基于骨免疫微环境探讨补肾活血方防治绝经后骨质疏松症的研究进展

骨质疏松症（OP）是我国人群中最常见的多发病,好发于绝经后的老年妇女,增加了患者骨折的风险。绝经后骨质疏松症（PMOP）是一种以骨量减少和骨折风险增加为特征的全身性疾病,主要是绝经后雌激素水平显著降低导致的。除了雌激素缺乏对骨骼的直接负面影响外,绝经后妇女免疫状态的改变间接导致骨骼的持续破坏,因为绝经后妇女通常表现出慢性低级别炎症表型,细胞因子表达和免疫细胞谱发生改变。PMOP已严重危害我国女性健康。补肾活血方是一种应用广泛的补肾活血中药,近年来,随着我国临床医师与患者越来越重视中医药,补肾活血方被应用于多种疾患,包括骨科的多种疾病,其对PMOP的防治效果亦明显。该文基于骨免疫微环境,以骨代谢对PMOP产生影响为基础,论述补肾活血方的作用机制。     

新型关节突钉板系统联合单侧椎弓根螺钉固定的生物力学研究

目的研究经椎间孔入路椎体间融合术(transforaminal lumbar interbody fusion,TLIF)结合新型关节突钉板系统(articular process fixation system,APFS)的腰椎稳定性。方法在已验证的有限元模型L3～S1完整节段(模型A)上,模拟TLIF手术,建立双侧椎弓根螺钉固定TLIF模型(模型B)、右单侧椎弓根螺钉固定TLIF模型(模型C)、APFS联合右侧椎弓根螺钉固定TLIF模型(模型D)。观察不同工况下腰椎模型的活动度(range of motion,ROM)以及椎弓根螺钉、APFS、椎间融合器应力分布情况。结果不同工况下,模型B、C、D整体ROM相当,均小于生理状态模型。模型D与模型B、C相比,右侧椎弓根螺钉及椎间融合器最大压应力在不同工况下最小或介于模型B、C之间。模型D在前屈状态下APFS及右侧椎弓根螺钉应力峰值均最大。结论 APFS联合对侧椎弓根螺钉固定可作为腰椎TLIF手术的一种新型固定方式。     

三维超声造影诊断宫腔镜分离术后合并重度宫腔粘连的价值

目的探讨三维超声造影（3D-CEUS）诊断宫腔镜下宫腔粘连分解术（TCRA）后重度宫腔粘连（SIUA）的价值。方法回顾性分析83例TCRA术后IUA患者临床资料,所有患者均行宫腔镜、经阴道二维三维超声检查、3D-CEUS检查,获得子宫内膜相关参数:子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数。以宫腔镜检查结果为准,分析3D-CEUS诊断TCRA术后SIUA的价值。结果本组TCRA术后确诊SIUA 36例,SIUA三维成像表现为宫腔形态异常、狭小、边缘不规则,内膜回声不连续等。经阴道三维超声诊断TCRA术后IUA分级准确率90.36%,与宫腔镜检查结果一致性较好（Kappa=0.795,P<0.05）。SIUA患者子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数低于中度组和轻度组（P<0.05）,二元Logistic回归分析子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数与TCRA术后SIUA发生显著相关（P<0.05）。ROC结果显示,子宫内膜厚度、血管化血流指数鉴别SIUA的效能较高,曲线下面积分别为0.794、0.856,灵敏度为80.56%、74.47%,特异度为88.89%、82.98%。结论经阴道三维超声可清晰显示TCRA术后宫腔粘连程度和累及范围,为IUA分级提供可靠参考。3D-CEUS测量相关子宫内膜参数可作为SIUA诊断的定量指标。      

Habitual intakes of sugar-sweetened beverages associated with gut microbiota-related metabolites and metabolic health outcomes in young Chinese adults

Background and aimsReducing consumption of sugar-sweetened beverages (SSBs) is a global public health priority because of their limited nutritional value and associations with increased risk of obesity and metabolic diseases. Gut microbiota-related metabolites emerged as quintessential effectors that may mediate impacts of dietary exposures on the modulation of host commensal microbiome and physiological status.Methods and resultsThis study assessed the associations among SSBs, circulating microbial metabolites, and gut microbiota–host co-metabolites, as well as metabolic health outcomes in young Chinese adults (n = 86), from the Carbohydrate Alternatives and Metabolic Phenotypes study in Shaanxi Province. Five principal component analysis-derived beverage drinking patterns were determined on self-reported SSB intakes, which were to a varying degree associated with 143 plasma levels of gut microbiota-related metabolites profiled by untargeted metabolomics. Moreover, carbonated beverages, fruit juice, energy drinks, and bubble tea exhibited positive associations with obesity-related markers and blood lipids, which were further validated in an independent cohort of 16,851 participants from the Regional Ethnic Cohort Study in Northwest China in Shaanxi Province. In contrast, presweetened coffee was negatively associated with the obesity-related traits. A total of 79 metabolites were associated with both SSBs and metabolic markers, particularly obesity markers. Pathway enrichment analysis identified the branched-chain amino acid catabolism and aminoacyl-tRNA biosynthesis as linking SSB intake with metabolic health outcomes.ConclusionOur findings demonstrate the associations between habitual intakes of SSBs and several metabolic markers relevant to noncommunicable diseases, and highlight the critical involvement of gut microbiota-related metabolites in mediating such associations.     

