绝经后骨质疏松性腰椎骨折骨代谢指标的变化

目的了解雌二醇和白细胞介素-6等骨代谢指标在骨质疏松症发病中的作用。方法选择女性腰椎骨折患者120例,绝经后有骨质疏松者60例(OP组),绝经后无骨质疏松者30例(NOP组),另外选择绝经前妇女30例为对照组。对120名妇女雌二醇、骨密度、白细胞介素-6、血清总碱性磷酸酶、骨钙素、尿羟脯氨酸肌酐比值、尿钙肌酐比值等指标进行了测定。结果绝经后妇女骨形成指标骨钙素及碱性磷酸酶明显高于对照组妇女,其中碱性磷酸酶在OP组和NOP组间有差异,而骨钙素在OP组和NOP组间无差异;绝经后妇女骨吸收指标尿羟脯氨酸肌酐比值及尿钙肌酐比值明显高于对照组妇女,OP组又明显高于NOP组;绝经后妇女的血清雌二醇的含量明显低于对照组(绝经前妇女),OP组又明显低于NOP组;绝经后妇女血清白细胞介素-6的含量明显高于对照组妇女,而OP组又明显高于NOP组。结论雌二醇、白细胞介素-6等骨代谢指标与骨质疏松关系密切。这充分说明雌激素水平的下降,IL-6分泌增多,导致骨吸收加速。     

绝经后骨质疏松症患者骨密度及骨代谢参数的调查研究

目的 了解E2和IL－6在骨质疏松症发病中的作用。方法 选择绝经后妇女120例，绝经后有骨质疏松60例（OP组），绝经后无骨质疏松60例（NOP组），另外选择绝经前妇女60例为对照组。对180名妇女雌二醇（E2）、骨密度（BMD）、白细胞介素－6（IL－6）、血清总碱性磷酸酶（ALP）、骨钙素（BGP）、尿羟脯氨酸肌酐比值（尿Hoc/Cr)、尿钙肌酐比值（尿Ca/Cr)等指标进行了测定。结果 绝经后妇女骨形成指标BGP及ALT明显高于对照组妇女，其中ALP在OP组和NOP组间有差异，而BGP在OP组和NOP组间无差异；绝经后妇女骨吸收指标尿HOP／Cr及尿Ca/Cr明显高于对照组妇女，OP组尿HOP／Cr及尿Ca/Cr又明显高于NOP组；绝经后妇女的血清E2的含量明显低于对照组（绝经前妇女），OP组又明显低于NOP组；绝经后妇女血清IL－6的含量明显高于对照组妇女，而OP组又明显高于NOP组。结论 本研究证明E2、IL－6与骨质疏松关系密切，雌激素水平的下降，IL－6分泌增多，是导致骨吸收加速的重要原因之一。     

黔岭藿合剂对大鼠去势后骨质疏松症的作用

黔岭藿合剂是一个治疗骨质疏松症的复方。雌性大鼠去势后３个月建立绝经后高转型骨质疏松症模型，分为模型组，中药组，尼尔雌醇组。治疗３个月后，中药组，尼尔雌醇组较模型组空腹尿钙／尿肌酐，尿羟脯氨酸／尿肌肝比值均明显降低。血清雌二醇，骨矿含量和骨密度无升高；而中药组血清骨钙素高于尼尔雌醇组，模型组，尼尔雌醇组血清碱性磷酸酶均低于中药组，模型组。     

