益钙宁治疗原发性骨质疏松症骨痛的临床体会

益钙宁治疗原发性骨质疏松症骨痛的临床体会李荫太王义生李月白骨质疏松症日渐增多，腰背痛严重。目前尚缺乏理想的药物而难以解决。作者在临床上应用益钙宁治疗具有腰背痛的骨质疏松症３６例，以观察它对骨质疏松症骨痛的疗效。实验选择患者３６例，其中女性２８例，平均...     

密钙息对老年性骨质疏松症所致腰背痛的作用

老年性骨质疏松症引起的腰背痛较常见,既往多用非甾体类消炎镇痛药治疗,多不能彻底解除疼痛。自1993年3月至1998年3月我们应用诺华制药公司(ＮＯＶＡＲＴＩＳ)生产的密钙息(Ｍｉａｃａｌｃｉｃ)治疗该症后效果非常显著,现报告如下。一、材料和方法共62例病人,男40例,女22例,年龄53～92岁,平均60岁。其中门诊病人58例,住院4例,诊原发性骨质疏松症55例,脊柱转移性肿瘤引起的腰背痛2例,因其他部位骨折而长期卧床引起的腰背痛7例。骨质疏松症所致脊柱压缩性骨折10例。诊断依据主要是腰背痛症状和脊柱Ｘ线表现显示明显骨质疏松性改变,有20例行单…     

绝经后骨质疏松症五种治疗方案临床疗效观察 (附389例资料分析）

为探讨绝经后骨质疏松症的有效治疗方案，本文对近年临床实施的五种方案３８９例疗效观察结果作了总结。发现益钙宁（鳗鱼降钙素，ＥｌｃａｔｏｎｉｎＥｌｃ），或其联合方案对止痛效果肯定、迅速；骨密度（ＢＭＤ）也有明显提高。尤其Ｅｌｃ加钙尔奇Ｄ方案效果最好。利维爱（ｌｉｖｉａｌ）加钙尔奇Ｄ有效但缓慢。而单纯钙尔奇Ｄ近期效果不肯定。并对方案与适用人群作出了建议。     

鲑鱼降钙素－密钙息对肺癌骨转移镇痛疗效的观察

自１９９２年１月～１９９３年６月，对６２例肺癌骨转移病例，采用肌注鲑鱼降钙素（密钙息ｍｉａ－ｃａｌｃｉｃ）治疗３０例，肌注安慰剂３２例患者作对照，经随诊６个月，前者获得显著镇痛效果，应用密钙息后可以完全不用麻醉止痛剂——杜冷丁（ｄｏｌａｎｔｉｎ），有效地控制剧烈疼痛，保持患者的生活质量，达到了肺癌骨转移患者的姑息治疗的主要目的。但鲑鱼降钙素的使用，并不能改善骨转移癌的预后，也不能影响肿瘤本身的发展过程与转归，只能作为骨转移癌顽固性骨关节疼痛病例镇痛治疗的一种选择方法。     

补肾中药治疗绝经后骨质疏松症疗效分析

目的：客观评价补肾中药治疗绝经后骨质疏松症治疗作用。方法：绝经后骨质疏松症患者７７例随机分成两组，分别应用补肾中药、密钙息治疗半年。结果：补肾中药、密钙息治疗半年后，骨质疏松症腰背症状明显缓解（Ｐ＜０．５），腰椎骨质密度平均值升高（Ｐ＜０．０５）；尺、桡骨矿物质含量较治疗前明显增加（Ｐ＜０．０５）；两组间无明显差异（Ｐ＞０．０５）。两组治疗后Ｕ－Ｃａ／Ｃｒ、Ｕ－ＨｏＰ／Ｃｒ的测定值均明显下降（Ｐ＜０．０５），但补肾组ＡＫＰ测定值明显上升（Ｐ＜０．０５），密钙息组ＡＫＰ测定值明显下降（Ｐ＜０．０５），ＡＫＰ测定值两组间有明显差异（Ｐ＜０．０５）。结论；补肾中药与密钙息均能较好地治疗绝经后骨质疏松症。提示：补肾中药有促进骨形成的作用，还有成本低、副作用少等优点。     

