痛风性关节炎骨质疏松患者血清LEP、OPG与IL-6、TNF-α相关性研究

目的 分析痛风性关节炎骨质疏松患者血清瘦素(LEP)、骨保护素(OPG)与炎症因子白细胞介素(IL-6)、肿瘤坏死因子α(TNF-α)相关性.方法 选择痛风性关节炎患者48例为研究对象(GA组),其中伴有骨质疏松19例(OP组),不伴有骨质疏松29例(非OP组),另选择健康体检者45例为对照.以双能X线骨密度吸收仪测定骨密度,ELISA检测血清LEP、OPG及IL-6、TNF-α水平并分析相关性.结果 GA组患者骨质疏松发生率39.6%明显高于对照组的13.3%(P=0.004),各部位骨密度明显低于对照组(P<0.05).与对照组及非OP组相比,OP组患者血清LEP水平明显升高,OPG水平明显降低,差异有统计学意义(P<0.05).非OP组患者血清LEP水平明显高于对照组(P<0.05),但OPG水平差异无统计学意义(P>0.05).OP组患者血清IL-6、TNF-α水平明显高于非OP组及对照组(P<0.05),非OP组明显高于对照组(P<0.05).OP组患者血清LEP与IL-6、TNF-α呈正相关(P<0.05),血清OPG与IL-6、TNF-α呈负相关(P<0.05).结论 痛风性关节炎伴发骨质疏松患者血清LEP、OPG呈异常变化,其与IL-6、TNF-α有一定相关性.     

补骨脂素对绝经后骨质疏松患者骨髓间充质干细胞Notch信号通路的影响

目的:观察补骨脂素对绝经后骨质疏松患者骨髓间充质干细胞Notch信号通路的影响。方法:无菌条件下抽取绝经后骨质疏松患者和体检健康女性的骨髓间充质干细胞,分离培养并进行传代。鉴定并确定培养细胞。比较绝经后骨质疏松患者骨髓间充质干细胞以及健康人群骨髓间充质干细胞的生物特征,根据实时定量聚合酶链式反应比较Notch信号通路关键因子的表达水平,对干细胞进行成骨诱导和成脂诱导,在补骨脂作用下根据RT-PCR检测Notch信号通路关键分子的表达情况。结果:与正常健康女性比较,绝经后骨质疏松患者的骨髓间充质干细胞内Notch信号通路减弱,差异有统计学意义(P0.05)。给予补骨脂后能够逆转干细胞内已降低的Notch信号通路活性,其中Hes1表达水平升高3倍左右。在成骨分化和成脂分化过程中补骨脂能够促进成骨分化,同时抑制成脂分化和Notch信号通路活化。结论:Notch信号通路能够影响绝经后骨质疏松症的发生发展,可能是补骨脂治疗绝经后骨质疏松症的新机制。     

Economic Consequences and Potentially Preventable Costs Related to Osteoporosis in the Netherlands

Background

Osteoporosis often does not involve symptoms, and so the actual number of patients with osteoporosis is higher than the number of diagnosed individuals. This underdiagnosis results in a treatment gap.

甘肃平凉地区中老年骨质疏松症的流行病学调查分析

目的通过流行病学调查甘肃平凉地区中老年骨质疏松症的发病状况与危险因素。方法 2013年9月至2016年5月采用分层随机抽样方式,在甘肃省平凉地区选择1 800名社区居民作为研究对象,调查所有居民的基线资料,同时进行骨质疏松的测定与判定。结果 1 800例中老年居民中共有骨质疏松患者320例,发病率为17.8%,其中男性240例,女性80例;平均年龄(61.93±7.93)岁;平均髋部骨密度为(1.33±0.22)g/cm~2。骨质疏松患者与非骨质疏松居民的性别、年龄、骨质疏松家族史、饮酒、吸烟、体质量指数、腰围等对比有明显差异(P0.05)。偏相关方法显示骨质疏松症患者的年龄、吸烟、体质量指数、腰围和骨质疏松家族史与骨密度均呈正相关(P0.05)。多因素Logistic回归分析显示年龄(OR=3.422)、吸烟(OR=2.671)、体质量指数(OR=2.681)为导致骨质疏松的独立危险因素(P0.05)。结论甘肃平凉地区中老年骨质疏松症的发病率比较高,年龄、吸烟、体质量指数为主要的危险因素,需要积极遵循个体化与整体化防控原则,从而降低骨质疏松症的发生率。     

Osteoporotic Animal Models of Bone Healing: Advantages and Pitfalls

The aim of this review was to summarize the advantages and pitfalls of the available osteoporotic animal models of bone healing. A thorough literature search was performed in MEDLINE via OVID and EMBASE to identify animal studies investigating the effect of experimental osteoporosis on bone healing and bone regeneration. The osteotomy model in the proximal tibia is the most popular osseous defect model to study the bone healing process in osteoporotic-like conditions, although other well-characterized models, such as the post-extraction model, might be taken into consideration by future studies. The regenerative potential of osteoporotic bone and its response to biomaterials/regenerative techniques has not been clarified yet, and the critical size defect model might be an appropriate tool to serve this purpose. Since an ideal animal model for simulating osteoporosis does not exist, the type of bone remodeling, the animal lifespan, the age of peak bone mass, and the economic and ethical implications should be considered in our selection process. Furthermore, the influence of animal species, sex, age, and strain on the outcome measurement should be taken into account. In order to make future studies meaningful, standardized international guidelines for osteoporotic animal models of bone healing need to be set up.     

