骨源性碱性磷酸酶检测对维生素D缺乏性佝偻病的诊疗意义

目的 探讨骨源性碱性磷酸酶的测定对维生素D缺乏性佝偻病的诊疗意义。方法 采用全血干化学免疫浓缩法对246例拟诊为维生素D缺乏性佝偻病患者进行骨源性碱性磷酸酶测定，根据检测结果采用适当的治疗方法。结果 全部病例症状消失，体征减轻，最终全部治愈。结论 骨源性碱性磷酸酶检测简便、快速、特异、结果可靠，对临床诊断维生素D缺乏性佝偻病极具指导价值。     

伊班膦酸钠联合骨化三醇治疗老年骨质疏松症的临床研究

目的 探讨伊班膦酸钠注射液联合骨化三醇胶丸治疗老年骨质疏松症的临床疗效。方法 选取2016年11月-2017年12月在上海市第三康复医院和第二军医大学附属公利医院收治的123例老年骨质疏松症患者作为研究对象,将患者随机分为骨化三醇组、伊班膦酸钠组、联合组,每组各41例。骨化三醇组患者口服骨化三醇胶丸,2粒/次,1次/d;伊班膦酸钠组患者静脉滴注伊班膦酸钠注射液,2 mg溶于0.9%氯化钠溶液250 mL中,滴注时间大于2 h,1次/3个月;联合组给予伊班膦酸钠注射液联合骨化三醇胶丸,用法用量同上。3组患者均连续治疗12个月。观察3组患者的临床疗效,比较3组患者治疗前后的数字疼痛评分（NRS）、骨密度（BMD）、血磷、血钙、抗酒石酸酸性磷酸酶5b（TRAP-5b）、骨源性碱性磷酸酶（BALP）水平和不良反应。结果 治疗后,骨化三醇组、伊班膦酸钠组、联合组的总有效率分别为82.93%、85.37%和95.12%,联合组总有效率显著优于骨化三醇组和伊班膦酸钠组,差异具有统计学意义（P<0.05）。治疗6、12个月后,3组患者的NRS评分值均显著降低,平均腰椎BMD和平均股骨颈BMD均显著升高,同组治疗前后比较差异具有统计学意义（P<0.05）;治疗6、12个月后,联合组患者的NRS评分值显著低于同期骨化三醇组和伊班膦酸钠组,而平均腰椎BMD和平均股骨颈BMD均明显高于同期骨化三醇组和伊班膦酸钠组,差异具有统计学意义（P<0.05）。治疗后,3组患者血钙、血磷相较于治疗前差异无统计学意义,且联合组患者的血钙、血磷较其他两组差异均无统计学意义。治疗6、12个月后,3组患者TRAP-5b、BALP水平均显著降低,同组治疗前后比较差异具有统计学意义（P<0.05）;治疗6、12个月后,联合组患者TRAP-5b、BALP水平显著低于同期骨化三醇组和伊班膦酸钠组,差异具有统计学意义（P<0.05）。3组患者的不良反应发生情况差异无统计学意义。结论 伊班膦酸钠注射液联合骨化三醇胶丸治疗老年性骨质疏松症具有较好的临床疗效,能够改善骨密度,减少疼痛,维持骨生化指标,具有一定的临床推广应用价值。     

A comparative study between the effect of 17-β estradiol and antioxidants combination on some menopausal changes in oophorectomised rats