Cumulative burden of abnormal visceral adiposity index and its components on the risk of hyperuricemia

Background and aimsThe visceral adiposity index (VAI), a gender-specific surrogate maker of adipose tissue distribution and function, is associated with risk of hyperuricemia. However, the impact of time-burden of abnormal VAI and its components on the risk of hyperuricemia remains unknown.Methods and resultsWe included 56,537 participants without hyperuricemia and underwent two health examinations during 2006–2008 from the Kailuan study. Abnormal VAI burdens were evaluated as follows: (1) cumulative number of abnormal VAI presented at each examination (0–2 times); (2) cumulative number of each abnormal VAI component presented at each examination (0–2 times per component); (3) cumulative number of total abnormal VAI components presented at each examination (0–8 times).During a median follow-up of 8.81 years, 10,762 participants were diagnosed with hyperuricemia. The risk of hyperuricemia showed a positive association with cumulative number of abnormal VAI, the adjusted hazard ratio (HR) with 95% confidence interval (CI) of 2 times compared to 0 times was 1.69 (1.58–1.81). All four components of abnormal VAI, when diagnosed repeatedly, were independently associated with an increased risk of hyperuricemia, adjusted HR (95% CI) from 1.15 (1.02–1.28) for low high-density lipoprotein to 1.68 (1.58–1.79) for elevated triglyceride. The risk of hyperuricemia also gradually as abnormal components was accumulated from 0 to 8 counts, reaching an adjusted HR (95% CI) of 3.72 (2.64–5.23). Furthermore, the effect of cumulative abnormal VAI was more pronounced in females than males (P-interaction < 0.0001).ConclusionsCumulative abnormal VAI burdens were positively associated with the risk of hyperuricemia, especially in females.     

Changes in abdominal fat depots after bariatric surgery are associated with improved metabolic profile

Background and aimsObesity associated with a change in the quantity and quality of fat depots. Using computed tomography (CT), we analyzed abdominal fat depots in patients with obesity after bariatric surgery according to their metabolic health status.Methods and resultsWe recruited 79 individuals with metabolically unhealthy obesity before bariatric surgery and compared them with age-sex matched healthy controls. The volume and fat attenuation index (FAI) of fat depots were measured using CT scans that were conducted prior to and a year after bariatric surgery. ‘Metabolically healthy’ was defined as having no hypertension, normal fasting glucose and a waist-to-hip ratio of <1.05 for men and <0.95 for women. Individuals who achieved a metabolic health status conversion (MHC) (n = 29, 37%)—from unhealthy to healthy—were younger (p < 0.001) as compared to individuals without MHC. Pre-surgery BMI and reduction of BMI did not differ between the two groups (p = 0.099, p = 0.5730). Bariatric surgery reduced the volume and increased the FAI of fat depots. Baseline lower abdominal periaortic adipose tissue (AT) volume (p = 0.014) and great percent reduction in renal sinus AT volume after surgery (p = 0.019) were associated with MHC after surgery. Increased intraperitoneal AT FAI (p = 0.031) was also associated with MHC.ConclusionMHC was not associated with improvement in general obesity, based on indicators such as reduction of BMI after surgery. Weight reduction induced specific abdominal fat depot changes measured by CT are positively associated with MHC.     

急性心肌梗死患者血浆LP(a) Hcy hs-CRP和cTnI水平检测的临床意义

目的探讨急性心肌梗死(AMI)患者血浆脂蛋白(a)[Lp(a)]、同型半胱氨酸(Hcy),超敏C反应蛋白(hs-CRP)和肌钙蛋白I(cTnI)水平监测的临床应用。方法对162例AMI患者和165例健康体检者(对照组)进行血浆LP(a)、Hcy、hs-CRP和cTnI水平测定,并进行统计分析。结果 AMI患者治疗前的血浆LP(a)、Hcy、hs-CRP和cTnI水平与对照组比较,均显著增高(P<0.01)。在AMI患者治疗后,与对照组比较,97例治疗好转患者血浆hs-CRP恢复至正常水平(t=1.586,P>0.05),而血浆cTnI水平降低明显(t=3.322,P<0.01);36例治疗无效死亡患者血浆Hcy、hs-CRP和cTnI水平均明显升高(P<0.01)。结论血浆LP(a)、Hcy、hs-CRP和cTnI是治疗前诊断AMI有价值的指标,对患者治疗预后判断和随访最有价值的指标是血浆hs-CRP和cTnI。     

