六味地黄丸预防乳腺癌芳香化酶抑制剂治疗相关骨丢失的研究

目的:探讨六味地黄丸预防芳香化酶抑制剂治疗相关骨丢失(AIBL)的可行性和安全性。方法:将72例符合应用芳香化酶抑制剂(AIs)行内分泌治疗的乳腺癌患者按随机化原则分为两组,对照组每日服用标准剂量的AIs+维生素D钙制剂,研究组在此基础上加用六味地黄丸。分别检测她们在治疗前和治疗后6月及12月的第2~4腰椎(L2-4)和双股骨Ward三角(Ward’s)平均骨密度值及骨代谢指标血清N端骨钙素(N-MID)和I型胶原C端肽(CTX-I)水平,并监测血清雌二醇(E2)水平。结果:对照组的L2-4和Ward’s骨密度值在治疗后6月和12月持续显著降低(P<0.001),并伴随着N-MID和CTX-I水平的持续显著增加(P<0.001)。而研究组在治疗后6月虽然血清N-MID和CTX-I水平亦明显增加(P<0.001),但骨密度并未出现降低;而治疗12月后血清N-MID和CTX-I水平明显回落,只略高于治疗前水平(P=0.067,P=0.052),L2-4和Ward’s骨密度值则较治疗前明显增加(P<0.001,P=0.005)。两组的E2水平在治疗后6月均出现显著降低(P<0.001和P=0.003),并维持于低水平。结论:六味地黄丸是预防AIBL的安全有效的药物。     

老年髋部骨折与骨质疏松的相关性分析

目的 探讨老年人髋部骨折与骨质疏松的相关性,并对结果进行验证.方法 选取2009年1月至2012年3月唐山市工人医院收治的85例老年髋部骨折患者(髋部骨折组),测定其骨密度和尿液中生化标志物Ⅰ型胶原羟基末端肽、脱氧吡啶啉浓度,并选取60名非髋部骨折正常对照组进行对照检验.结果 髋部骨折组骨密度显著低于正常对照组(P＜0.05),尿液Ⅰ型胶原羟基末端肽、脱氧吡啶啉的含量显著高于正常对照组,验证骨质疏松患者更易发生髋部骨折.结论 老年髋部骨折多发于外伤,但骨密度和尿液Ⅰ型胶原羟基末端肽、脱氧吡啶啉的含量检测表明,骨质疏松是老年髋部骨折一个重要因素.     

类风湿性关节炎患者两种急性时相蛋白检测的临床价值

[目的]探讨两种急性时相蛋白在类风湿关节炎(Rheumatoid arthritis,RA)活动性评估中的意义。[方法]应用散射免疫比浊法对58例RA活动期患者和43例非活动期患者以及50例正常对照组的血清淀粉样蛋白A(Serum amyloid A,SAA)和A1-酸性糖蛋白(alphal acidglyco protein,AAG)进行检测,并与RA活动期患者的C反应蛋白(CRP)和血沉(ESR)比较。[结果]RA活动期患者血清中的SAA、AAG明显高于正常对照组(P﹤0.01),且RA患者活动期的SAA、AAG明显高于非活动期组(P﹤0.01)。[结论]RA患者活动期的SAA、AAG反应灵敏迅速与患者的CRP和ESR基本一致呈正相关,SAA、AAG的检测更能反应RA患者的活动性。     

托吡酯对癫痫患儿骨代谢的影响

目的:研究托吡酯(TPM)对癫痫患儿骨代谢的影响。方法:正常体检儿童25例作为对照组,诊断明确的癫痫患儿40例作为实验组,于治疗前、托吡酯单药治疗3个月后,分别测定血清骨钙蛋白(OC)和尿脱氧吡啶啉/尿肌酐(DPD/Cr)。结果:①托吡酯组治疗3个月后,托吡酯组的血清OC浓度低于正常对照组(P<0.05)。②托吡酯组治疗3个月后,托吡酯组的DPD/Cr高于正常对照组(P<0.05)。结论:托吡酯对癫痫儿童骨代谢中的骨形成和骨吸收过程均有影响,长期服用此药治疗的癫痫患儿需要同时服用钙剂和Vit D。     

云克联合电子脉冲治疗类风湿关节炎的疗效观察及护理

目的:探讨云克联合电子脉冲治疗类风湿关节炎的疗效和护理要点.方法:随机抽取在九江市第一人民医院住院治疗就诊的处于活动期的RA患者40例,使用联合治疗方法,治疗3个疗程,观察疗效.结果:在首次云克联合电子脉冲治疗后有9例患者(22.5％)达到ACR 20改善程度,2疗程后达到27例(67.5％)达到ACR 20改善程度,其中有6例达到ACR 50改善程度.3个疗程结束后达到ACR 70改善程度的患者比例逐渐增至12例(30％).结论:云克联合电子脉冲治疗类风湿关节炎的疗效较好,值得推广使用,但需注意联合使用时相关护理要点.     

