慢性肾脏病患者骨代谢与尿蛋白量的关系

目的 研究慢性肾脏病（CKD）患者骨代谢状况与尿蛋白量的关系。 方法 随机挑选2008年1月至2009年5月在本院肾活检证实为原发性肾小球疾病的CKD患者71例为对象。按尿蛋白量分为3组：A组25例,尿蛋白量<1.0 g/24 h;B组16例,尿蛋白量 （1.0~<3.5） g/24 h;C组30例,尿蛋白量≥3.5 g/24 h。健康体检者58例为健康对照组。常规测定血清白蛋白、24 h尿蛋白量及血清钙、磷、PTH、25羟基维生素D3[25-(OH)D3]、骨钙素（BGP）、I型胶原吡啶交联C终端肽（CTx）及尿钙/肌酐（UCa/Cr）等骨代谢指标。双能X线骨密度仪检测患者骨密度（BMD）。对各因素间进行Pearson相关分析。 结果 与健康对照组比较,A、B、C组CKD患者血钙分别为（2.23±0.08）、（2.13±0.09）、（2.04±0.06）比 （2.37±0.12） mmol/L;血25-（OH）D3分别为（50.19±6.58）、（47.78±6.69）、（42.42±10.85）比（56.34±8.34） nmol/L（均P < 0.05）;而UCa/Cr显著升高,分别为0.25±0.11、0.34±0.13、0.41±0.05比0.14±0.06（均P < 0.05）。B、C组血BGP分别为（18.69±7.35）、（16.13±5.76） μg/L,显著低于健康对照组的（22.88±6.21） μg/L;血CTx分别为（413.59±114.93）、（516.21±314.25） ng/L,显著高于健康对照组的（304.53±234.15） ng/L（均P < 0.05）。A、B两组BMD与健康对照组差异无统计学意义;C组BMD显著低于健康对照组[（1.028±0.090）比（1.090±0.062） g/cm2,P < 0.05]。Pearson相关分析显示,24 h尿蛋白量与血钙、血 25-(OH)D3呈负相关,与UCa/Cr 呈正相关;UCa/Cr与血CTx 呈正相关,与血BGP呈负相关;25-(OH)D3与BGP呈正相关,与CTx呈负相关。 结论 原发性肾小球疾病CKD患者的骨代谢异常主要表现为骨形成降低,骨吸收增加,其变化与蛋白尿程度相关,而大量尿蛋白患者骨代谢显著异常。     

糖皮质激素诱导胰岛素样生长因子1降低对原发性肾病综合征患者骨代谢的影响

目的 观察糖皮质激素（GC）治疗的原发性肾病综合征（PNS）患者胰岛素样生长因子1（IGF-1）变化,探讨其水平改变对PNS患者骨代谢的影响及意义。 方法 以本院2008年1月至2009年8月临床资料完整的PNS患者39例为对象。口服泼尼松0.8~1.0 mg&#8226;kg-1&#8226;d-1,完全缓解2周后,以每2周减去原剂量的5％～10％的方式减量。最终每日或隔日5～10 mg维持（总疗程>24周）。测定应用激素前、治疗第4、8、12、24周末血白蛋白、24 h尿蛋白量、血清钙、磷、甲状旁腺激素（PTH）、25羟基维生素D3（25-（OH）D3）、骨钙素（BGP）、I型胶原吡啶交联C终端肽（CTx）及尿钙/肌酐;双能X线骨密度仪检测患者骨密度（BMD）;酶联免疫法测定血清IGF-1水平。使用Pearson 相关分析探讨IGF-1与骨代谢改变的关系。 结果 36例完成随访,并具备完整临床数据。治疗第4、8、12和24周与治疗前比较,患者血钙、25-（OH）D3水平均呈时间依赖性升高（P < 0.05）,相关分析提示,与尿蛋白量呈负相关 （r=-0.749,r=-0.831,P < 0.05）。骨形成指标血BGP、IGF-1水平呈时间依赖性降低（P < 0.05）,骨吸收指标CTx逐渐升高,至第12周起差异有统计学意义（P < 0.05）。第4周各部位BMD与治疗前差异均无统计学意义;第8周起腰椎（L1~L4）BMD值较治疗前显著下降（P < 0.05）;第 24 周,股骨颈和股骨干的BMD与治疗前差异有统计学意义（P < 0.05）。PNS患者经糖皮质激素治疗后,IGF-1与BMD和BGP呈正相关（r=0.495和r=0.896,均P < 0.05）,与血CTx呈负相关（r=-0.697,P < 0.05）。 结论 糖皮质激素呈时间依赖性导致PNS患者血清IGF-1水平降低。IGF-1下降与患者早期骨形成指标降低、骨吸收指标增高及后期骨密度下降相关。IGF-1途径可能参与GC 引起的PNS患者骨代谢改变。IGF-1有望成为反映或预测糖皮质激素诱导的骨质疏松的新型生化指标。     

