骨转换生化标志物的临床应用和评估

目的比较妇女绝经前后骨转换生化标志物变化率,研究各指标在各种疾病组的浓度变化,并对临床应用作出初步评价。方法应用酶联免疫测定法或电化学发光免疫法分别测定164名健康成年人和120例患者血清和尿液中10项骨代谢指标。结果绝经后妇女骨代谢指标明显升高;高转换型骨质疏松组与对照组相比骨转换生化标志物的差异有统计学意义;变形性骨炎组和甲状旁腺功能亢进组与对照组比较除Ⅰ型胶原羧基端前肽(PICP)外,骨转换生化标志物的差异有统计学意义;甲状腺功能亢进组和肿瘤骨转移组除PICP和甲状腺激素(PTH)外,与对照组相比差异有统计学意义;风湿性关节炎除吡啶啉(PYD)和脱氧吡啶啉(DPD)与对照组比较差异有统计学意义外,其余差异均无统计学意义。结论各种骨代谢疾病不同程度影响骨转换,PICP应用于临床敏感性较差。     

骨代谢生化指标与老年男性骨质疏松症关系的探讨

目的调查老年男性血、尿中与骨形成有关的生化指标与年龄的关系,研究老年性骨质疏松症骨代谢生化指标的变化特点及在骨质疏松诊断中的应用价值.方法分别应用高压液相色谱法、酶免疫分析法和电泳法测定210例老年男性血中骨钙素(BGP)、Ⅰ型前胶原羧基肽(PICP)、骨碱性磷酸酶(BALP)和睾丸酮(Tes),尿中羟脯氨酸(Hyp)、脱氧吡啶啉(Dpd)和钙(Ca),与更年期后女性和年轻男性比较.结果发现老年男性骨吸收指标随着年龄的增长而增高(Dpd12.6%,Hyp23.5%),骨形成指标随着年龄增长而降低(BGP3.1%,PICP145.90%).老年男性尿中Dpd平均水平为(4.53±1.34) nmol/mmolCre,明显低于绝经后妇女[(7.90±3.27) nmol/mmolCre]和青中年男性[(6.78±3.31) nmol/mmolCre],经t检验P<0.001.老年男性尿中Hyp均为(1.73±0.66) mol/molCre,低于绝经后妇女(2.46±1.31 mol/molCre),经t检验P<0.01.而与青中年男性组比较差异无显著意义.老年男性血中BGP、PICP的平均水平分别为BGP(3.01±1.99) μg/L,PICP(78.29±47.20) μg/L,均低于绝经后妇女组[BGP(3.81±2.16) μg/L,PICP(115.04±97.32) μg/L],经t检验P<0.001.男性骨质疏松症患者和健康老年男性的各种生化指标比较,差异无显著性意义.结论老年男性从50岁到90岁的骨转化呈现骨吸收增加骨合成减少的缓慢变化过程.骨代谢生化项目可以作为骨质疏松症治疗的观察指标和辅助诊断的项目.     

骨代谢生化指标测定在妇科临床中的应用价值

目的：探讨四项骨代谢酶免疫生化指标：血骨钙素（BGP）、骨碱性磷酸酶（BAP）、I型 前胶原羧基肽（CICP）、尿呲啶酚（PYD）及传统的Ca/Cr及HOP／Cr比值对由于雌激素缺乏引起的高骨转换及骨量减少的诊断意义。并了解上述哪些指标对绝经引起的雌激素缺乏更敏感。方法：测定51名绝经前妇女（I组）,42名绝经后妇女（II组）,和53例双侧卵巢切除术（OVX）患者（III组）的上述各项指标,同时对各项生化指标间作相关分析。并与超声骨密度值（BMD）作相关分析。结果：绝经后组与卵巢切除术组的大部分酶免疫骨生化指标均显著高于绝经前组,与BMD的下降变化一致。但传统的HOP／Cr及Ca/Cr各组间无差异。相关性：所有病例中,BGP、BAP、CICP、PYD间均有相关性,尽管r值较低,但统计学分析差异有显著意义（P＜0.01）。其中BGP与BAP,BGP与PYD／Cr间相关性较好。BMD与BGP、BAP、CICP及PYD呈明显负相关。Ca/Cr及HOP／Cr与所有其他指标无相关。结论：BGP、BAP、CICP、PYD等骨代谢生化指标是反映绝经后（自然绝经及手术后绝经）妇女由于雌激素降低导致的高骨转换及骨量减少的敏感指标,在妇科临床中有较好的应用前景。而传统的Ca/Cr、HOP／Cr测定由于方法的不敏感、不特异而在妇科临床中应用受到限制。     

