GLP-1对2型糖尿病大鼠血清OPG、RANKL及骨密度的影响研究

目的探讨GLP-1类似物利拉鲁肽对糖尿病大鼠血清OPG、RANKL及骨密度的影响。方法健康雄性SD大鼠随机分为正常对照组(NC组)、糖尿病组(DM)、利拉鲁肽低剂量组(LR-L)、利拉鲁肽高剂量组(LR-H)。高脂高糖饮食联合小剂量链脲佐菌素(STZ)诱导建立2型糖尿病大鼠模型,低剂量组予利拉鲁肽400μg/(kg.d)皮下注射,高剂量组予利拉鲁肽800μg/(kg.d)皮下注射,给药4w后处死大鼠,测血糖、血钙、血磷、碱性磷酸酶、胆固醇、甘油三酯,ELISA法检测OPG、RANK,DXA法检测大鼠骨密度。结果与NC组比较,1 DM组、LR-L组、LR-H组体重均减轻,LR-L组、LR-H组较DM组更轻,但LR-L组与LR-H组间比较无差异;2DM组、LR-L组、LR-H组血糖均升高,LR-L组、LR-H组血糖较DM组低,但LR-L组与LR-H组间比较无差异;3DM、LR-H、LR-L组血清OPG、RANKL明显升高,差异具有统计学意义(P0.05),LR-L组OPG较DM组更高差异有统计学意义(P0.05),LR-H组OPG高于DM组但差异无统计学意义;LR-H与LR-L组RANKL明显低于DM组;4DM组血清OPG/RANKL比值低于NC组,LR-L、LR-H组血清OPG/RANKL较DM升高,差异具有统计学意义(P0.05);5DM组、LR-L、LR-H组大鼠全身及各部位骨密度均降低,差异具有统计学意义(P0.05),但DM组、LR-L组、LR-H组3组间差异无统计学意义。结论利拉鲁肽具有降低2型糖尿病大鼠体重、减低血清RANKL、升高血清OPG的作用,但利拉鲁肽治疗后未见骨密度的提高。     

慢性乙型肝炎患者血清骨保护素和核因子κB受体活化因子配体变化的研究

目的观察慢性乙型肝炎患者血清骨保护素(OPG)和核因子κB受体活化因子配体(RANKL)水平的变化,探讨慢性肝病致骨质疏松的发病机制。方法随机选取300例慢性乙型肝炎患者作为试验组,其中95例不伴有肝硬化,205例伴肝硬化,根据Child-Pugh分级:A级69例,B级62例,C级74例,选取年龄、性别、身高、体重相匹配的100例健康志愿者作为对照组。血清OPG、RANKL应用ELISA方法检测,应用跟骨超声骨密度测定仪测定跟骨硬度指数(SI),对相关数据进行相应的统计学分析。结果各组患者OPG水平差异均具有统计学意义,对照组、不伴肝硬化组、肝硬化A组、肝硬化B组和肝硬化C组患者的血清OPG水平逐渐降低,RANKL值则逐渐升高(P<0.05)。对照组、不伴肝硬化组、肝硬化A组、肝硬化B组和肝硬化C组患者血清OPG/RANKL比值逐渐降低,对照组OPG/RANKL值较其余4组均显著升高(P<0.05)。慢性乙型肝炎组患者的跟骨SI与对照组比较,差异具有统计学意义(P<0.05)。肝硬化A组、B组、C组患者SI值显著低于对照组SI(P<0.05)。结论 OPG、RANKL和OPG/RANKL系统可能参与慢性肝病相关性骨质疏松症的发病过程,慢性乙型肝炎患者可引起OPG、RANKL以及OPG/RANK的变化,上调破骨细胞,使得骨吸收大于骨形成,从而引发骨质疏松。     

阻塞性睡眠呼吸暂停低通气综合征患者氧化应激、性激素水平与骨密度的相关性研究

目的探讨男性阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者骨密度改变以及与氧化应激、性激素水平变化的相关性。方法通过多导睡眠(polysomnography,PSG)监测入选48例男性OSAHS患者,其中轻中度组19例,重度组29例,同时选择经PSG监测排除OSAHS的男性对照组20例。受试者填写Epworth嗜睡量表(Epworth sleepiness scale,ESS)问卷;使用双能X线吸收测定法(dual energy X-ray absorptiometry,DEXA)测定腰椎前后位腰1至腰4、股骨颈面积骨密度(bone mineral density,BMD)和T值。测定外周血以下指标的水平并进行相关性分析:总抗氧化能力(total antioxidant capacity,TA0C)、活性氧(reactive oxygen species,ROS)、血清睾酮(testosterone,T)、血清钙、磷。结果 (1)与对照组相比,OSAHS组股骨颈和腰椎BMD及T值减低,两组比较有显著性差异(P0.05)。(2) OSAHS组与对照组比较TAOC、ROS、睾酮水平下降,两组间有显著性差异(P0.05)。(3) OSAHS轻中度组和重度组股骨颈和腰椎BMD及T值比较均无显著性差异(P0.05),轻中度组和重度组间睾酮、TAOC、ROS比较均无显著性差异(P0.05)。(4)患者组睾酮水平与TAOC呈正相关(r=0.436,P0.01),与ROS呈负相关(r=-0.471,P0.05)。睾酮水平与股骨颈和腰椎BMD呈正相关(r=0.357、0.396,P0.01)。结论 OSAHS患者存在氧化抗氧化失衡,与氧化应激和睾酮水平下降有一定关系,性激素水平下降可增加患者骨质疏松发生的风险。     