降钙素对骨质疏松症治疗的临床观察

目的 研究降钙素在骨质疏松症（OP）治疗中对骨密度（BMD）的作用。方法 198例根据自愿选择分为钙剂组92例，降钙素＋钙剂组102例，其中各组按疗程分为3个月和6个月两个亚组；钙剂组：每日口服元素钙600mg，维生素D125U。降钙素＋钙剂组：每日口服元素钙600mg，维生素D125U；鲑降钙素50IU（商品名密钙息，北京诺华制药有限公司），肌肉注射，每d1次，连续14d，接着隔日1次，连续14次，以后为每周2次直至完成疗程。治疗前及疗程结束后，采用双能X线骨密度仪测定前后位k。腰椎及非优势侧（左）股骨颈骨密度。结果 降钙素＋钙剂组缓解疼痛快而有效。降钙素＋钙剂组腰椎和股骨颈骨密度在3个月和6个月治疗后均有显著提高，6个月组骨密度提高大3个月组（P〈0．01），腰椎疗效优于股骨颈。结论 降钙素治疗骨质疏松症有明显疗效，选择适当的长疗程患者受益更大。     

益钙宁干预治疗老年人异位钙化并骨质疏松26例

益钙宁干预治疗老年人异位钙化并骨质疏松２６例杨蕊敏，朱继珩近年文献［‘－‘１提及老年退行性心瓣膜病与骨及软骨组织中钙分布有联系。鳗鱼降钙素能提高骨质疏松病人骨密度亦有不少报告“，’］。为此本组采用益钙宁对同时伴有心瓣膜钙化或前列腺钙化的老年骨质疏松症...     

密钙息治疗骨质疏松性骨折20例临床观察

骨痛和骨折是原发性骨质疏松症(OP)最主要的症状体征。采用密钙息小剂量间歇注射疗法对骨质疏松性骨折有显著的止痛和固钙作用,临床观察20例,总有效率95%,缓解显效率达80％。     

密钙息防治闭经患者骨丢失机制的探讨

本文作者对20例高促性腺激素性闭经患者给予密钙息用药3个月,并于给药前后分别测定空腹尿钙与肌酐(Ca/Cr)、羟脯氨酸与肌酐(OHPr/Cr)比值以及血清雌二醇(E2)、降钙素(CT)和碱性磷酸酶(AKP)的值,以了解上述年轻但已有显著雌激素缺乏的患者其骨代谢对密钙息用药的反应性,结果发现,密钙息给药前后患者之血清AKP及E2的水平差异未见显著性,但其空腹尿Ca/Cr、OH-Pr/Cr比值却均较给药前显著下降(P<0.05或P<0.01)。血清CT的水平较给药前有升高趋势,说明密钙息可抑制高促性腺激素性闭经患者骨质的吸收,促进其骨质的形成,故此密钙息对防治闭经患者骨质疏松的发生有重要的临床意义。     

帕米磷酸钠和降钙素对人工关节磨损微粒引起单核细胞分泌溶骨性因子的影响

目的　探讨帕米磷酸钠和降钙素防治人工关节松动的可能性。方法　采集人体外周血 ,分离单核细胞 ,分组培养。实验分 4组 ,第 1组 :仅单核细胞 ,为对照组 ;第 2组 :单核细胞及微粒 ,为微粒组 ;第 3组 :单核细胞、微粒及帕米磷酸钠 (阿可达 ) ,为阿可达组 ;第 4组 :单核细胞、微粒及降钙素 (密钙息 ) ,为密钙息组。培养 48h后 ,检测细胞上清液中肿瘤坏死因子 (TNF) α、白细胞介素 (IL) 1和IL 6的含量。结果　微粒组的细胞上清液中溶骨性因子含量明显高于对照组 (P <0 .0 1) ;而阿可达组和密钙息组的溶骨性因子含量明显低于微粒组 (P <0 .0 1)。结论　阿可达和密钙息能有效地抑制微粒刺激单核巨噬细胞分泌溶骨性因子 ,从而间接抑制破骨细胞的活性。     

Calcitonin gene-related peptide (CGRP) acts independently of calcitonin on cyclic AMP formation in clonal osteogenic sarcoma cells (UMR 106-01)