维生素D受体基因多个位点多态性与绝经后妇女骨密度及骨转换生化标志物的关系

目的:观察维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性与绝经后妇女骨密度及骨转换生化标志物的相关性.方法:①2007-01/2008-12从福州常住汉族人中随机检测绝经后妇女576例,年龄48～84(62.17±6.37)岁.受试者均知情同意.②记录年龄、绝经年限、体质量指数和绝经后骨折情况.③双能X射线骨密度仪检测正位第2～4腰椎、左侧股骨颈、大转子和Ward's三角区骨密度.④PCR-RFLP技术检测维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性.⑤用酶联免疫吸附法检测骨转换生化标志物(血清骨钙素、血清骨碱性磷酸酶、尿吡啶啉和尿脱氧吡啶啉).结果:561例合格受试者进入结果分析.①维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性各基因型间骨密度比较差异无显著性意义(P>0.05).②维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性各基因型间骨转换生化标志物比较差异无显著性意义(P>0.05).⑧维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性各基因型间骨质疏松症发生率比较差异无显著性意义(P>0.05).④维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性各基因型间绝经后骨折发生率比较差异无显著性意义(P>0.05).结论:维生素D受体基因BSM Ⅰ,TAQ Ⅰ,APA Ⅰ多态性与绝经后骨质疏松症无明显关联,不能作为福州地区绝经后妇女骨质疏松的遗传标志.     

骨代谢标志物与绝经后妇女骨质疏松症的相关性研究

目的探讨绝经后骨质疏松及其引起的骨折与骨代谢标志物之间的关系。方法应用单能X线骨密度仪测量绝经期妇女脚跟骨骨密度（BMD）,并根据有无骨质疏松和骨折将108例绝经后妇女分为无骨质疏松（NOP）组,骨质疏松无骨折（OP1）组和骨质疏松伴骨折（OP2）组,测定各组受试者BMD和骨代谢标志物骨钙素（N—MID）,总骨Ⅰ型前胶原N端肽（P1NP）和口胶原特殊序列（β-Crosslaps）水平。结果血清N—MID、PINP和β-Crosslaps水平：NOP组低于OP1组,OP1组低于OP2组,且差异均有统计学意义（P〈0．05）。结论绝经后骨质疏松患者血清骨代谢标志物水平与骨质疏松及骨折存在密切的相关性;血清N—MID、P1NP和β-Crosslaps是诊断绝经后妇女骨质疏松症、预测骨折风险的理想指标。     

女性绝经前后骨生化代谢指标尿D-Pyd、尿钙及血AKP-B检测

目的了解尿脱氧吡啶啉(D-Pyd),血清骨特异性碱性磷酸酶(AKP-B),尿钙三项指标在正常女性绝经前后骨生化代谢的情况。方法测定了63例正常女性、正常男性的尿D-Pyd/肌酐(Cr)、尿钙/肌酐(Cr)及血AKP-B。结果骨代谢生化三项指标的正常男性、正常绝经前期的女性、正常绝经后期的女性各值(-x±s)进行统计学分析比较(t检验)。D-Pyd/cr在三组之间在统计学上无显著性差异(P>0.05);AKP-B在正常绝经前后比较有非常显著性差异(P<0.01);尿钙/Cr在正常绝经前后与正常男性比较有非常显著性差异(P<0.01)。结论女性尿钙/Cr比男性高,血AKP-B除正常绝经后期女性偏高外,其它组基本相近;同时特别提示的是绝经后女性都要预防骨质疏松的发生。     

骨代谢标志检测在骨质疏松、糖尿病、甲状腺功能亢进及类风湿性关节炎中的应用

目的 研究检测骨代谢标志在骨质疏松、糖尿病（DM）、甲状腺功能亢进（简称甲亢）及类风湿性关节炎（RA）临床诊断中的应用价值。方法 检测89例骨质疏松患者，DM、甲亢及RA患者各50例和60名健康对照组血清中骨钙素（BGP）、骨特异性碱性磷酸酶（B-ALP）、I型前胶原羧基端前肽（PICP）及尿中骨吸收指标尿脱氧吡啶酚（DPd）。结果 骨质疏松男性患者组骨形成标志BGP、B-ALP、PICP明显低于健康对照组（P〈0．01），而骨吸收指标DPd则明显高于健康对照组（P〈0．01）；绝经女性组BGP、B—ALP、PICP及DPd均明显高于健康对照组（P〈0．01）；未绝经女性组仅DPd明显高于健康对照组（P〈0．01）。2型DM患者的BGP检测值明显低于健康对照组（P〈0．01）；而DPd则明显高于健康对照组，（P〈0．01）；B-ALP及PICP与健康组相比差异无显著性。RA患者DPd明显高于健康对照组（P〈0．05）。甲亢患者BGP、B-ALP、PICP及DPd均高于健康对照组（P〈0．01）。结论 检测骨代谢标志在上述4种疾病中可早期发现骨代谢紊乱，其中男性骨质疏松及RA患者均以骨吸收改变为主，而绝经后女性骨质疏松及甲亢患者又以骨丢失为主。4项标志的组合检测能反映骨代谢的整体状况，如仅用一项标志易漏诊误诊。     