软骨寡聚基质蛋白在类风湿性关节炎中的临床应用价值

目的研究RA活动期患者治疗前后血清COMP水平,分析COMP变化与RA疾病活动之间的关系。方法收集60例RA活动期患者设为活动期组和30例健康者设为健康组,经临床治疗后60例活动期患者均进入缓解期设为缓解期组;ELISA法检测血清COMP和抗CCP抗体水平,并检测CRP、ESR,记录性别、年龄、BMI;分别比较活动期组和健康组、活动期组和缓解期组、缓解期组与健康组血清COMP水平。结果活动期组与健康组COMP水平比较,差异有统计学意义(P0.05)。活动期组与缓解期组COMP水平比较,差异有统计学意义(P0.05)。健康组与缓解期组COMP水平比较,差异无统计学意义(P0.05)。X线分期2期患者血清COMP水平分别与1期和3期患者比较,差异均有统计学意义(P0.05)。结论 COMP水平可提示RA疾病软骨破坏程度及疾病活动程度,检测COMP水平对RA早期诊断及评估临床疗效有一定意义。     

磷酸化磷虾肽对骨质疏松症大鼠炎症因子的影响

目的探讨磷酸化磷虾肽(phosphorylated peptides from Antarctic krill,PP-AKP)对骨质疏松症大鼠血清炎症因子及骨吸收的影响。方法采用双侧去卵巢方法建立骨质疏松症大鼠模型,将大鼠随机分为假手术组,模型对照组,阳性对照组(阿仑膦酸钠,1 mg/kg·bw),PP-AKP低、高剂量组(400、800 mg/kg·bw)。连续灌胃90d,1/d。实验结束后,检测大鼠血清抗酒石酸酸性磷酸酶、组织蛋白酶K活性,和血清α-肿瘤坏死因子等相关炎症因子含量;检测尿液钙、磷和脱氧吡啶啉含量。结果 PP-AKP可显著抑制血清抗酒石酸酸性磷酸酶和组织蛋白酶K活性(P0.01),显著降低尿液钙、磷和脱氧吡啶啉含量(P0.01);显著降低大鼠血清α-肿瘤坏死因子、白细胞介素6、白细胞介素1β、一氧化氮含量(P0.01)和环氧化酶2活性(P0.01)。结论 PP-AKP可显著抑制骨质疏松症大鼠骨吸收,其作用机制可能与抑制炎症因子的分泌有关。     

痹肿消汤对类风湿关节炎患者血清转化生长因子-β1的影响

目的观察痹肿消汤(BZXD)对类风湿关节炎(RA)患者血清转化生长因子-β1(TGF-β1)含量的影响,从细胞因子角度探讨该方药的作用机制。方法选择RA活动期患者60例,随机分为BZXD治疗组和西药(MTX和普威)治疗对照组;20名健康人为正常对照组,于治疗前和治疗3个月后分别检测血清TGF-β1含量。结果治疗前RA患者血清TGF-β1含量较正常人对照组明显降低(P<0.001);治疗3个月后,两治疗组血清TGF-β1含量升高,均接近于正常,两组间比较差异无显著性(P>0.05)。结论RA患者体内存在较低浓度的TGF-β1,可能是导致RA发病的机制之一;痹肿消汤能升高血清TGF-β1含量,有助于机体恢复免疫稳定状态,具有类似MTX与非甾体药之联合用药的免疫调节效应。     

骨折患者长期固定治疗尿脱氧吡啶啉变化的临床研究

目的　探讨骨折长期固定治疗患者尿脱氧吡啶啉的变化及其临床意义。方法　测定 3 7例 (男 2 2例 ,女 15例 )骨折长期固定治疗患者及 3 0例 (男 15例 ,女 15例 )健康对照者的血清钙 (Ca)、磷 (P)、总碱性磷酸酶 (AKP)、尿钙 /肌酐 (Ca/Cr)、尿脱氧吡啶啉 (DPD)的水平。结果　骨折长期固定治疗患者血清钙、磷水平较正常对照组显著降低 (P <0 0 5 ) ;AKP、Ca/Cr、DPD水平较正常对照组有不同程度的增高 (P <0 0 5 ,P <0 0 5和P <0 0 1)。其中以尿DPD的活性增高更为显著 (增高 5 98倍 )。而且 ,骨折长期固定治疗患者尿DPD的变化还与病程呈正相关。结论　尿DPD是反映骨吸收的一项敏感而特异的指标 ,尿DPD的监测对骨折长期固定治疗患者的临床治疗和预防发生新的骨折具有重要的参考价值。     