强骨胶囊联合鲑鱼降钙素针剂辅助治疗老年骨质疏松性压缩骨折临床观察

目的探讨强骨胶囊联合鲑鱼降钙素针剂辅助治疗老年骨质疏松性压缩骨折临床疗效及影响。方法 257例胸腰椎骨质疏松性骨折患者随机分为3组,观察组口服强骨胶囊同时肌肉注射鲑鱼降钙素注射液,对照I组口服强骨胶囊,对照Ⅱ组肌肉注射鲑鱼降钙素针剂。观察临床疗效,测定治疗前和治疗后骨密度(BMD),血骨钙素(BGP)、血钙、血磷浓度及碱性磷酸酶。尿液中尿钙,尿羟脯氨酸,尿肌酐的含量,并计算尿钙/尿肌酐与羟脯氨酸/尿肌酐比值。结果观察组总有效率明显优于对照I组和对照II组(P0.05)。治疗后,3组BMD明显升高,痛觉评分均明显降低(P0.01),尤其观察组更加明显(P0.05)。治疗后,3组骨钙素较治疗前有明显的升高(P0.05或0.01),碱性磷酸酶和羟脯氨酸/尿肌酐较治疗前有明显的下降(P0.05或0.01),尤其治疗组明显优于对照I组和对照II组。治疗后对照组I组和观察组血钙较治疗前有明显的下降(P0.05),但3组组间无差异性(P0.05)。治疗后,3组血磷和尿钙/尿肌酐较治疗前变化不明显,组间比较无差异性(P0.05)。结论骨胶囊和鲑鱼降钙素治疗老年骨质疏松性骨折疗效肯定,能缓解疼痛,促进愈合和降低骨折的再发生,无明显不良反应。     

糖尿病雄性大鼠骨代谢特点的观察

目的观察Ⅰ型糖尿病雄性大鼠骨代谢的特点以及骨密度和骨组织形态计量学指标的变化。方法采用高糖高脂饮食加腹腔注射小剂量链脲佐菌素诱导建立Ⅱ型糖尿病大鼠模型。20周后处死大鼠,测定股骨和腰椎骨密度、骨形态计量学以及骨代谢相关指标（血清骨钙素、抗酒石酸酸性磷酸酶、24h尿Ca、24h尿羟脯氨酸）,此外还观察了GHbAlc、胆固醇、低密度脂蛋白-胆固醇、胰岛素样生长因子-1等变化。结果Ⅱ型糖尿病大鼠血清骨钙素、股骨和腰椎骨密度以及骨形态计量学指标反映骨形成参数均明显低于正常对照组,而血抗酒石酸酸性磷酸酶活性和尿钙、尿羟脯氨酸排出量以及形态计量学反映骨吸收参数均明显高于正常大鼠。结论Ⅱ型糖尿病大鼠的骨吸收加快丽骨形成不足。导致其骨量下降和骨形态计量学特性改变。     

醋酸甲羟孕酮长效避孕对骨代谢影响的临床研究

目的 观察醋酸甲羟孕酮（DMPA）对妇女骨质代谢的影响.方法 120位使用DMPA避孕者随机分为150 mg和100mg两个组,每组60例,采用避孕套避孕者60例组成对照组,测定血清雌二醇（E2）、血清碱性磷酸酶（AKP）、尿钙/肌酐（Ca/Cr）、尿羟脯氨酸/肌酐（Hyp/Cr）及非惯用臂桡尺骨远端骨矿含量（BMC）、骨矿密度（BMD）.结果 3组血清雌二醇、血清碱性磷酸酶、尿钙/肌酐、尿羟脯氨酸/肌酐差异均无显著性（P＞0.05）,各组非惯用臂桡尺骨远端骨矿含量、骨矿密度差异均无显著性（P＞0.05）.结论 使用DMPA避孕一年对妇女骨质代谢无影响.     

鲑鱼降钙素联合葡萄糖酸钙对老年性骨质疏松骨代谢指标的影响

目的 探讨鲑鱼降钙素联合葡萄糖酸钙对老年性骨质疏松骨代谢指标的影响.方法 105例老年性骨质疏松患者随机分为两组:鲑鱼降钙素组56例,给予鲑鱼降钙素和葡萄糖酸钙治疗;对照组49例,单纯给予葡萄糖酸钙治疗.治疗24周后比较治疗前后血清钙、磷、碱性磷酸酶(ALP)、骨碱性磷酸酶(B-ALP)、骨钙素(BGP)及尿中钙/肌酐比值和骨密度的变化.结果 治疗24周后,鲑鱼降钙素组血清骨钙素和骨密度均明显升高(P<0.05),血B-ALP和尿钙/肌酐比值均显著下降(P<0.01),对照组均无显著改变.两组血ALP、钙、磷浓度无显著改变(P>0.05).结论 鲑鱼降钙素联合葡萄糖酸钙疗法治疗老年性骨质疏松、改善骨代谢优于单纯葡萄糖酸钙疗法;联合治疗能改善老年性骨质疏松骨代谢异常,影响骨矿化,促进骨形成.     