Summary In several human cancer cell lines and in a subclone of rat osteogenic sarcoma cells (UMR 106-06) possessing calcitonin receptors and a calcitonin-responsive adenylate cyclase, calcitonin gene-related peptide (CGRP) behaved as a weak calcitonin agonist. In another subclone of the same osteogenic sarcoma (UMR 106-01) with no measureable calcitonin receptors or response, both rat and human CGRP were found to increase cyclic AMP formation in a dose-dependent manner. The data indicate that CGRP is capable of a weak calcitonin-like action in cells with calcitonin receptors, but also that in some cells CGRP activates adenylate cyclase itself, independently of calcitonin receptors.     

Calcitonin kinetics in the early postoperative period of medullary thyroid carcinoma

INTRODUCTION: Calcitonin is a sensitive marker for medullary thyroid carcinoma. Normalisation of calcitonin levels following resection of medullary thyroid carcinoma has been described after a few hours; however, it may be observed more than 4 weeks after surgery. The aim of this study was to correlate the postoperative calcitonin kinetics with preoperative calcitonin levels and tumour stage. Furthermore, we wanted to test the prognostic impact of the calcitonin kinetics. Therefore, only patients with postoperative normalisation of calcitonin levels (biochemical cure) were included in this study. METHODS: Fourteen biochemically cured patients were analysed, including measurement of postoperative basal and pentagastrin-stimulated calcitonin concentration. With respect to the time of postoperative basal calcitonin normalisation, patients were classified into two groups: (A) patients with normalisation of basal calcitonin levels within 24 h and (B) patients with normalisation of basal calcitonin levels later than 24 h postoperatively. RESULTS: Eight patients were found to have normalisation of basal calcitonin levels within 24 h (group A). In the remaining six patients (group B), the period to normalisation of basal calcitonin levels varied from 6 days to 14 days and longer. There were no differences between the two groups with regard to tumour size, number and pattern of lymph node metastases and tumour stage. However, preoperative basal calcitonin levels were significantly different (258 ng/ml vs 955 ng/ml, P<0.01). In the group with slow-decreasing calcitonin levels, no strong correlation between the preoperative level and the postoperative time to normalisation of basal calcitonin levels could be established, which may be due to the small number of patients. After a median follow-up of 21 months, no patient developed tumour recurrence. However, an increased basal calcitonin level was observed in one patient from group B. All other patients had normal basal and peak calcitonin levels. CONCLUSION: Using a highly sensitive calcitonin assay, we demonstrated that normalisation of basal calcitonin levels may be delayed in patients suffering from medullary thyroid carcinoma. The lack of correlation of preoperative levels and the time to normalisation of the basal calcitonin levels, as well as the positive pentagastrin test in some of the patients, argues that this phenomenon is not simply due to prolonged biochemical calcitonin elimination. Nevertheless, a prognostic influence could not be shown in this study due to the short follow up-period. Further investigations and a longer follow-up are necessary to determine the nature and the prognostic impact of delayed normalisation of calcitonin levels.     

Circulating monomer-like calcitonin in osteoporotic patients

Physiological concentrations of monomeric calcitonin can inhibit osteoclastic bone resorption in vitro. We therefore investigated the circulating molecular forms, including monomer-like calcitonin, and their concentrations in 9 men and 9 women with established osteoporosis. Calcitonin was immunoextracted from serum by the use of rabbit calcitonin antibodies coupled to Sepharose 4B. The lyophilized extracts were incubated with 6 M urea overnight and gel chromatographed in a fast protein liquid chromatography (FPLC) system; calcitonin was measured by radioimmunoassay in the fractions. FPLC disclosed immunoreactive calcitonin of three different molecular sizes in the patients. The two largest forms were approximately 30 and 10 kDa and one eluted at the same position as monomeric calcitonin (3.4 kDa). After extraction and FPLC we found slightly higher calcitonin concentrations in osteoporotic women than previously reported levels in age-matched healthy women. Male patients had higher levels than female patients. None of the osteoporotic patients lacked monomer-like calcitonin. There was no significant correlation between the extracted total or monomer-like calcitonin and bone mineral density of the femoral neck. It is concluded that the circulating calcitonin in both male and female patients comprises three different molecular forms and that there is no deficiency of the monomer-like form. The calcitonin levels in the female patients were slightly higher than in a previous control group.     