绝经前女性系统性红斑狼疮患者骨密度和骨代谢指标测定

目的 探讨绝经前女性系统性红斑狼疮(SLE)患者骨密度(BMD)和骨代谢指标的变化.方法 采用双能x线骨密度吸收仪(DEXA)测定178例绝经前女性SLE患者以及60例正常对照组的腰椎、股骨颈的骨密度以及T值,血钙、磷浓度,血清碱性磷酸酶(AKP)、血清骨钙素(BGP)、尿I型胶原交联氨基末端肽(NTX)水平,并将SLE组患者分为SLE初诊组与治疗组,分别对其数据进行统计分析.结果 SLE初诊组的腰椎BMD,股骨颈BMD及T值,血清AKP、尿NTX较正常对照组均无明显差异,而腰椎骨密度T值、血清BGP较正常对照组低(P＜O.05);SLE治疗组的腰椎BMD、T值和股骨颈1值,血清BGP低于正常对照组,但股骨颈BMD、血清AKP、尿NTX较正常对照组差异未达统计学意义;SLE治疗组的腰椎、股骨颈BMD与T值均显著低于SLE初诊组.SLE组的骨质疏松及骨量减少率分别为6.74%、16.85%.结论 绝经前SLE患者较同年龄正常女性易发生骨质疏松,血清BGP和腰椎骨密度可能较早反映骨质疏松的发生.     

护骨素与女性年龄和骨密度的关系

目的 探讨血清护骨素(Osteoprotegrin,OPG)与女性年龄和骨密度(BMD)之间的关系.方法 用ELISA测定672名20～80岁女性志愿者的OPG,用DXA测定腰椎正位总体和股骨颈的BMD.根据年龄段、是否绝经分组.结果 ①OPG在30～39岁年龄段最低(2.80±1.37)pmol/L,与40～69岁的各组比较有统计学意义(P均＜0.05).②40～59岁人群中,绝经后组的OPG(5.70±3.14)pmol/L比绝经前组(3.45±2.01)pmol/L高(P均=0.000).③年龄与OPG和腰椎及股骨颈的BMD相关(r值分别为0.130,P均＜0.01);OPG与腰椎和股骨颈的BMD呈负相关(r=-0.183和-0.108,P＜0.01).结论 sOPG能较敏感地反映妇女随年龄及绝经变化的骨转换状况;且生化指标的变化先于骨密度的变化,可辅助用于预测骨丢失.     

阻塞性睡眠呼吸暂停低通气综合征患者并发勃起功能障碍的机制及治疗进展

正阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是指在每晚7h睡眠时间内呼吸暂停反复发作在30次以上,每次发作时间持续10s以上,或睡眠呼吸暂停/低通气指数(apnea/hypopnea index,AHI,即平均每小时睡眠中的呼吸暂停加上低通气的次数)大于等于5次/h。临床上主要表现为打鼾,并且鼾声不规律,患者自觉憋气,甚至反复被憋醒,常伴有夜尿     

幼年型强直性脊柱炎病人的骨质疏松

目的 探讨幼年型强直性脊柱炎病人的疾病活动性与骨质疏松的关系以及服用强的松对骨质疏松的影响。方法 16例病人按血沉>30 mm/h和<30 mm/h分成两组,用双能X射线吸收法(DEXA)测定他们的腰椎正位和股骨颈的骨密度。比较服用和未服用强的松的两组病人的骨密度。结果 两组病人的C反应蛋白(CRP)有显著差异,高活动性组的腰椎与股骨颈的骨密度都小于低活动性组,股骨颈骨密度的差异在统计学上有显著性意义。服用和未服用强的松的两组病人的腰椎骨密度和股骨颈骨密度无差异。结论 对于幼年型强直性脊柱炎病人,测定股骨颈的骨密度比腰椎更加合适。服用和不服用强的松的两组病人的腰椎和股骨颈骨密度无显著差异,说明病人可以尽早使用强的松以控制炎症。不过持续使用强的松的时间不宜超过半年,剂量不宜超过15 mg/d。     