被动吸烟对大鼠骨代谢和血浆TNF水平的影响

目的探讨吸烟诱导骨吸收的可能机理。方法将32只Wister大白鼠随机分成4组,分别予以不吸烟、被动吸烟2个月、3个月和4个月;检测血清骨钙素、尿钙与尿肌酐以及血浆肿瘤坏死因子(TNF)水平。结果4组大鼠血清骨钙素水平差异无显著性;吸烟2个月组与对照组尿CaCr差异无显著性,吸烟3个月和4个月组大鼠尿CaCr分别为0.787±0.226和0.781±0.217,显著低于对照组(P<0.05)。3个实验组大鼠血浆TNF水平均显著高于空白对照组(P<0.05,P<0.01,P<0.01),且随吸烟时间延长TNF水平升高,二者呈正相关;直线回归方程式为Y=0.048X 0.8902,r=0.989(P<0.05)。结论被动吸烟可使大鼠骨吸收增强,从而导致骨丢失、发生骨质疏松;而吸烟升高血浆TNF水平可能是吸烟刺激骨吸收、导致骨质疏松的机理之一。     

骨代谢生化指标诊断骨质疏松症的价值

测定１１４例骨质疏松症患者和正常对照老年人的尿羟脯氨酸／肌酐、血清骨钙素,并计算羟脯氨酸／肌酐与骨钙素的比值。应用受试者工作特性曲线计算各指标曲线下面积,分别为６９．３％、６９．２％和７６．９％,羟脯氨酸／肌酐与骨钙素比值的最佳临界点≥４．３０。按不同区间羟脯氨酸／肌酐与骨钙素比值计算拟然比,能敏感反映骨质疏松症患病概率的增减     

绝经后妇女血清瘦素水平与骨代谢的关系

目的探讨绝经后妇女血清瘦素水平与骨代谢的关系.方法测定85例绝经妇女血清瘦素水平及体重指数、体脂量、甘油三脂和总胆固醇,用双能X线法测定股骨和腰椎的骨密度,并测定骨钙素及尿钙水平,分析瘦素与上述指标之间的相关性.结果用骨密度与瘦素及瘦素相关指标进行多元逐步回归分析,瘦素没有进入腰椎和股骨颈骨密度方程;瘦素与骨钙素及尿钙水平也均无相关.结论瘦素与绝经后妇女的骨代谢无直接关系.     

A study on urinary free gamma-carboxyglutamic acid in patients with idiopathic urinary calcium stone]

Currently, urinary excretion of free gamma-carboxyglutamic acid (gamma-gla.), a terminal amino acid degraded from gamma-gla. containing protein including bone Gla. Estimated to be a more specific marker for bone metabolism and useful clinically rather than urinary excretion of hydroxyproline. In addition, serum levels of BGP have proved to be a significantly valuable indicator for bone metabolism, especially for process of bone formation, in recent studies. Therefore, we measured these parameters in 40 patients with idiopathic urinary calcium (Ca) stone and investigated bone metabolism in those patients. However, in majority of cases studied, urinary levels of gamma-gla. as well as that of hydroxyproline proved to be definite difference from that in healthy subjects (n = 12) and failed to suggest the presence of abnormality in bone turnover in the background of stone formation. Urinary excretion of hydroxyproline were 6.68 +/- 3.89 micrograms/mg.Cr in the patients and 6.95 +/- 3.08 micrograms/mg.Cr in healthy subjects. Urinary excretion of gamma-gla were 55.0 +/- 15.8 nmol/mg.Cr in the patients and 47.2 +/- 7.3 nmol/mg.Cr in healthy subjects.     

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。     

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.     