血清胰岛素样生长因子-1与原发性肾病综合征患儿骨代谢情况的相关性研究

目的:探讨血清胰岛素样生长因子1(IGF-1)与原发性肾病综合征患儿骨代谢情况的相关性。方法:选取2018年02月—2020年02月本院儿科52例PNS患儿为PNS组,52例健康儿童为对照组;测定血清中IGF-1、Alb、PTH、25-羟基维生素D、骨保护素(OPG)、骨钙素(BGP)及钙磷浓度等反应患儿骨代谢情况的指标。结果:与健康儿童组相比,PNS组尿蛋白量显著升高(P=0.014),Alb显著降低(P=0.023),血肌酐浓度(Scr)显著上升(P=0.006),血尿素氮水平显著升高(P=0.013);Ca²⁺、IGF-1、25-羟基维生素D、OPG和BGP较对照组比较显著降低,差异有统计学意义(P<0.05);PNS组血清IGF-1与尿蛋白量呈负相关(r=-0.784,P=0.034),与骨形成指标BGP呈正相关(r=0.819,P=0.021),与25-羟基维生素D呈正相关(r=0.507,P=0.014);评估IGF-1用于诊断PNS的ROC,曲线下面积为0.768,敏感度为65.37%,特异度为80.97%,95%CI为0.696～0.841(...     

Ⅰ型神经纤维瘤病伴脊柱侧凸患者骨密度与血清骨钙素和骨代谢生化指标的相关性

【摘要】 目的：探讨Ⅰ型神经纤维瘤病（neurofibromatosis type 1,NF1） 伴脊柱侧凸患者骨密度（BMD）与血清骨钙素（BGP）及骨代谢生化指标的相关性。方法：选取2012年2月~2013年3月我院脊柱外科收治的17例NF1伴脊柱侧凸（NF1-S）患者为观察对象（病例组）,年龄8~18岁,Cobb角40°~143°;17例正常儿童及青少年作为对照组,年龄7~19岁。两组均采用双能X线骨密度吸收仪测量非优势侧的股骨近端和腰椎（L2~L4）的BMD,同时采用免疫分析仪检测BGP水平,血生化分析仪检测碱性磷酸酶（ALP）、血钙（血Ca）、血磷（血P）、尿钙/肌酐比值（尿Ca/Cr）和尿磷/肌酐比值（尿P/Cr）。应用SPSS 16.0软件进行统计分析,采用独立样本t检验分析两组BMD及各项骨代谢生化指标之间的差异;Pearson相关分析病例组患者腰椎BMD与对应各项骨代谢生化指标的相关关系。结果：两组受试者年龄、性别构成比无统计学差异（P>0.05）。病例组所测各部位BMD均明显低于正常对照组,差异有显著性（P<0.05）;BGP（135.6ng/ml）、血Ca（2.59mmol/L）、血P（1.75mmol/L）、尿Ca/Cr（0.10mg/mg）均高于正常对照组（79ng/ml、2.45mmol/l、1.47mmol/l、0.06mg/mg）,差异均具有显著性（P<0.05）,而ALP（141.6u/L vs 141.8u/l,t=3.611,P=0.991）和尿P/Cr（0.47mg/mg vs 0.46mg/mg,t=0.054,P=0.957）则无显著性差异（P>0.05）。NF1-S患者腰椎BMD与BGP（r=-0.916,P=0.000）、尿Ca/Cr（r=-0.968,P=0.000）存在显著性负相关。结论：NF1-S患者BMD明显低于正常人;BGP、血Ca、血P和尿Ca/Cr均高于正常人,测定BGP、尿Ca/Cr水平是监测NF1-S患者BMD变化较为敏感的方法之一。     