RANKL、OPG在初发系统性红斑狼疮患者中的表达及意义

目的 研究初发系统性红斑狼疮(systemic lupus erythematosus,SLE)患者外周血淋巴细胞中细胞核因子-kB受体激活剂配体(receptor activator of nuclear factor kappa B ligand,RANKL)、护骨素(osteoprotegerin,OPG)基因mRNA的表达情况,探讨其表达水平与初发SLE患者骨质疏松的关系.方法 选择初发SLE患者45例及正常对照42例,运用实时定量PCR方法检测患者外周血淋巴细胞RANKL、OPG的mRNA表达水平.采用双能X线骨密度仪分别检测患者腰椎(L1～4)和股骨近端2个部位的骨密度,单因素分析RANKL、OPG基因mRNA表达水平与SLE患者骨密度的关系.结果 SLE患者RANKL、OPG基因mRNA表达水平较正常对照组明显减低(P＜0.01);SLE患者2个部位的骨密度均低于正常对照组(P＜0.05),骨量异常发生率为28.89%,骨量异常降低的SLE患者OPG基因mRNA的表达水平比骨量正常的患者显著降低,两者间的差异有统计学意义(P＜0.01);而RANKL基因mRNA表达水平的差异无统计学意义(P＞0.05);OPG基因ndtNA表达水平与初发SLE患者骨密度间存在正相关(r=0.461;P=0.001),即OPG表达水平越低,骨量减少越明显;而BANKL基因mRNA表达降低与初发SLE患者骨密度无明显相关性(r=-0.189,P=0.214);初发SLE患者疾病活动度与骨量减少、RANKL及OPG基因表达水平间不存在相关性(r=0.293,P=0.138;r=-0.099,P=0.493;r=0.138,P=0.493).结论 初发SLE患者骨量减少的发病率较正常人群增高,并且初发SLE患者体内RANKL和OPG基因表达存在异常;其中OPG表达水平的降低可能与初发SLE患者的骨量减少有密切关系.     

不同糖耐量人群骨密度变化及与血清护骨素水平的相关性研究

目的研究不同糖耐量人群骨密度的变化及与血清护骨素水平的关系。方法 2013年1月至12月期间收集社区绝经后女性共271人,根据不同的糖耐量水平分为3组,其中2型糖尿病组93人、糖调节受损组90人、正常糖调节组88人。所有研究对象测量身高、体重、腰围、臀围,采用全自动生化分析仪检测血生化指标,酶联免疫法检测血清OPG水平,双能X线骨密度仪检测腰椎(L_2-L_4)及股骨颈骨密度。结果正常糖调节组人群腰椎及股骨颈骨密度明显低于2型糖尿病组,差异有显著性(P=0.004,P=0.008)。血清OPG水平、年龄、碱性磷酸酶、血肌酐、高密度脂蛋白与腰椎及股骨颈骨密度呈负相关(P0.05),身高、体重、体质指数、臀围、腰围、血尿酸与腰椎及股骨颈骨密度呈正相关(P0.05)。进行多因素回归分析发现,年龄、体质指数、体脂含量、碱性磷酸酶、血尿酸、血肌酐等与腰椎骨密度相关(P0.05),年龄、体质指数、碱性磷酸酶、血尿酸与股骨颈骨密度相关(P0.05)。结论不同糖耐量人群骨密度存在差异,并且受多种因素影响,血清OPG水平可能与糖尿病患者骨密度变化相关。     

补肾活血汤联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的疗效分析

目的探讨补肾活血汤联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折(osteoporotic thoracolumbar compression fracture,OTCF)的疗效及对患者血清骨保护素(osteoprotegerin,OPG)和核因子κB受体活化因子配体(receptor activator of nuclear factor kappa-Βligand,RANKL)含量的影响。方法本研究共筛选OTCF患者92例,按数字表法随机分为对照组和治疗组,每组均46例。对照组予经皮椎体成形术。在对照组基础上治疗组予补肾活血汤干预,每天1剂,每日两次。比较两组治疗前后腰背痛Oswestry功能障碍指数、疼痛VAS评分及腰椎正位(L_2~L_4)和右股骨颈的骨密度(bone density determination,BMD)。根据中国人骨质疏松症生存质量简明量表(Chinese osteoporosis quality of life short-form questionnaire,COQOL)评定两组治疗前后生存质量积分。检测两组血清中OPG和RANKL水平。结果与对照组相比,治疗组治疗后Oswestry功能障碍指数和VAS评分减少更显著,腰椎正位(L_2~L_4)和右股骨颈的BMD水平升高更明显(P0.01)。治疗后,治疗组患者的COQOL积分显著少于对照组(P0.01)。与对照组相比,治疗组患者血清OPG含量显著高于对照组,而RANKL明显低于对照组(P0.01)。结论补肾活血汤联合经皮椎体成形术治疗OTCF疗效显著,调节患者体内OPG和RANKL含量可能是其疗效途径之一。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。