Prevention of glucocorticoid-induced osteoporosis

There is increasing evidence that pamidronate and related compounds are effective in the prevention and treatment of osteoporosis. It is therefore of relevance to document the time course and mechanism of bisphosphonate action in this condition. To this end, the present study describes the biochemical responses to prophylactic treatment with oral pamidronate (APD, 150 mg/day) in 16 glucocorticoid-treated patients and contrasts them with those in 19 steroid-treated control subjects. Measurements were made over a period of 12 months. The treated patients showed a fall in urine hydroxyproline excretion at 6 weeks associated with a reduction in serum ionized calcium concentration, a rise in serum 1,25-(OH)2D3, and a nonsignificant rise in serum bone gla protein (BGP). In contrast to BGP, serum alkaline phosphatase activity declined at 6 weeks, falling further at 3 months. Between 3 and 12 months, BGP levels paralleled those of alkaline phosphatase and hydroxyproline, all these being significantly below their initial values, and the other parameters returned to baseline. There was a gradual increase in plasma phosphate concentrations in the treated group over the 12 month period. It is concluded that pamidronate produces an acute and sustained inhibition of bone resorption followed by a more gradual reduction in bone formation. This transient dissociation results in a reduction in serum calcium, leading to a rise in serum 1,25-(OH)2D3, which in turn stimulates BGP production. Thereafter, indices of bone turnover remain subnormal but serum calcium and 1,25-(OH)2D3 return to baseline.     

Variable efficacy of bone remodeling biochemical markers in the management of patients with Paget’s disease of bone treated with tiludronate

The aim of this work was to evaluate the response of different biochemical bone markers to tiludronate administration in Paget’s disease of bone. Ten patients (five men and five women), 56–77 years old (67 ± 6.5), were treated for 3 months with tiludronate tablets (400 mg/day). Bone formation markers: alkaline phosphatase (AP), bone alkaline phosphatase (bAP), osteocalcin (BGP), and procollagen I carboxyterminal propeptide (PICP) in serum; and bone resorption markers: serum cross-linked carboxyterminal telopeptides of type I collagen (ICTP), urinary hydroxyproline/creatinine (Hyp/Cr), pyridinoline/Cr (Pyr/Cr), and alpha-1 collagen chain products degradation (CrossLaps) were assessed. Samples were taken before and at monthly intervals for 3 months after treatment began. The results of the present work show that serum AP and bAP are sensitive and reliable biochemical markers of bone formation in the follow-up of tiludronate in this disease. Serum PICP shows less sensitivity than serum AP, and serum BGP is not indicated as biochemical marker in these types of studies. Urinary hydroxyproline seems to be the most reliable biochemical marker of bone resorption. More studies should be performed with urinary Pyr and CrossLaps determinations. Serum ICTP is not adequate for the follow-up of tiludronate treatment in Paget’s disease of bone.     

Serum bone gla-protein in osteoporosis treated with 1α-hydroxyvitamin D3 for more than five years

It has been reported that 1,25-dihydroxyvitamin D₃ increases serum bone Gla-protein (BGP) in a short period in osteoporotic patients as well as in normal subjects. There have been, however, no reports on serum BGP in osteoporotic patients under long term treatment with 1α-hydroxyvitamin D₃. We measured serum BGP in 11 osteoporotic women treated with 1α-hydroxyvitamin D₃ and calcium for 5–12 years, 8.4 years on average. Bone mineral density of distal radius was assessed by single photon absorptiometry. Other biochemical parameters such as serum alkaline phosphatase, fasting urinary hydroxyproline/creatinine and calcium/creatinine were also measured. Serum BGP levels were 6.25±0.36ng/ml (mean±S.E.), being all within the normal range (6.2±3.86ng/ml). We found no significant correlation between serum BGP and other biochemical parameters. Significant correlation was found neither between serum BGP and period of treatment nor between serum BGP and bone mineral density. Our result that serum BGP is within the normal range in osteoporotic patients whose bone mineral density has been maintained by long-term treatment suggests the normal bone turnover in these patients.     