BackgroundAs oxidative stress is proposed to be responsible for many of the menopause associated disorders, antioxidants may play an important role in this situation. The aim of this work was to compare between the effects of oestrogen replacement therapy and antioxidant supplements of vitamin C and low dose of vitamin A on some menopause associated changes in oophorectomised rats.Materials and methodsForty albino female rats were divided into 4 groups: normal control group, oophorectomised group, oophorectomised group treated with 17-β estradiol (oophorectomised + E₂) and oophorectomised group treated with vitamins (oophorectomised + vit).The following were measured: total antioxidant (TAO) and malondialdehyde (MDA), lipid profile, serum insulin, glucose and homeostasis model assessment-insulin resistance (HOMA-IR), bone specific alkaline phosphatase (BALP), urinary hydroxyproline, weight gain and visceral fat.ResultsA positive correlation was found between MDA and low density lipoprotein-cholesterol (LDL) (r = 0.694 and P = 0.000), HOMA-IR (r = 0.691 and P = 0.000.) and BALP (r = 0.563 and P = 0.000) and urinary hydroxyproline level (r = 0.761 and P = 0.000). Those results denoted that OS might be a cause of dyslipidemia, insulin resistance and osteoporosis associated with menopause.Both E₂ and vitamins in oophorectomised rats led to a significant decrease in MDA (F = 33.402, P = 0.000), weight gain, visceral fat (F = 7.589, p = 0.000 and F = 3.748, P = .019, respectively), cholesterol (F = 40.748, P = 0.0001), LDL cholesterol (F = 55.168, P = 0.0001), and significant increase in HDL (F = 18.393, P = 0.0001) and TAO levels (F = 14.781, P = 0.000) compared to oophorectomised rats. Also, both treatments led to a significant decrease of HOMA-IR (F = 18.933, P = 0.000, respectively), BALP (F = 13.202, P = 0.000) and urinary hydroxylproline (F = 220.012, P = 0.000). An interesting finding was detected where oophorectomised rats showed a decrease in triglyceride level which was significantly increased by E₂ administration whereas antioxidant administration produced no change (F = 34.267, P = 0.0001).ConclusionOur results denote similar effects of both E₂ and antioxidant’ supplements (vitamin C and low dose vitamin A) administration in surgically induced menopause in rats regarding oxidative stress, weight gain, atherogenic lipid profile changes, insulin sensitivity and bone turnover. However differences between preclinical and clinical studies must be taken into consideration especially when moving from animal studies to clinical trials.     

大豆异黄酮抗骨质疏松症的实验研究及作用机制的探讨

目的 观察大豆异黄酮的抗骨质疏松作用,并探讨其作用机制。方法 (1)切除10月龄大鼠双侧卵巢,3个月后分为己烯雌酚组、模型组、大豆异黄酮高、中、低荆量组,并灌胃,每日1次,连续3个月;用切除双侧卵巢旁部分脂肪的假手术同龄大鼠作对照(对照组)。测定各组动物的骨形态学指标、血清雌二醇(E2)、血清骨源性碱性磷酸酶(BALP)、血清钙磷、骨钙磷、尿钙磷以及子宫系数。(2)用含药血清培养成骨细胞,以MTT法检测成骨细胞增殖情况。结果 (1)大豆异黄酮能明显增加去卵巢大鼠骨小梁平均宽度、单位面积骨小粱骨细胞数、骨皮质平均厚度、股骨头平均吸光度和股骨干平均吸光度;明显升高血清E水平：明显降低血清BALP值;明显增加血清钙、骨钙含量：明显增加子宫系数。(2)大豆异黄酮能明显促进成骨细胞增殖。结论 大豆异黄酮具有明显的抗骨质疏松作用,其作用机制可能与其拟雌激素作用、提高体内雌激素水平、提高机体对钙的吸收与利用、促进成骨细胞DNA合成和生长增殖有关。     

