骨质疏松症的中医治疗研究进展

骨质疏松症是以骨量减少,骨质量受损及骨强度降低,导致骨脆性增加,易发生骨折为特征的全身性骨病,属中医学 “骨痿”、“骨痹”等范畴。中医药对骨质疏松症有独特的认识及治疗方法,近年来在治疗骨质疏松症方面已取得一定成果。本文基于近年来的文献研究,结合“从肾论治”、“从脾论治”、“瘀血论”等中医理论,着重从骨质疏松症的病因病机、辨证论治、专方专药、针灸疗法等方面进行探析,以期更加清楚地认识中医药治疗骨质疏松症的现状,从而更好地发挥中医药治疗本病的优势。     

PI3K/AKT通路与骨质疏松症的关系及中医药干预的研究进展

骨质疏松症是一种由多种信号通路共同介导和影响的临床骨科常见的代谢性疾病,因其并发症常严重影响患者正常生活质量,并造成较大的经济损失而被广泛研究及报道。中医药治疗方案与PI3K/AKT通路因其能直接或间接影响骨骼组成细胞中的成骨细胞与破骨细胞共同介导的"骨平衡",在骨质疏松症治疗中产生显著效果而被越来越多学者深入的研究。近年来,大量动物实验及分子研究分析指出,中医药治疗方案、PI3K/AKT通路与骨质疏松症之间具有较大的相关性,国内外学者也对中医药手段直接或间接激活PI3K/AKT通路治疗骨质疏松症的相关机制进行了多维度、深层次的研究。虽然目前对于中医药治疗方案、PI3K/AKT通路与骨质疏松症之间的相关性研究不断深入,但在其分子机制研究等方面仍存在欠缺。本文将通过对中医药治疗方案、PI3K/AKT通路与骨质疏松症的相关性研究进行综述,旨在为中医药干预骨质疏松症提供新的思路。     

原发性骨质疏松症的中医药防治研究进展

原发性骨质疏松症(primary osteoporosis,POP)是老年人以及绝经后女性的常见病、多发病。据调查显示,我国拥有60岁以上人口1.4亿,而50岁以上女性人群骨质疏松症发病率为20.7%,男性为14.4%,并呈逐年上升趋势。POP导致的骨折也是老年人致残、致死的主要原因之一。因此,POP的预防及治疗已成为当今人类重要的公共健康问题。近年来许多研究者从分子生物学水平研究中医药治疗原发性骨质疏松症并取得了明显的进展,越来越多的基础及临床研究证实中医药在治疗该病方面有着独特的优势。本文主要就近3年的相关文献进行总结,从中药、针灸、其他疗法等方面将近年来中医药防治该病的研究进展作一综述,旨在方便各位学者及时获得相关研究进展信息,并指出现有研究中存在的不足,以期能进一步探索有效而安全的治疗方案,更好的指导科研和临床工作。     

中医药治疗原发性骨质疏松症的研究近况

研究中医药治疗原发性骨质疏松症的治疗作用,笔者阅读了近几年来最新发表的相关文献资料,中医药学者以"肾主骨"理论为指导,对中医药防治骨质疏松症进行了大量的临床及实验研究,取得了明显临床疗效.     

益气温经方强骨饮治疗原发性骨质疏松症的研究进展

中医药治疗原发性骨质疏松症是一种新趋势,市场上已有仙灵骨葆中医药成果,院内研究的也有诸如强骨饮等中医药名方。强骨饮是以黄芪、鹿角霜为君药,辅以骨碎补、炒杜仲、秦艽等补肾通络的药物以益气温经法治疗原发性骨质疏松症的中医药方剂。本文意在探讨强骨饮治疗原发性骨质疏松症的研究进展,论述中医药强骨饮治疗原发性骨质疏松症的成方意义、治疗效果,影响原发性骨质疏松症骨量的参数指标以及支持临床实验的部分药理研究,便于后期进一步的研究以及探讨中医药治疗原发性骨质疏松症的理论依据,使得中医药治疗疾病的优势最大化的运用于治疗原发性骨质疏松症。     

骨质疏松症中医临床研究探讨

骨质疏松（osteoporosis，OP）是一种全身性代谢性骨骼疾病。近年来，中医药领域在原发性骨质疏松症的预防和治疗等方面进行了系统研究，包括病因病机、辨证论治规律、中药有效治疗药物、中药新药临床研究等多个方面，取得了不少成果，但也存在一些亟待解决的问题需要进一步探索。     

原发性骨质疏松症防治的研究现状与展望

截至目前,虽然对骨质疏松症的临床及实验研究均取得较大的进展,但涉及探索药理作用、作用机制的研究很少,因此运用当今先进科学技术阐明中医药在治疗骨质疏松症过程中的具体作用机制成为有待解决的首要问题.中西医结合治疗可将传统医学辩证论治、整体调理的优势和现代西医学的尖端技术充分结合起来,有利于提高、稳定疗效,推动祖国传统医学的持续发展,是未来临床研究的必由之路.本文系统综述近年来原发性骨质疏松症的临床与实验研究状况,旨在为中、西医治疗原发性骨质疏松症药物和方法 的研究提供参考.     

骨质疏松症的中医证型与治疗原则探讨

我国医务工作者在中医药防治骨质疏松症的理论、临床以及实验研究等方面进行了大量的工作 ,使中医药在骨质疏松症治疗中的应用日趋广泛 ,并显现出广阔的发展前景。然而 ,由于对中医病因病理认识不一 ,导致临床证型、中医治则各家不一。为了使中医研究进一步标准化、规范化、科学化 ,我们在文献研究的基础上结合自己的临床体会和实验结果 ,对骨质疏松症的中医证型与治则作了进一步的研究 ,以与同道共同探讨。一、中医对骨质疏松症病因病机的认识中医对骨质疏松症的现代认识是近十年来才开始的。虽然古典医籍中“骨痿”、“骨痹”、“骨枯”、…     

基于通络法探讨骨质疏松症与微循环障碍的相关性

骨质疏松症,是指人体全身骨量减少的代谢性疾病。近年来现代医学在该病的研究中发现微循环障碍与本病的发生有一定的相关性。而中医药作为中华民族伟大的医学宝库,运用通络法治疗骨痿取得了较好的疗效,且随着现代医学发展对通络法本质有了深入认识。故基于通络法,探讨骨质疏松症与微循环障碍的关系,分析其在临床应用中的优势,以期为骨质疏松症的中医药治法提供理论依据。     

基于“乙癸同源”理论探讨绝经后骨质疏松症的中医药治疗

绝经后骨质疏松症(PMOP)的西医治疗大多采用激素替代疗法(HRT),有良好的临床疗效,但副作用明显,中医药在骨质疏松症的治疗中具有疗效确凿及副作用小等明显优势,值得在临床推广应用。但如何探索有效的中医药治疗方案的经典指导理论,是发挥中医药治疗优势的重要内容。通过对古籍文献中"乙癸同源"理论的认识,探讨该理论与绝经后骨质疏松症的相关性,并与现代研究相结合,从该病的病因病机出发,基于"乙癸同源"的经典理论,针对肝肾亏虚的基本病因病机,发挥其对绝经后骨质疏松症治疗的理论指导作用,指导临床对绝经后骨质疏松症治疗的中医药使用,从根本上对患者进行中医药干预,能够达到治病求本的目的,为绝经后骨质疏松症的治疗提供有效的理论依据。     

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.     

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。     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.