复方雷公藤制剂对活动期类风湿性关节炎相关实验室指标的影响

目的观察复方雷公藤制剂对活动期类风湿性关节炎(RA)患者红细胞沉降率(ESR)、C-反应蛋白(CRP)、抗链球菌"O"(ASO)、类风湿因子(RF)和抗环瓜氨酸肽抗体(抗CCP)的影响。方法将141例RA患者按病程分为A、B、C 3组,每组再按病情分为湿热型和寒湿型。湿热型用自制黄藤酒和痹症1号方治疗2周,寒湿型则用黄藤酒和痹症2号方治疗2周。对治疗前后的3组RA患者进行ESR、CRP、ASO、RF和抗-CCP检测。结果 3组RA患者治疗后ESR、RF和CRP水平明显下降,差异均有统计学意义(P<0.01或P<0.05);其中10例抗-CCP阳性RA者,治疗后抗-CCP水平也明显下降(P<0.01)。结论复方雷公藤制剂能够改善RA患者相关实验室指标,对活动期RA有较好的疗效。     

淋巴结阴性乳腺癌骨髓CK19的检测及临床意义

目的:应用乳腺癌组织特异性标志物细胞角蛋白(Cytokeratin,CK19)检测腋淋巴结阴性乳腺癌(Axillarylymph nodes negative breast cancer,ALNNBC)骨髓中的微转移癌,并探讨其与临床病理因素之间的关系。方法:采用RT-PCR方法检测86例ALNNBC骨髓中CK19mRNA的表达,并以MCF-7乳腺癌细胞为阳性参考检测该方法的灵敏度。结果:ALNNBC骨髓中CK19mRNA的阳性表达率为30.23%(26/86),该方法检测骨髓微转移的灵敏度可达1/107,肿瘤大小与微转移发生率正相关(P<0.05),年龄、病理类型、Her-2表达、ER/PR状态及p53表达等与微转移无关。结论:CK19可作为乳腺癌骨髓微小转移检测的标志物;ALNNBC微转移与肿瘤大小密切相关。     

类风湿性关节炎患者IL-1、IL-15的水平变化及意义

目的研究类风湿性关节炎（RA）患者血清IL-1、IL15的水平变化及意义。方法收集91例RA患者和45例健康体检者，分别采用放射免疫分析法和ELISA法测定血清IL-1、IL-15的水平。结果RA非活动组和RA活动组的血清IL-1、IL-15水平均明显高于对照组，差异有统计学意义（P〈0．05）。RA活动组的血清IL-1、IL-15水平高于RA非活动组，差异有统计学意义（P〈0．05）。在91例RA患者中血清IL-1、IL-15水平显著相关（r=0.813，P〈0．05）。结论IL-1、IL-15在RA患者的疾病发展过程中发挥着重要作用，同时检测RA患者中血清IL-1、IL-15的水平，有利于监测RA病情和指导临床治疗。     

Longitudinal changes in bone metabolism and bone mineral content in children with celiac disease during consumption of a gluten-free diet

BACKGROUND: A gluten-free diet (GFD) rapidly corrects the bone mineral deficit of children with untreated celiac disease. The mechanisms underlying such changes are still poorly understood. OBJECTIVE: In a longitudinal study, we monitored changes in bone metabolism during consumption of a GFD. DESIGN: We studied 22 white patients with celiac disease (11 girls) aged 10.5 +/- 1.0 y at the time of diagnosis. We compared bone metabolism and bone mass values in these patients with those in 428 healthy white children aged 11.3 +/- 0.2 y. Bone-specific alkaline phosphatase (a bone formation index) and N-terminal telopeptide of type I collagen (NTx; a bone resorption marker) were measured at the time of diagnosis and after 2, 6, and 12 mo of the GFD. Bone mineral content was measured at the lumbar spine and for the whole skeleton. RESULTS: The bone mineral content of patients was significantly lower than that of control subjects at the time of diagnosis but not after 1 y of the GFD. Serum bone-specific alkaline phosphatase concentrations of patients were significantly lower than those of control subjects at the time of diagnosis (P = 0.0064) and increased gradually and significantly during the GFD (ANOVA F = 4.71; P = 0.024). Conversely, patients with untreated disease had significantly higher urinary concentrations of NTx than did healthy control subjects (P < 0.0001). Urinary concentrations of NTx were not significantly affected by treatment (P = 0.37). CONCLUSIONS: The rate of bone metabolism is altered in children with untreated celiac disease, and these alterations may be the cause of osteopathy. Remarkable changes occur after the initiation of a GFD, and they result in a more balanced equilibrium.     