各期慢性肾脏病患者骨代谢生化指标与骨密度的相关性

目的 观察各期慢性肾脏病（CKD）患者血清骨代谢生化指标与骨密度（BMD）的变化情况及其相关性,探讨这些指标在肾性骨营养不良（ROD）早期诊断中的意义。 方法 78例入选患者共分6组,其中Ccr≥15 ml/min者按CKD临床1~4期分期标准分为4组; Ccr <15 ml/min者按是否行规律血液透析而分为2组。ELISA法测定骨保护素(OPG)。放射免疫法测定血清骨钙素（OC）、降钙素(CT)。化学发光法测定甲状旁腺素(iPTH)。6组患者中共47例行腰椎及股骨不同部位BMD测定。分析各组患者以上指标的差异及其相关性。 结果 （1）血清OPG、iPTH及磷分别从CKD 3、4、5期开始显著上升（P < 0.01）,其中OPG在血液透析后达（5.10±1.34）ng/L,显著高于透析前的（3.35±0.76） ng/L,差异有统计学意义（P < 0.05）。各期CKD患者血清OC、CT、钙及碱性磷酸酶水平差异无统计学意义,而血液透析可使OC显著升高（P < 0.05）。股骨沃德三角BMD在 CKD 4期患者下降至0.77±0.09,显著低于CKD 1期患者的1.15±0.05,差异有统计学意义（P < 0.01）,而血液透析不影响其水平。（2）血清OPG与Ccr、磷、iPTH、OC呈负或正相关（r分别为-0.70、0.51、0.39、0.36,均P < 0.01）。股骨沃德三角BMD与血清iPTH、OC呈负相关（r分别为-0.59、-0.51,均P < 0.01）;与血清磷、OPG亦呈负相关（r分别为-0.45、-0.48,均P < 0.05）。 结论 CKD患者骨代谢生化指标与BMD均随Ccr下降而出现明显异常,这些变化之间存在一定的相关性。血清OPG改变早于iPTH及BMD,在ROD的早期诊断中意义最大。血液透析可使血清OPG、OC水平升高,但不影响BMD水平。     

慢性肾脏病3～4期患者骨矿物质代谢紊乱的调查

目的 调查慢性肾脏病（chronickidney disease,CKD）3 ～4期患者慢性肾脏病矿物质及骨代谢紊乱（chronic kidney disease-mineral and bone disorder,CKD-MBD）的状况和检测有关骨代谢的指标.方法 检测111例CKD3～4期患者的血钙、血磷、血清全段甲状旁腺素（intact parathyroid hormone,iPTH）,并随机对其中20例患者行25羟维生素D[25（OH）D]及骨性碱性磷酸酶（bone-alkaline phosphare,b-ALP）的检测.结果 CKD3 ～4期患者矫正钙分别为（2.25 ±0.12 mmol/L）和（2.20±0.14 mmol/L）,血磷分别为（1.20 ±0.23 mmol/L）和（1.36 ±0.28 mmol/L）,iPTH分别为（73.18±51.77pg/mL）和（118.95±64.97pg/mL）,低钙血症的发生率分别为2.22％和6.06％,高磷血症的发生率分别为0％和7.58％,SHPT的发生率分别为37.78％和48.48％.CKD4期患者与CKD3期的患者相比,血钙显著性下降（P＜0.05）,iPTH水平显著升高（P＜0.05）,iPTH水平与血磷（r=0.103,P＞0.05）成正相关,与GFR（r=-0.422,P＜0.01）、血钙（r=-0.268,P＜0.01）成负相关.多元逐步回归分析显示,血钙、血磷、GFR是iPTH的独立影响因素（复相关系数R=0.482,p＜0.05）.CKD3～4期患者b-ALP（74.476±56.056ng/mL）,显著高于健康人（24.141±14.741ng/mL）（P＜0.01）,而25（OH）D（173.763±52.375ng/mL）显著低于健康人（306.995±93.085ng/mL）（P＜0.05）.结论 CKD早期患者存在CKD-MBD及骨代谢异常,且随着疾病的进展而愈加明显,应重视并早期干预,从而改善预后.     