中老年2型糖尿病患者骨量与骨转换指标的相关性分析

目的探讨中老年2型糖尿病患者骨量与骨转换指标的变化及相关性。方法将124中老年2型糖尿病患者作为研究对象,根据骨质疏松症分级标准将分为骨量正常组(37例)、低骨量组(42例)和骨质疏松组(45例)。检测研究对象空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、血钙、血磷和糖化血红蛋白(HbA1c)等生化指标,血清25-羟维生素D3 [25-(OH)D3]、钙素(N-MID)、Ⅰ型胶原羧基端肽交联(β-CTX)、I型前胶原氨基末端(N端)前肽(PINP)和Ⅰ型前胶原氨基末端(C端)前肽(PICP)等骨转换指标水平,以及髋骨和腰椎骨密度水平。结果低骨量组患者血清FPG、HbA1c、N-MID、β-CTX、PINP和PICP等指标水平均高于骨量正常组,血清25-(OH)D3水平低于骨量正常组,差异有统计学意义(P0.05);骨质疏松组患者血清FPG和HbA1c水平高于骨量正常组,血清N-MID、β-CTX、PINP和PICP水平均高于低骨量组和骨量正常组,血清25-(OH)D3水平低于其他两组,差异有统计学意义(P0.05);研究对象血清N-MID、β-CTX、PINP和PICP各指标均与髋骨骨密度、腰椎骨密度呈现明显负相关,差异有统计学意义(P0.05)。结论血清N-MID、β-CTX、PINP和PICP等骨转换指标可反映机体骨代谢情况,与中老年2型糖尿病患者的骨量变化存在密切关系。     

骨生化标志物联合检测在骨质疏松症中的意义

目的研究骨生化标志物在骨质疏松症患者中的变化,探讨联合检测的临床应用价值。方法采用电化学发光法（ECLIA）和酶联免疫吸附试验（ELISA）检测134例骨质疏松症患者及64名正常对照者（均按男性、绝经前女性及绝经后女性分别分组）的骨生化标志物。结果骨质疏松症患者骨生化标志物与同类型正常对照组比较有明显差异;联合应用骨形成和骨吸收指标有助于提高检测阳性率。结论联合检测骨生化标志物能提高临床骨质疏松症捡出率。     

绝经后妇女血清基质金属蛋白酶与骨转换生化指标及骨密度的关系

目的探讨绝经后妇女血清基质金属蛋白酶(MMP)-1和MMP-2与骨密度及骨转换生化指标之间的关系。方法采用酶联免疫吸附法测定297名48~80岁女性志愿者的血清MMP-1、MMP-2和血清骨碱性磷酸酶(BAP)、血清骨钙素(OC)及血清Ⅰ型胶原氨基末端肽(NTX),用双能X线吸收法测定腰椎正位1~4总体、股骨颈、华氏区、髋部总体的骨密度。结果MMP-1与骨密度及骨转换生化指标无明显相关性;MMP-2与骨密度呈较弱的负相关,校正年龄与体重指数后,MMP-2与股骨颈、髋部骨密度的相关性消失;MMP-2与BAP、OC、NTX正相关(P<0.01);绝经后骨质疏松症患者血清MMP-2水平高于年龄匹配的正常对照组和骨量减少组(P<0.01)。结论绝经后妇女血清MMP-2与骨转换生化指标相关联,血清MMP-2水平升高可能为高骨代谢转换过程(如绝经后骨质疏松症)中的一种伴随表现。     

唐山市二级医院护士离职倾向现状分析

目的了解唐山市护士离职倾向现状及影响因素,为有效降低护士离职率,保持护理队伍的稳定提供科学的依据和建议。方法随机抽取唐山市二级医院675名护士作为调查对象,采用一般资料调查表和离职倾向量表调查护士的离职倾向。结果唐山市二级医院护士离职倾向较高,得分为(13.18±3.69)分,其影响因素为学历、职务、用工性质及工作年限。结论唐山市二级医院护士离职倾向较高,医院管理者应该通过采取岗前培训、职业规划、提高薪酬等措施,有力降低护士的离职率,稳定护理队伍,促进医疗卫生事业健康发展。     

Meta-analysis of the reliability and validity of the Anticipated Turnover Scale across studies of registered nurses in the United States