受体相互作用蛋白激酶1在类风湿关节炎发病中的作用及其遗传易感性

  目的  分析受体相互作用蛋白激酶1(receptor interacting serine/threonine protein kinase 1, RIPK1)在类风湿关节炎(rheumatoid arthritis, RA)发病中的作用及其基因多态性与RA遗传易感性的关联。  方法  采用实时定量PCR(quantitative real-time PCR, qRT-PCR)方法检测RA和健康对照者的外周血单个核细胞(peripheral blood mononuclear cell, PBMC)中RIPK1的mRNA水平,分析其在RA发病中的作用。在RIPK1调控区和蛋白修饰功能区中筛选单核苷酸多态性(single nucleotide polymorphism, SNP)位点,筛选了rs111393904、rs115041708、rs1158343326、rs116040763、rs116603010、rs116696494、rs1186968649、rs1189800403、rs1193251671、rs1255389565、rs138277932、rs17548629、rs200610530、rs547953577、rs557588787、rs561972571、rs760405932、rs77736895和rs934053809共19个位点,采用iMLDR技术进行基因分型,分析RIPK1基因多态性与RA遗传易感性的关联。  结果  比较88例RA患者和85例健康对照者RIPK1 mRNA表达水平,结果显示RA组低于健康对照组(Z=3.152, P < 0.000 1);进一步比较RA活动组(50例)、RA稳定组(38例)和健康对照组三组间差异,结果显示RA活动组RIPK1 mRNA表达水平低于稳定组(Z=2.987, P=0.008 4)和健康对照组(Z=4.247, P < 0.000 1),RA稳定组与健康对照组间差异无统计学意义(Z=0.584, P>0.999 0)。对103例RA患者和90例健康对照者的SNP位点进行基因分型,结果显示RA患者上述SNP位点基因型和等位基因频率与健康对照组的差异均无统计学意义(均有P>0.05)。  结论  RIPK1对RA病情活动可能有保护作用,但其基因多态性与RA遗传易感性可能无关联。     

类风湿关节炎活动度及骨侵蚀预测指标研究

目的探讨类风湿关节炎活动度及骨侵蚀预测指标,为临床建立一个实用的RA预后评价依据。方法随访收集的168例RA患者和21例正常体检者,应用ELISA、速率散射比浊法联合检测抗环瓜氨酸肽（CCP）抗体、RF亚型（RF—IgA、RF—Igc、RF—IgM）、C-反应蛋白（CRP）,结合手、足X线片变化进行分析抗-CCP抗体、RF亚型、CRP与类风湿关节炎活动度及骨侵蚀关系。结果抗CCP抗体、CRP在早期RA组与非早期RA组之间比较无统计学意义（P〉0．05）,RA活动组与缓解组、骨侵蚀组与非骨侵蚀组比较有显著性差异（P〈0．05）;RF-IgA、RF—IgM在早期RA组与非早期RA组、RA活动组与缓解组、骨侵蚀组与非骨侵蚀组比较均有显著性差异（P〈0．05）,RF—IgG变化不明显。结论抗～CCP抗体、RF亚型、CRP联合检测对类风湿关节炎活动度及骨侵蚀具有预测价值。     

Investigation of the relationship between low environmental exposure to metals and bone mineral density,bone resorption and renal function