不同分期慢性肾脏病患者BMD水平与IGF-1表达的 相关性研究

目的研究不同分期慢性肾脏病患者血清胰岛素样生长因子-1(IGF-1)的表达与骨密度(BMD)的相关性。方法选取CKD2~5期患者各25例,应用DEXA骨密度仪测定1-4腰椎前后位BMD和T值,检测血清IGF-1水平及其他相关生化指标的表达。结果 CKD5期患者BMD和T值与体检人群有明显差异(P0.05),血清IGF-1值显著减少(P0.01),血清甲状旁腺激素(iPTH)及碱性磷酸酶(ALP)明显增高(P0.01),且血清IGF-1水平与BMD呈正相关(r=0.673)。结论 BMD测定敏感性较高,是目前早期诊断肾性骨病的较好方法;血清IGF-1值不仅可反应骨转换水平高低,而且与慢性肾脏病5期患者BMD的变化相平行,对CKD患者肾性骨病早期诊治和严重程度的判断中亦具有重要临床价值。     

老年男性骨质疏松患者血清胰岛素样生长因子、内皮素与骨钙素及骨转换生化指标的相关性研究

目的 探讨老年男性骨质疏松患者血清胰岛素样生长因子、内皮素与骨钙素及骨转换生化指标水平的变化及相关性。方法 采用酶联免疫法（ELISA）检测70例老年男性骨质疏松组（OP）及50例正常老年男性对照组（NS）的血清胰岛素样生长因子（IGF-1）、内皮素（ET-1）、骨钙素（BGP）、抗酒石酸酸性磷酸酶-5b（TRACP-5b）,采用美国NORLAND双能X线骨密度仪测定腰椎（L2-4）的骨密度。结果 与对照组比较,OP患者的血清IGF-1、BGP和腰椎BMD明显的降低（P<0.05）,而血清ET-1、TRACP-5b明显升高（P<0.05）;老年男性血清IGF-1与BMD、BGP成明显的正相关（P<0.05）,而与ET-1、TRACP-5b成明显的负相关（P<0.05）,ET-1与IGF-1、BMD、BGP成明显的负相关（P<0.05）,而与TRACP-5b成明显的正相关（P<0.05）。结论 血清内皮素的升高,胰岛素样生长因子的降低在老年男性骨质疏松患者的发病机制中可能发挥重要的作用。     

慢性肾脏病患者尿血管紧张素原与肾脏肾素血管紧张素系统活性的相关性

目的 探讨慢性肾脏病（CKD）患者尿血管紧张素原（AGT）与肾损伤指标及肾脏局部肾素血管紧张素系统（RAS）活性的关系。 方法 用放射免疫法和酶联免疫吸附法（ELISA）测定血、尿RAS组分的浓度,并用免疫组织化学方法评价肾内肾素、AGT、血管紧张素Ⅱ（Ang Ⅱ）和血管紧张素Ⅱ受体的表达。分析129例CKD患者尿AGT与临床指标的相关性以及73例行肾组织活检的CKD患者尿AGT与肾脏局部RAS组分表达的相关性。 结果 129例CKD患者尿AGT （159.08±125.18）μg/g Cr,Scr（113.20±105.05） μmol/L,估算肾小球滤过率(eGFR)（58.52±27.15） ml·min-1·(1.73 m2)-1,尿蛋白量（2.03±2.65） g/24 h,尿AngⅡ（164.71±139.25） ng/g Cr,尿Ⅳ型胶原（447.60±800.66）μg/g Cr,尿钠（162.17±81.61） mmol/24 h。 经Pearson单因素相关分析,尿AGT与eGFR （r = -0.55,P < 0.01）、尿钠 （r = -0.20, P < 0.05）呈负相关;与Scr（r = 0.51,P < 0.01）、24 h尿蛋白量（r = 0.30,P < 0.01）、尿Ang Ⅱ（r = 0.20, P < 0.05）及尿Ⅳ型胶原（r = 0.47,P < 0.01）呈正相关。多元回归分析发现尿AGT与eGFR呈负相关（P < 0.01）,与Scr（P < 0.01）、24 h尿蛋白量（P < 0.05）、尿AngⅡ（P < 0.05）、尿Ⅳ型胶原（P < 0.01）呈正相关。73例CKD患者肾活检组织中,尿AGT与肾脏AGT（r = 0.45,P < 0.01）、AngⅡ（r = 0.52,P < 0.01）和AngⅡ 1型受体（r = 0.28,P < 0.05）免疫组化阳性面积呈正相关。 结论 尿AGT可能是反映CKD肾脏损伤尤其是慢性损伤程度的指标,可作为肾脏局部AngⅡ活性的无创评价指标。     

