子含量,第1、2、3周测定血液生化指标[谷草转氨酶(AST)、谷丙转氨酶(ALT)、血尿素氮(BUN)、肌酐(Cr)、肌酸激酶(CK)]并作各组间的比较.第3周采用摘眼球放血方式将小鼠全部处死取心、肝、肾做病理切片及电镜观察.结果 注射氯化钴溶液后第4天、1、2、3周分别测量血清中钴离子含量,结果显示随着注射剂量的增加,小鼠血清中钴离子含量相应增加,实验组之间比较差异有统计学意义.术后第1、2、3周分别测量血液生化指标,结果显示低、中剂量组AST、ALT、BUN、Cr、CK活性正常,高剂量组AST、ALT、CK与空白对照组比较,随时间的延长氯化钴对肝、心的毒性影响有加重趋势.病理切片及电镜观察显示:各实验组的心、肝出现坏死、凋亡等病理性改变,但肾脏无毒性变化.结论 高剂量的血清钴离子浓度具有肝毒性与心脏毒性,但肾毒性不显著;低、中剂量对肝、心、肾功能与形态无明显影响.     

The Effect of Intense Passive Apnea in the Acid-Base Balance and Electrolytes

The aim of this study was to investigate the disturbances of the acid-base balance and electrolyte disorders in healthy individuals in the greatest passive apnea (prior to apnea and prior to first inhalation). The changes of the acid-base balance, the serum potassium and calcium levels as well as the disturbances of the cardiac rhythm were studied in a group of 15 healthy males aged 18 to 41 years old. Seven individuals part of the original group participated in a second trial. Following the initial apnea trial the individuals were allowed to 2–3 free inhalations and a second passive apnea effort was performed. The same parameters were measured in the second effort. In the primary effort the apnea duration was 170 ± 53 s (mean ± SD). The results received prior to the effort and immediately before the end of the apnea (paired t-test), showed no significant changes in the blood pH. The PaCO₂ increased significantly, the PaO₂ decreased significantly, blood bicarbonate increased significantly, the hemoglobin oxygen saturation decreased significantly. In addition the serum potassium and calcium levels decreased significantly. In the subgroup (7 individuals) the second effort of apnea lasted 50–70 s and showed no significant changes in the blood pH. The same changes concerning PaCO₂ and blood bicarbonate were observed in the first and second effort of passive apnea. The serum potassium and calcium levels as well as the hemoglobin oxygen saturation showed no significant changes. During the initial effort of apnea all men presented bradycardia, which was followed by tachycardia immediately after the end of the effort. One individual, whose effort lasted 290 s suffered intense tachycardia, cyanosis, convulsions, and loss of consciousness. It is concluded that during an intense effort of passive apnea: (a) the blood PaCO₂ is significantly increased, as well as the blood bicarbonates, (b) the PaO₂, the hemoglobin oxygen saturation and the serum potassium and calcium levels are significantly decreased, (c) the cardiac rate is significantly decreased, and (d) the second effort of apnea, following immediately the initial one, is sorter in duration and produces similar or milder changes of the above parameters.