原发性肾病综合征患者血清胰岛素样生长因子1的变化及其与骨代谢的关系

目的 探讨原发性肾病综合征（PNS）患者血清胰岛素样生长因子1（IGF-1）的变化及其与骨代谢指标之间的关系。评价IGF-1在PNS患者骨代谢异常机制中的临床价值。方法 随机选取2008年1月至2009年5月临床资料完整的慢性肾脏病（CKD）1、2期PNS患者30例为对象;健康体检者61例为健康对照组。测定血清IGF-1、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/尿肌酐（UCa/Cr）。双能X线骨密度仪检测患者骨密度（BMD）。 结果 与健康对照组比较,PNS组血Ca、25-（OH）D3及BGP水平显著降低;血CTx水平及UCa/Cr比值显著增高（均P < 0.05）;BMD水平降低[（1.078±0.090） g/cm2 比（1.090±0.062） g/cm2,P > 0.05],但差异无统计学意义。PNS组血清IGF-1水平显著低于健康对照组,差异有统计学意义[（155.75±17.48） μg/L比（223.17± 16.44） μg/L,P < 0.05],且与24 h尿蛋白量及CTx呈负相关（r = -0.757和r = -0.786,均 P < 0.05）;与血BGP和BMD呈正相关（r = 0.861和r = 0.584,均P < 0.05）。 结论 PNS患者（CKD 1、2期）存在骨代谢异常,表现为骨形成减少、骨吸收增加。血清IGF-1与血BGP、CTx及BMD相关,可作为反映PNS患者骨代谢改变的临床指标之一。     

Circulating levels and bone contents of bone gamma-carboxyglutamic acid-containing protein are decreased in streptozocin-induced diabetes. Possible marker for diabetic osteopenia

To investigate the pathophysiology of diabetic osteopenia, circulating levels and bone contents of bone gamma-carboxyglutamic acid-containing protein (BGP) were measured in streptozocin-induced diabetic rats . Plasma calcium and total protein were significantly decreased (P less than .01) in the diabetic group, and the plasma level of BGP in diabetic rats was 19.6 +/- 2.8 (mean +/- SE) ng/ml, which is significantly lower than the value of 89.2 +/- 14.0 ng/ml in control rats (P less than .01). Bone contents of calcium and hydroxyproline per femur were significantly decreased in the diabetic group (P less than .01), and the ratios of bone calcium to hydroxyproline were not different. Bone BGP content per femur in the diabetic group was 669 +/- 58 micrograms, which was also significantly lower compared with 1241 +/- 126 micrograms in control rats (P less than .01). The decreased bone content of BGP is consistent with the hypothesis that BGP synthesis is impaired in insulin-deficient diabetes. Because a relationship between plasma levels of BGP and bone turnover has been established, the low plasma BGP value suggests there is a decrease in bone turnover in diabetic rats. Therefore, we postulate that the low bone turnover is one of the pathological features of diabetic osteopenia and is at least partly responsible for the occurrence of this complication in diabetes mellitus.     

天灸对实验性骨质疏松的影响

目的：旨在探讨天灸防治骨质疏松症的作用机制。方法：采用卵巢切除所致的骨质疏松大鼠为模型,通过对大鼠骨密度及血清E2,骨钙素（BGP）,Ca,P碱性磷酸酶（AKP）等指标检测,结果：天灸外治可刺激成骨细胞的活性,增加骨形成,同时通过对体内激素的调整,在一定程度上抑制骨吸收,从而有效地防止骨量丢失,增强骨骼抵抗外力的能力,结论：天灸与钙的联合应用并正确掌握治疗时机是防治骨质疏松症的关键所在。     

Clinical evaluation of bone turnover in patients with bone metastasis of various cancer of urogenital tract

To study the bone turnover in patients with bone metastasis from cancers of the kidney, bladder, prostate and other organs, Ca metabolism, vitamin D related hormones and various markers, such as bone glaprotein (BGP) and hydroxyproline, were investigated. In the group with osteolytic metastasis of non-prostatic cancer patients, BGP which is a measure of bone absorption was significantly increased and urinary excretion of hydroxyproline, Ca and P was elevated. Serum Ca was also higher and 1 alpha 25 (OH)2D and 250HD, measures of the metabolism of vitamin D, were lower. It was shown that bone absorption was promoted with the osteolytic findings by clinical X-ray examination, but osteoblastic changes which did not depend on osteoblast cells, seemed to exist in this group. On the contrary, in the group with osteoblastic metastasis from prostatic cancer, the level of BGP was not increased, but urinary hydroxyproline was moderately increased. Serum and urinary Ca and P levels were increased. In addition, 1 alpha 25 (OH)2D and 24 x 25 (OH)2D were lower than in the control group. These results indicate that urinary hydroxyproline is a useful marker for patients with bone metastasis, but BGP was correlative with neither the clinical findings of bone metastasis nor the bone turn over and metabolisms.