老年女性骨质疏松患者血清IGF-1和ET-1水平变化的意义

目的探讨老年女性骨质疏松患者血清胰岛素样生长因子-1(IGF-1)和内皮素-1(ET-1)水平变化的意义。方法选取93例老年女性骨质疏松患者作为病例组,并选取同期50例老年女性健康者作为对照组。采用ELISA法检测血清IGF-1和ET-1水平及骨代谢指标;采用双能X线骨密度(BMD)测量仪对每位研究对象L1~4椎体处和股骨颈的BMD进行检测。采用Pearson相关分析对变量间相关关系进行分析。结果病例组IGF-1、骨钙素(BGP)、骨碱性磷酸酶(BAP)和BMD水平均低于对照组,而ET-1、Ⅰ型胶原交联羧基端肽(CTX-1)和抗酒石酸酸性磷酸酶5b(TRACP-5b)水平均高于对照组,差异均有统计学意义(P0.001)。Pearson相关分析显示,病例组血清IGF-1水平与ET-1、CTX-1和TRACP-5b呈负相关(P0.05),而与BGP、BAP和BMD呈正相关(P0.05);病例组血清ET-1水平与BGP、BAP和BMD呈负相关(P0.05),而与CTX-1和TRACP-5b呈正相关(P0.05)。结论老年女性骨质疏松患者血清IGF-1水平降低而ET-1水平升高,且与BMD和骨代谢指标密切相关,可能共同参与了骨质疏松发病过程。     

Effect of etidronate disodium on bone turnover following surgical menopause

Summary A longitudinal study was performed to document the effect of surgical menopause and postmenopausal etidronate disodium therapy on several nonhistomorphometric indices of bone turnover. Twenty healthy, premenopausal women undergoing oophorectomy for nonmalignant conditions were studied preoperatively and at 3 monthly intervals postoperatively. Sequential measurements of serum calcium (Ca), alkaline phosphatase (AP), bone Gla protein (BGP), and urinary calcium and hydroxyproline excretion, expressed as a ratio of urinary creatinine (UCa/Cr and UOHp/Cr, respectively) were obtained. Twenty-four-hour whole body retention of diphosphonate (WBR) and radial bone density were also measured. When a postoperative increase in bone turnover was observed, patients were randomized to receive either 400 mg etidronate disodium daily or placebo for 3 months. Oophorectomy was associated with a significant increase in WBR, Ca, AP, and BGP and an insignificant rise in UCa/Cr. A variable pattern of UOHp/Cr was seen. Patients on placebo maintained these elevated levels of Ca, BGP, and UCa/Cr. WBR and AP continued to rise. Etidronate disodium therapy resulted in a fall towards premenopausal levels in WBR, Ca, and UCa/Cr. AP and BGP were unchanged. Three months after stopping etidronate, BGP fell significantly and the decrease in Ca was maintained; however, WBR and UCa/Cr had returned towards pretreatment values. Bone density measurements did not change significantly. An increase in several of the indices of bone turnover was seen following oophorectomy. Etidronate disodium suppressed this increase, affecting indices of both resorption and formation. This effect on formation may be an unavoidable consequence of normal resorption-formation coupling. The ability of etidronate alone to maintain postmenopausal bone mass has yet to be established. However, the suppressive effect of this diphosphonate on the accelerated bone turnover found after oophorectomy suggests that etidronate may have a potentially useful role as an inhibitor of resorption in a pulsed regimen.     