椎体压缩性骨折高度恢复与治疗效果的相关性研究

目的评价经皮椎体成形术、经皮椎体球囊扩张后凸成形术、保守疗法治疗OVCF的近期临床疗效,探讨椎体高度恢复与疼痛程度的相关性。方法将符合条件的并进行相关治疗的患者分成:经皮椎体成形术(PVP)组和经皮后凸成形术(PKP)组,保守治疗组,每组选取15例患者。采用VAS、ODI评分标准和影像资料分别评估,对比分析组之间的疗效、影像资料变化,并分析椎体高度恢复与治疗效果的相关性。结果①PVP、PKP组椎体高度的恢复效果显著;②两组早期止痛效果确切,有助于患者早期恢复日常生活,但远期疼痛缓解效果与保守治疗组相当;③骨折椎体前缘高度压缩程度与疼痛有一定的相关性,治疗后椎体前缘高度恢复程度与疼痛的缓解无相关性;④PVP手术过程中发生了4例骨水泥渗漏、PKP组2例,术后随访发生了4例椎体再骨折。保守治疗组在卧床恢复期间出现肺部感染2例、褥疮2例。结论骨折椎体前缘高度压缩程度与疼痛有一定的相关性,压缩骨折椎体中等程度压缩时疼痛值相对较高;手术后椎体前缘高度恢复程度与疼痛的缓解无相关性。PVP与PKP手术治疗后中短期临床疗效优于保守疗法;保守疗法在经济性及安全性有较大优势。     

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。     

骨硬化蛋白与绝经后妇女脆性骨折的相关性

目的 了解绝经后跌倒骨折妇女及跌倒无骨折妇女人群血液循环中骨硬化蛋白与血清骨代谢标志物、骨密度之间的关系,探讨骨硬化蛋白是否可作为一种新的预测脆性骨折的生化标志物.方法 采用横向前瞻性研究,对50例健康的未绝经女性(A组)、50例绝经后跌倒股骨颈骨折妇女(B组)及50例绝经后跌倒无骨折妇女(C组)进行评估,评估内容包括血清骨硬化蛋白水平、骨代谢标志物及骨密度.结果 骨代谢标志物如Ⅰ型胶原交联C-端肽(CTX)、CTXⅡ、骨特异性碱性磷酸酶(b-ALP)、前胶原1型N端前肽(P1NP)、核因子出受体激活因子(RANK)和核因子出受体激活因子配体(RANKL)在3组间差异均有统计学意义(P＜0.05,P＜0.01);相较于A组,B组及C组的骨硬化蛋白水平升高(P＜0.05,P＜0.01)、骨钙素水平降低(P＜0.01),但B、C两组间骨硬化蛋白水平和骨钙素水平差异无统计学意义.股骨颈、全髋、转子间及L1～L4部位的骨密度在3组之间差异有统计学意义(P＜0.01),B组中骨密度较A、C两组降低(P＜0.01).在所有研究对象中,骨硬化蛋白水平与股骨颈骨密度(r=-0.228,P=0.004)、转子间骨密度(r=-0.199,P=0.002)和全髋骨密度(r=-0.273,P＜0.001)均呈负相关.结论 绝经后妇女中骨折人群与未骨折人群血清骨硬化蛋白水平差异无统计学意义,提示血清骨硬化蛋白水平无法预测脆性骨折风险.     

Periodontal disease and women’s health

Background: Periodontal disease (PD) is a multifactorial inflammatory condition in which inappropriate interaction between the host immune response and specific groups of bacterial pathogens leads to destruction of connective and bone tissues supporting the tooth. Dissemination of pathogens, toxins, and immune complexes from and to periodontal lesions is at the basis of the increasingly recognized association between PD and various systemic diseases (SDs). Considering the growing attention of the medical community to “gender medicine”, this review focuses on the association between PD and six systemic conditions heavily impacting women’s health, with the aim of providing evidence in support of a joint effort between physicians and dentists to improve clinical management of these conditions.

Methods: We considered systematic reviews, meta-analyses and narrative reviews evaluating all possible associations between periodontitis, systemic diseases and women.

Results: Gender prevalence for PD is discordant, but the literature strongly supports an association between PD and female infertility and adverse pregnancy outcomes. Moreover, PD is bidirectionally linked to several systemic diseases characterized by an established female gender bias, i.e. osteoporosis (OP), cardiovascular diseases (CVD), autoimmunity, Alzheimer’s disease (AD) and cancer.

Conclusions: Overall, the literature data reviewed here provides a strong foundation for further characterization of molecular and microbial drivers of PD and of several female-prevalent systemic diseases, highlighting the possible importance of a good oral condition in preventing or attenuating women’s systemic diseases.