Environmental exposure to metals has been linked to adverse health outcomes. Exposure to cadmium has been associated with decreased bone density, an increased risk of osteoporotic fracture and possible renal dysfunction. Older women are a group at risk of renal and bone density impacts and exposure to metals may be an important risk factor for these health outcomes. This study was a cross sectional study of 77 women aged 50 years and above examining the relationship between metals exposure and renal and bone health. Urinary and blood metals concentrations, plasma creatinine, iron, ferritin and transferrin were measured in these subjects. Bone biomarkers assessed included the pyridinium crosslinks, pyridinoline and deoxypyridinoline measured by ELISA. Renal function was assessed using eGFR and KIM-1. Whole body, hip and lumbar spine bone mineral density was assessed using DEXA. Blood and urinary metals concentrations were generally low in the subjects, with a median urinary cadmium concentration of 0.26 μg/g creatinine (range <0.065–1.03 μg/g). Urinary cadmium was found to be a significant predictor of bone mineral density at whole body, lumber spine, total hip and femoral neck, with increasing urinary Cd concentrations associated with decreased bone density. Urinary cadmium and aluminium concentrations were positively correlated with bone resorption whilst blood zinc and mercury concentrations were negatively correlated. Urinary aluminium was positively correlated with KIM-1 concentrations, a marker of early kidney damage, however blood zinc concentrations were significantly negatively correlated with this biomarker. This study provides additional support for low cadmium exposure being of concern for the health of older women. Further investigation into the role of exposure to other metals on bone and renal health is warranted.     

艾拉莫德联合甲氨蝶呤治疗类风湿性关节炎的临床疗效及对患者骨代谢的影响

目的 探讨艾拉莫德联合甲氨蝶呤治疗类风湿性关节炎(RA)的临床效果及对患者骨代谢的影响.方法 将我院收治的86例RA患者随机分为两组各43例.对照组采用甲氨蝶呤治疗,观察组采用艾拉莫德联合甲氨蝶呤治疗.比较两组的临床疗效、骨代谢指标(β-CTX.、TPI.NP、N-MI.D)及不良反应发生情况.结果 观察组治疗总有效率...     

Effects of two low-dose combined oral contraceptives containing drospirenone on bone turnover and bone mineral density in young fertile women: a prospective controlled randomized study

BACKGROUND: The effects of a 21-day combined oral contraceptive containing 30 mcg ethinyl estradiol plus 3 mg drospirenone with a 21-day preparation containing 20 mcg ethinyl estradiol plus 3 mg drospirenone on bone turnover and bone mineral density (BMD) in young fertile women were compared. METHODS: A randomized, controlled trial was conducted on healthy fertile women treated with 30 mcg ethinyl estradiol plus 3 mg drospirenone (Group A; n=21), 20 mcg ethinyl estradiol plus 3 mg drospirenone (Group B; n=23) and healthy controls (Group C; n=21). At 3, 6, 9 and 12 months, serum and urinary calcium, osteocalcin (BGP), urinary pyridinoline and deoxypyridinoline were measured. At baseline and after 12 months, lumbar bone mineral density was determined by dual-energy X-ray absorptiometry. RESULTS: In Groups A and B, urinary pyridinoline and deoxypyridinoline at 6, 9 and 12 months were significantly reduced in comparison with basal values and Group C (p<.05). In Groups A and B, serum calcium levels were significantly increased after 6 months. No significant difference was detected between Groups A and B in urinary levels of pyridinoline and deoxypyridinoline, in calcium levels and in BGP levels. At 12 months, no significant difference was detected in spinal BMD values between the three groups and in comparison with basal values. CONCLUSION: Both combined oral contraceptives exert a similar positive influence on bone turnover in young postadolescent women.     

Hyperprolactinemia in systemic lupus erythematosus. A prospective study of 38 cases

OBJECTIVE: To study prospectively the serum prolactin concentrations among patients with systemic lupus erythematosus and their possible relationship to disease activity and manifestations. METHODS: Serum prolactin levels were measured by radioimmunoassay in 38 patients with systemic lupus erythematosus and 22 age matched controls. Patients with known secondary causes for hyperprolactinaemia, such as pregnancy, lactation, prolactinoma and taking medications known to induce prolactin secretion, were excluded from the study. Demographic, clinical and laboratory features of the patients were obtained. Patients were divided into two subgroups according to their disease activity. Mean prolactin levels from both groups were compared using student test, and prolactin from patients with systemic lupus erythematosus was correlated with variables of disease activity, including the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). RESULTS: Mean prolactin levels were higher in patients with systemic lupus erythematosus (15.4) than healthy controls (9.83); however, the difference did not reach statistical significance (p=). Hyperprolactinemia was found in 24 patients with systemic lupus erythematosus and 5 controls. The frequency of hyperprolactinaemia in systemic lupus erythematosus group was higher than healthy controls. No significant difference in mean prolactin levels was found between patients with active versus inactive disease (18.9 vs 18.5). CONCLUSION: Hyperprolactinaemia occurred significantly in patients with systemic lupus erythematosus, but did not correlate with disease activity.