维生素K2结合钙剂在甲状腺功能亢进症继发骨质疏松症中的临床应用

目的探讨维生素K_2对甲状腺功能亢进性骨质疏松症患者骨密度、骨代谢指标及细胞因子水平变化的影响。方法选取2014年7月至2015年7月来我院治疗的57例甲状腺功能亢进性骨质疏松症患者作为研究对象,随机分为治疗组(n=29)和对照组(n=28)。对照组给予钙剂治疗,治疗组给予维生素K2联合钙剂治疗,为期12个月。检测所有对象治疗前后髋部及腰椎的骨密度(bone mineral density,BMD)、骨代谢指标[骨钙素(osteocalcin,BGP)和总I型前胶原氨基端延长肽(total Nterminal propeptide of type I procollagen,PINP)]以及细胞因子[胰岛素样生长因子-1(insulin-like growth factor,IGF-1)、白细胞介素(interleukin,IL)-2、6(IL-2、IL-6)],并进行比较。结果治疗前,两组患者的BMD、BGP、PINP及IL-2、IL-6和IGF-1比较差异无统计学意义(P0.05);治疗12个月后,治疗组髋部及腰椎的BMD水平显著高于对照组(P0.05);治疗组BGP、PINP水平显著低于对照组(P0.05);治疗组IL-2水平显著高于对照组(P0.05);治疗组IL-6和IGF-1水平显著低于对照组(P0.05)。结论维生素K2可以明显提高甲状腺功能亢进性骨质疏松患者的骨密度、降低骨转换,提高IL-2表达且降低IL-6和IGF-1水平,对骨质疏松有保护作用。     

妊娠妇女性激素、骨密度、骨代谢生化指标的变化及相关性研究

目的：探讨妊振妇女骨密度和骨代谢的变化及其与性激素的关系。方法：随机选取63例健康脑力劳动孕妇和21例健康脑力劳动妇女分别测定骨密度,血清Ca、P、ALP、BGP和E2、P、FSH、LH、PRL以及尿HP/Cr、Ca/Cr比值。结果：孕期骨密度虽有下降但无显变化（P＞0.05),ALP和BGP在晚孕期有显变化（P＜0.05)且此变化与E2成正相关（r=0.61、0.36)。结论：妊娠期骨密度虽无明显变化,但晚孕期骨转换率明显增加且与E2呈正相关。提示可通过测定E2了解孕期骨代谢情况,并及时予以补钙等措施可能有益。     

Acute Effects of Calcitonin Nasal Spray on Serum C-telopeptide of Type 1 Collagen (CTx) Levels in Elderly Osteopenic Women with Increased Bone Turnover

Salmon calcitonin is a potent inhibitor of osteoclastic activity. The effect of calcitonin in elderly women with high bone turnover at higher risk of developing osteoporosis has not been studied. To investigate acute effects of calcitonin treatment on bone resorption markers in elderly women, we conducted a randomized trial in women >65 years of age with high bone turnover assessed as urinary N-telopeptide of type-I collagen (NTx) levels 1 SD higher than mean premenopausal levels, which was irrespective of bone density. A total of 98 elderly women were randomly assigned to receive either 200 IU calcitonin nasal spray (n = 75) with calcium (500 mg) and vitamin D (200 IU) or calcium and vitamin D (n = 23) alone for 6 months. Blood and urine samples were collected at 0, 2, 4, and 6 months and analyzed for urinary NTx and serum C-telopeptide of type-1 collagen (CTx). At baseline, mean age was 72.1 ± 4.7 (mean ± SD) in the calcitonin group and 72.2 ± 6 years in the control group. The spine and total hip BMD, serum PTH levels and urinary calcium/creatinine ratios were similar in both groups. Mean BMD was in the osteopenic range in both groups. Calcitonin treatment resulted in significant decreases in serum CTx levels, 2, 4 and 6 months after treatment as compared to baseline, and after 4 and 6 months as compared to controls. A maximum decrease from baseline of 33% was seen at 6 months. The urinary resorption marker, urine NTx, showed a significant decrease in the calcitonin group when compared to baseline only at the 6-month time point. Analysis of least significance change (LSC) showed that 70% of calcitonin patients were categorized as responders using serum CTx after 6 months of treatment. We conclude that 200 IU calcitonin effectively decreases bone resorption within 60 days of therapy, thus preventing further bone loss in elderly women who are at a high risk of developing osteoporosis.     