Effect of seminal plasma calcitonin levels on sperm mobility

This study investigated the effect of the seminal and blood plasma calcitonin levels on the sperm motility in idiopathic infertile patients. The number of sperm cells and their motility were evaluated in the spermiograms of 52 idiopathic infertile patients. The levels of seminal plasma calcitonin were studied with double antibody technique using a DPC kit. Fifty-two patients were divided into 2 groups according to the motility rates of sperm and 20 healthy volunteers were assigned to a control group. The difference between the groups was evaluated by using Kruskall-Wallis and Mann-Whitney U tests, and the correlation of seminal and blood calcitonin levels with sperm motility were determined. The difference in motility rates between the 3 groups was statistically significant (p = .000, p < .05). Blood plasma calcitonin levels were in normal ranges in all cases and no significant difference was found among the 3 groups (chi2 = 2.7219, p = .2589, p > .05). While sperm motility was correlated with seminal calcitonin levels (r = .8581), blood calcitonin levels did not show a correlation with sperm motility rate (r = -.0265). Moreover, there was no correlation between seminal and blood plasma levels of calcitonin (r = -.0010). Motility rates decreased in the patients with low seminal calcitonin levels and seminal calcitonin levels had a significant effect on sperm motility.     

Calcitonin concentrations in patients with chronic kidney disease and medullary thyroid carcinoma or c-cell hyperplasia

It is currently not known which level of pentagastrin-stimulated calcitonin serum concentration indicates medullary thyroid carcinoma in patients with chronic kidney disease (CKD). We examined CKD stage 3-5 patients who had total thyroidectomy because of a pentagastrin-stimulated calcitonin concentration greater than 100 pg/ml, and tested the diagnostic performance of basal and pentagastrin-stimulated calcitonin levels for differentiating medullary thyroid carcinoma and C-cell hyperplasia in this patient population. A total of 180 CKD patients presented with an elevated calcitonin level and had a pentagastrin stimulation test. Forty patients showed a maximum pentagastrin-stimulated calcitonin concentration greater than 100 pg/ml, and 22 patients had a total thyroidectomy. Seven of these 22 patients presented with a medullary thyroid carcinoma, all other patients showed C-cell hyperplasia. Patients with medullary thyroid carcinoma showed higher unstimulated (212 pg/ml (36-577) vs 42 pg/ml (17-150); P < 0.001) and higher maximum pentagastrin-stimulated calcitonin concentrations (862 pg/ml (431-2423) vs 141 pg/ml (102-471); P < 0.001) as compared to patients with C-cell hyperplasia. The sensitivity (100%) and specificity (93%) estimates suggested that a maximum pentagastrin-stimulated calcitonin concentration greater than 400 pg/ml indicates the presence of medullary thyroid carcinoma in patients with CKD. Receiver-operating characteristic (ROC) analysis revealed an area under the ROC plot of 0.99 for maximum pentagastrin-stimulated calcitonin concentrations. A maximum pentagastrin-stimulated calcitonin concentration greater than 400 pg/ml appears to be a clinically meaningful threshold for thyroidectomy.     

74例老年骨质疏松患者应用鲑鱼降钙素联合阿仑膦酸钠治疗的疗效观察

目的　评估联合应用鲑鱼降钙素与阿仑膦酸钠治疗缓解老年性骨质疏松症患者骨关节疼痛及血清骨钙素(BGP)、降钙素(CT)及骨密度(BMD)水平的变化。方法 联合应用鲑鱼降钙素和阿仑膦酸钠治疗本院收治的74例老年性骨质疏松症患者,给予鲑鱼降钙素50IU肌肉注射,隔日1次,连续使用15次后改为口服阿仑膦酸钠1粒/周,共经6个月治疗,采用数字模拟评分法(VAS)比较治疗前、后全身骨关节疼痛程度,治疗前、后骨钙素、降钙素及第2～第4腰椎(L2-4 )、股骨颈、Ward区骨密度水平的变化,并进行统计学分析。结果 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症患者6个月后,对缓解骨关节疼痛症状疗效良好,治疗前与治疗后比较差异显著(P<0.01);治疗前后骨密度、血清骨钙素和降钙素水平均有显著差异（P<0.05）。结论 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症使血清降钙素的水平明显升高,骨钙素水平明显降低,能显著减轻患者骨关节疼痛,改善症状,并增加骨密度,对老年性骨质疏松症有明显的疗效。     