Barlow K.M. & Zangaro G.A. (2010) Journal of Nursing Management 18, 862–873
Meta-analysis of the reliability and validity of the Anticipated Turnover Scale across studies of registered nurses in the United States Background Globally, there are serious human and financial costs associated with registered nurse (RN) turnover. Anticipating turnover before turnover occurs is important to prevent costly and unnecessary turnover. Using a reliable and valid measure of anticipated turnover is essential to credible healthcare research on which nursing policy decisions are based. This meta-analysis provides a systematic way to determine the legitimacy of the use of the Anticipated Turnover Scale (ATS) in RN workforce research. Aims The aims of this meta-analysis were to determine the consistency of reliability estimates and evidence of construct validity of ATS scores across studies of RNs in the US. A secondary purpose was to evaluate variability in reliability and validity according to study quality, century within which studies were conducted and whether studies were published or unpublished. Methods Search strategies included accessing computerized databases, emailing researchers, consulting experts, footnote-chasing and accessing unpublished reports. Two independent reviewers examined studies according to inclusion criteria and quality. Consensus was reached on selected studies and quality ratings. Results Overall mean weighted effect size (MWES) of reliability from 12 studies was 0.89. Overall MWES of validity correlating the ATS and four job satisfaction measures for seven studies was −0.53. There was variability in reliability according to quality of studies. Conclusion The ATS demonstrated excellent reliability and construct validity across studies of RNs in the US. Implications for nursing management Nursing management should consider the ATS in research on prevention of RN turnover.     

Effects of a sympathetic activation by lower body negative pressure on glucose and lipid metabolism

The effects of a sympathetic activation elicited by a lower body negative pressure (LBNP) (at ?15 mmHg for 75 min) were assessed in 7 healthy subjects on two occasions: (i) in post-absorptive conditions, and (ii) during glucose infusion (22·2 μmol kg^?1 min^?1). LBNP increased plasma norepinephrine concentration and heart rate. It did not alter whole-body glucose metabolism (measured with [6,6-²H]glucose) and glycerol turnover (measured with [1,1,2,3,3-²H]glycerol). Interstitial glycerol concentrations were monitored with microdialysis in subcutaneous adipose tissue and in skeletal muscle. LBNP increased dialysate glycerol concentrations in muscle by 16% (P < 0·03) but not in adipose tissue in post-absorptive conditions, and by 37% in adipose tissue (P < 0·05) but not in muscle during glucose infusion. These results indicate that an LBNP-induced sympathetic activation (i) does not increase endogenous glucose production, and (ii) induces only a slight stimulation of lipolysis in adipose tissue during glucose infusion.     

Effects of a preceptorship programme on turnover rate,cost, quality and professional development

Aim and objectives. The purpose of the present study was to design a preceptorship programme and to evaluate its effects on turnover rate, turnover cost, quality of care and professional development. Background. A high turnover rate of nurses is a common global problem. How to improve nurses’ willingness to stay in their jobs and reduce the high turnover rate has become a focus. Well‐designed preceptorship programmes could possibly decrease turnover rates and improve professional development. Design. A quasi‐experimental research design was used. Methods. First, a preceptorship programme was designed to establish the role and responsibilities of preceptors in instructing new nurses. Second, a quasi‐experimental design was used to evaluate the preceptorship programme. Data on new nurses’ turnover rate, turnover cost, quality of nursing care, satisfaction of preceptor’s teaching and preceptor’s perception were measured. Results. After conducting the preceptorship programme, the turnover rate was 46·5% less than the previous year. The turnover cost was decreased by US$186,102. Additionally, medication error rates made by new nurses dropped from 50–0% and incident rates of adverse events and falls decreased. All new nurses were satisfied with preceptor guidance. Conclusions. The preceptorship programme effectively lowered the turnover rate of new nurses, reduced turnover costs and enhanced the quality of nursing care, especially by reducing medication error incidents. Positive feedback about the programme was received from new nurses. Relevance to clinical practice. Study findings may offer healthcare administrators another option for retaining new nurses, controlling costs, improving quality and fostering professional development. In addition, incentives and effective support from the organisation must be considered when preceptors perform preceptorship responsibilities.     

Determinants of turnover among low wage earners in long term care: the role of manager-employee relationships

The demand for Long-Term Care (LTC) is steadily increasing as Baby Boomers age and enter retirement. High turnover rates among employees in LTC creates challenges for supervisors and administrators, and can negatively impact quality of care. This study examines manager-subordinate relationship quality using Leader-Member Exchange Theory (LMX) as an antecedent to turnover among low-wage earners in the LTC environment. Survey data measuring LMX, job satisfaction, and demographic information was collected at time 1, and turnover data was collected 18 months later at time 2. The results reveal that all four LMX dimensions were rated significantly different among subordinates who left versus those who stayed, however, only the LMX dimension of supervisor loyalty was a significant predictor of turnover among low wage earners. Our study adds a more nuanced view of the reasons low-wage employees turnover, and presents implications for clinical managers and LTC organizations more broadly.