中药龟丝补骨片对绝经后早期妇女骨转换指标和骨密度的影响

目的 从中医“肾虚”理论出发，观察中药龟丝补骨片对绝经后早期妇女骨转换指标和骨密度的影响。方法 将63例加岁以上的自然绝经1年以上但不超过5年的健康妇女，先完成中医肾虚证症状量化表调查、并采用DEXA测量BMD，根据骨密度值T-score低于-2．0为标准分为绝经后骨质疏松症组(OP)和非骨质疏松症组(NO)，依就诊次序按1：2比率序贯进入尼尔雌醇组(n)和龟丝补骨片组(g)。单盲观察尼尔雌醇和龟丝补骨片的治疗作用6个月。成功随访率达93．65％。治疗前和后第3、6个月分别检测骨转换标志物血清BGP和尿Dpd／Cr，治疗结束时复查BMD。结果 采用龟丝补骨片治疗后，第6个月无论NO组还是0P组，血清BGP水平均显著升高；尿Dpd／Cr比值更早、更显著地降低，在OP组治疗第3、6个月时降低分别有显著和极显著性意义，OP-g组尿Ca^2 ／Cr排出明显下降。干预治疗第6个月，龟丝补骨片和尼尔雌醇都有增加骨量的作用，各组BMD都有不同程度的升高；且发现对治疗的反应性似乎骨质疏松者比非骨质疏松者好，腰椎较股骨好，其中椎体部分最好，股骨颈最差。结论 龟丝补骨片具有保护绝经早期妇女的骨丢失作用，我们认为，这一保护作用主要与抑制骨吸收、促进骨形成有关。     

Osteoprotegerin and bone mineral density in hemodiafiltration patients

A newly identified cytokine, osteoprotegerin (OPG) appears to be involved in the regulation of bone remodeling. In vitro studies suggest that OPG, a soluble member of the TNF receptor family of proteins, inhibits osteoclastogenesis by interrupting the intercellular signaling between osteoblastic stromal cells and osteoclast progenitors. As patients with chronic renal failure (CRF) often have renal osteodystrophy (ROD), we investigated the role of osteoprotegerin (OPG) in ROD, and investigated whether there was any relationship between serum OPG, intact parathyroid (PTH) (iPTH), vitamin D, and trabecular bone. Serum OPG combined with iPTH might be a useful tool in the noninvasive diagnosis of ROD, at least in cases in which the range of PTH values compromises reliable diagnosis. Thirty-six patients on maintenance hemodiafiltration (HDF) and a control group of 36 age and sex matched healthy subjects with no known metabolic bone disease were studied. The following assays were made on serum: iPTH, osteocalcin (BGP), bone alkaline phosphatase, 25(OH)-cholecalciferol, calcium, phosphate, OPG, IGF-1, estradiol, and free testosterone. Serum Ca++, P, B-ALP, BGP, IGF-1, iPTH, and OPG levels were significantly higher in HDF patients than in controls, while DXA measurements and quantitative ultrasound (QUS) parameters were significantly lower. On grouping patients according to their mean OPG levels, we observed significantly lower serum IGF-1, vitamin D3 concentrations, and lumbar spine and hip bone mineral density in the high OPG groups. No correlation was found between OPG and bone turnover markers, whereas a negative correlation was found between serum OPG and IGF-1 levels (r=-0.64, p=0.032). Serum iPTH concentrations were positively correlated with bone alkaline phosphatase (B-ALP) (r=0.69, p=0.038) and BGP (r=0.92, p<0.001). The findings made suggest that an increase in OPG levels may be a compensatory response to elevated bone loss. The low bone mineral density (BMD) levels found in the high OPG group might have been due to the significant decrease in serum IGF-1 and vitamin D3 observed. In conclusion, the findings made in the present study demonstrate that increased OPG in hemodiafiltration patients is only partly due to decreased renal clearance. As it may partly reflect a compensatory response to increased bone loss, this parameter might be helpful in the identification of patients with a marked reduction in trabecular BMD.     