The calcitonin levels can sometimes mislead parathyroid surgeons in patients with chronic kidney disease and renal hyperparathyroidism: report of a case

Renal hyperparathyroidism (rHPT) as a consequence of an abnormal calcium balance is a frequent complication in patients with chronic kidney disease (CKD). However, calcium homeostasis is also regulated by calcitonin. The relevance of elevated calcitonin levels in patients with rHPT is unclear. This report presents a case of a patient with CKD and mild rHPT scheduled for thyroidectomy for a suspected medullary thyroid carcinoma (MTC) within a mononodular goiter. A hemithyroidectomy with resection of both adjacent parathyroid glands and unilateral central lymph node dissection was performed. Histopathology revealed no evidence of MTC. The rHPT, calcitonin and pentagastrin test subsequently normalized and follow-up revealed no evidence for MTC within the remaining right thyroid lobe. Elevated calcitonin levels in patients with CKD may reflect a physiological response to rHPT than rather represent MTC. The thresholds for calcitonin levels need to be better defined in affected patients to determine the optimal extent of surgical resection.     

Multiple endocrine neoplasia type II: the role of gastrointestinal humoral factors in calcitonin release following alcohol and pentagastrin stimulation

Familial medullary carcinoma of thyroid (MCT) can be diagnosed early by measuring stimulated plasma calcitonin following provocation with 50 ml of oral whisky, or 0.5 microgram kg-1 i.v. pentagastrin. The calcitonin release, however, can be variable following both stimuli. To determine whether a humoral mechanism might be involved in mediating this calcitonin release, nine gut peptides, histamine, alcohol, calcium, and calcitonin, were measured in the plasma of eight patients whose family was affected by multiple endocrine neoplasia Type II syndrome. Pentagastrin produced significant rises in plasma calcitonin, histamine and pancreatic polypeptide. Whisky produced a variable rise in plasma alcohol, but significant rises in plasma calcitonin, histamine and pancreatic polypeptide as well as insulin (P less than 0.05). This study suggests that histamine may be the mediator of calcitonin release following provocation by either pentagastrin or alcohol. Histamine infusion requires evaluation as a screening test for MCT in MEN II syndrome.     

鲑鱼降钙素在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用

目的观察鲑鱼降钙素对骨质疏松性椎体压缩骨折行椎体后凸成形术后骨密度及腰背痛症状的改善情况。方法将行椎体后凸成形术后的骨质疏松性椎体压缩骨折患者79例分成两组,鲑鱼降钙素组44例,予以鲑鱼降钙素肌肉注射,术后每天1次100IU,连用3 d后,改为50 IU隔天1次,连用1个月,间歇1个月后再重复,共半年,同时加服维D2磷葡钙;对照组35例,单纯口服维D2磷葡钙,疗程半年。两组治疗前后均测定腰1～腰4椎体及股骨颈骨密度(BMD);并观察患者腰背痛的情况。结果:鲑鱼降钙素组有6例因肌注降钙素出现面部潮红和皮肤瘙痒等反应停止疗程,其余38例和对照组35例得到了随访。鲑鱼降钙素组腰椎及股骨颈BMD较治疗前明显升高(P<0.01),对照组各部位骨密度较治疗前无明显改变(P>0.01)。鲑鱼降钙素组没有病例再次出现腰背痛,而对照组在半年内有7例再次出现腰背痛,经腰椎MRI证实发生其他节段的椎体压缩骨折。结论:鲑鱼降钙素与钙剂联合治疗行椎体后凸成形术后的骨质疏松性椎体压缩骨折患者,可以提高患者的骨量,降低再骨折的风险。