电针预处理对脂多糖诱导的小鼠心功能障碍及炎性反应的影响

目的  观察电针预处理对脂多糖(LPS)诱导的脓毒症模型小鼠心功能障碍和炎性反应的影响, 探讨电针预处理促心肌保护的可能机制。方法  24只SPF级雄性C57BL/6J小鼠随机分为对照组、模型组和电针预处理组, 每组8只。电针预处理组在异氟烷麻醉状态下电针双侧足三里穴, 疏密波, 频率2/15 Hz, 强度2 mA, 持续15 min; 对照组、模型组同样的方式抓取、固定。电针结束后, 模型组和电针预处理组腹腔注射LPS(10 mg/kg)构建脓毒症模型; 对照组注射等量生理盐水。采用超声心动图评价心功能; ELISA法检测血清TNF-α、IL-1β水平; qPCR和Western blot法检测心肌组织中TNF-α、IL-1β、IL-6和IL-10 mRNA和蛋白表达量; 流式细胞术检测心肌组织中F4/80+CD11b+总巨噬细胞、F4/80+CD11b+CD206lowM1型和F4/80+CD11b+CD206highM2型巨噬细胞含量。结果  与对照组相比, 模型组小鼠的LVEF、LVFS均显著下降(P < 0.01), 血清中TNF-α、IL-1β含量均升高(P < 0.01), 心肌组织中TNF-α、IL-1β、IL-6、IL-10 mRNA和蛋白表达增加(P < 0.05,P < 0.01), 心肌组织中巨噬细胞含量增多(P < 0.01), 且M1型巨噬细胞比例增高(P < 0.01);与模型组相比, 电针预处理组的LVEF、LVFS均显著提高(P < 0.01), 血清中TNF-α、IL-1β含量下降(P < 0.05,P < 0.01), 心肌组织中TNF-α、IL-1β、IL-6 mRNA和蛋白表达下降(P < 0.05,P < 0.01), 而IL-10表达上升(P < 0.05,P < 0.01), 巨噬细胞含量下降(P < 0.01), 且M2型巨噬细胞比例增高(P < 0.01)。结论  电针预处理可能通过促进心肌组织中巨噬细胞由促炎M1型向抗炎M2型极化, 减轻全身和局部炎性反应水平, 改善心功能, 产生心肌保护效应。      

基于STAT3通路探讨补肾活血方抑制骨细胞凋亡

目的探讨补肾活血方通过信号转导与转录激活子3(STAT3)通路抑制骨细胞的凋亡对骨质疏松的治疗作用。方法选取SPF级健康雌性C57BL/6小鼠75只,随机分为正常对照组11只及造模组64只。造模组采用去势法建立骨质疏松症模型,正常对照组仅暴露双侧卵巢而不切除。将造模成功的小鼠随机分为模型组、补肾活血方低、中、高剂量组及阳性对照组,各12只。模型组和正常对照组分别灌胃给予蒸馏水5 mL·kg^-1,1次/d;补肾活血方低、中、高剂量组分别灌胃给予1.79、3.57、7.14 g·mL^-1补肾活血方药液5 mL·kg^-1,1次/d;阳性对照组灌胃给予0.14 mg·mL^-1尼尔雌醇混悬液5 mL·kg^-1,1次/d。各组小鼠均治疗12周。检测比较各组骨形态参数,骨细胞凋亡指数(AI),以及骨组织B淋巴细胞瘤-2(Bcl-2)、Bcl-2相关X蛋白(Bax)、Janus激酶2(JAK2)、STAT3表达水平。结果与模型组比较,各组小鼠骨体积分数(BV/TV)、骨小梁厚度(Tb.Th)、骨小梁数量(Tb.N)及骨密度(BMD)值较高,骨组织Bcl-2蛋白表达水平较高,且补肾活血方低剂量组<补肾活血方中剂量组<补肾活血方高剂量组和阳性对照组,差异有统计学意义(P<0.05)。与模型组比较,各组小鼠骨组织AI较低,骨组织Bax蛋白表达水平较低,骨组织JAK2、STAT3表达水平较低,且补肾活血方低剂量组>补肾活血方中剂量组>补肾活血方高剂量组和阳性对照组,差异有统计学意义(P<0.05)。结论补肾活血方能剂量依赖性的增加骨质疏松小鼠骨密度,增加骨小梁厚度和数量,抑制骨细胞凋亡,其作用可能与抑制STAT3信号通路,调节凋亡相关蛋白Bcl-2、Bax表达有关。     

早产儿预防性使用肺表面活性物质的临床观察

目的分析胎龄≤30周的早产儿预防性使用肺表面活性物质（PS）对临床结局的影响。方法将本院收治的31例（最终纳入25例）胎龄≤30周的早产儿纳入观察组,生后30min内即予气管内滴入PS,并使用经鼻持续气道正压通气维持等待转运;将同期同级别同地区的另一家医院转运至同一家医院的52例（最终纳入40例）胎龄≤30周的早产儿纳入对照组,转运前未使用PS,入院后根据病情需要作为治疗性使用PS。比较2组早产儿出院前临床结局的差异。结果2组早产儿呼吸窘迫综合征（RDS）和支气管肺发育不良（BPD）的患病率、机械呼吸使用率、氧疗天数均有显著差异,2组早产儿的死亡率、早产儿视网膜病变（ROP）、坏死性小肠结肠炎（NEC）的患病率无显著差异。结论早期预防性使用PS可降低RDS的发生率及机械呼吸的使用率,同时缩短氧疗时间,降低BPD的患病率。