Osteoprotegerin and Bone Mineral Density in Hemodiafiltration Patients

A newly identified cytokine, osteoprotegerin (OPG) appears to be involved in the regulation of bone remodeling. In vitro studies suggest that OPG, a soluble member of the TNF receptor family of proteins, inhibits osteoclastogenesis by interrupting the intercellular signaling between osteoblastic stromal cells and osteoclast progenitors. As patients with chronic renal failure (CRF) often have renal osteodystrophy (ROD), we investigated the role of osteoprotegerin (OPG) in ROD, and investigated whether there was any relationship between serum OPG, intact parathyroid (PTH) (iPTH), vitamin D, and trabecular bone. Serum OPG combined with iPTH might be a useful tool in the noninvasive diagnosis of ROD, at least in cases in which the range of PTH values compromises reliable diagnosis. Thirty-six patients on maintenance hemodiafiltration (HDF) and a control group of 36 age and sex matched healthy subjects with no known metabolic bone disease were studied. The following assays were made on serum: iPTH, osteocalcin (BGP), bone alkaline phosphatase, 25(OH)-cholecalciferol, calcium, phosphate, OPG, IGF-1, estradiol, and free testosterone. Serum Ca^{+ +}, P, B-ALP, BGP, IGF-1, iPTH, and OPG levels were significantly higher in HDF patients than in controls, while DXA measurements and quantitative ultrasound (QUS) parameters were significantly lower. On grouping patients according to their mean OPG levels, we observed significantly lower serum IGF-1, vitamin D3 concentrations, and lumbar spine and hip bone mineral density in the high OPG groups. No correlation was found between OPG and bone turnover markers, whereas a negative correlation was found between serum OPG and IGF-1 levels (r= ? 0.64, p = 0.032). Serum iPTH concentrations were positively correlated with bone alkaline phosphatase (B-ALP) (r = 0.69, p = 0.038) and BGP (r = 0.92, p < 0.001). The findings made suggest that an increase in OPG levels may be a compensatory response to elevated bone loss. The low bone mineral density (BMD) levels found in the high OPG group might have been due to the significant decrease in serum IGF-1 and vitamin D3 observed. In conclusion, the findings made in the present study demonstrate that increased OPG in hemodiafiltration patients is only partly due to decreased renal clearance. As it may partly reflect a compensatory response to increased bone loss, this parameter might be helpful in the identification of patients with a marked reduction in trabecular BMD.     

老年男性2型糖尿病患者骨密度及骨代谢生化指标的研究

目的：探讨老年男性2型糖尿病患骨密度改变及其机制，以了解2型糖尿病是否易合并骨质疏松及其特点。方法：测定70例老年男性2型糖尿病患及60例年龄、体重指数相匹配的健康对照的骨密度，血清骨钙素（BGP）、抗酒石酸酸性磷酸酶（TRAP）、碱性磷酸酶（ALP）、尿钙（Ca）、尿羟脯氨酸（HOP）、空腹及餐后血糖、糖化血红蛋白（HbA1c）等，两组进行比较。结果：老年男性2型糖尿病患较健康对照组骨密度显降低。BGP浓度显低于对照组（P＜0．001）；TRAP、甲状旁腺素（PTH）、尿钙、HOP显高于对照组（P＜0．05）、糖尿病患BMD与病程、年龄、HbA1C、FBG、PBG呈显负相关，与平均体重指数（BMI)呈正相关。结论：老年男性2型糖尿病患较易患骨质疏松，其骨改变特点是：骨吸收增加，骨形成下降；发病机理主要是血糖升高，钙的排出增多和继发性甲状旁腺功能亢进以及胰岛功能减退。