鹿胍多肽在治疗创伤性胸腰椎骨折中的作用机制

目的:探讨将鹿胍多肽应用于创伤性胸腰椎骨折的疗效及相关作用机制。方法:选取2014年4月至2017年4月青海大学附属医院收治的创伤性胸腰椎骨折患者167例,按照药物治疗措施不同分为对照组(n=82)和观察组(n=85)。对照组予以利塞膦酸钠单独给药治疗,观察组使用了利塞膦酸钠+鹿胍多肽联合用药方案治疗。比较应激反应指标Cor、NE、ALD、骨代谢BGP、PTH、BALP、C1CP等生化指标以及生活能力方面在治疗前后的变化幅度。结果:观察组BALP(26. 92±2. 67) pg/m L显著高于对照组,CTX(0. 33±0. 14) mg/m L、BGP(5. 71±1. 25)μg/L、P1NP(47. 33±4. 14) mg/m L、PTH(31. 38±3. 17) pg/m L、C1CP(7. 07±0. 91)μg/L显著低于对照组(P 0. 05);观察组AngⅠ(3. 38±0. 46) pg/m L、E(71. 46±3. 71) ng/m L、ALD(96. 92±5. 38) pg/m L、AngⅡ(31. 47±2. 75) pg/m L、显著低于对照组,NE(96. 71±4. 64) ng/m L、Cor(278. 87±12. 57) nmol/L显著高于对照组(P 0. 05);观察组在治疗后Barthel指数总分(43. 34±4. 15)分明显高于对照组(30. 83±3. 04)分(P 0. 05)。观察组临床总有效率为92. 94%,与对照组73. 17%比较,差异有统计学意义(χ2=3. 38,P 0. 05)结论:针对创伤性胸腰椎骨折患者骨组织修复的治疗,可给予鹿胍多肽作为辅助药物,鹿胍多肽具有降低患者应激反应,促进骨代谢修复的作用,提供患者生活能力。     

骨转换生物标记物在乳腺癌骨转移瘤疗效评价与监测中的作用

骨转换生物标记物是近年来探索用于骨转移瘤疗效评价及监测的新方法.这些存在于骨转移患者血液及尿液中的生物标记物让我们更深入了解骨破坏的过程及骨骼与肿瘤之间的相互作用.本文旨在通过回顾常用骨生物标记物在骨转移瘤治疗与监测的相关研究,探讨其潜在的临床价值.     

新生儿骨碱性磷酸酶活性增高与其血铅水平的相关性研究

为研究新生儿骨碱性磷酸酶（ＢＡＬＰ）活性与其血铅水平的相关关系,于１９９７年１１月～１９９８年１１月对我院产科出生的５８５例新生儿,采用全血干化学免疫浓缩法,取耳垂微量血３０μｌ进行ＢＡＬＰ活性测定,同时,对测得ＢＡＬＰ〉２００Ｕ／Ｌ的２１５例新生儿随机抽取１００例,用石墨炉原子吸收光谱法进一步测定血铅含量。结果：①５８５例新生儿中,ＢＡＬＰ活性≤２００Ｕ／Ｌ（正常）３７０例,～２５０Ｕ／Ｌ（临界佝偻病）１６７例,～３００Ｕ／Ｌ（佝偻病活动期）４８例,阳性检出率３６．７５％;②所测血铅的１００例中,其血铅含量最高值１９７μｇ／Ｌ,最低值２７．４０μｇ／Ｌ,均值７６．９２μｇ／Ｌ,≥１００μｇ／Ｌ２１例（占２１％）;③ＢＡＬＰ为２０１Ｕ～２５０Ｕ／Ｌ的１６７例中,血铅≥１００μｇ／Ｌ者８例,ＢＡＬＰ２５１Ｕ／Ｌ～     

婴幼儿合理补钙干预性试验的研究

目的对各种钙剂治疗佝偻病效果进行临床研究。方法选取我院2004-01~2005-01期间,在儿科门诊就诊的0~3岁婴幼儿,根据“婴幼儿佝偻病防治方案”中的全国统一标准诊断确诊为轻度佝偻病的患儿100例。将患儿随机分为2组:分别应用葡萄糖酸钙和凯思立D,每组患儿治疗前后均查血清Ca(mmol/L),P(mmol/L),BALP(U/L),PTH(pg/mL)。结果两组患儿治疗后,血清Ca,P,BALP均明显上升,两组间无显著差异,每组治疗前后各项生化指标比较有显著差异,两组治疗后血清PTH值较治疗前明显降低,B组较A组抑制PTH分泌更显著。结论钙剂多少对血液生化指标影响无显著差异,所以治疗佝偻病与钙剂量大小无关,主要与VD3有关。     

Impact of radiotherapy on bone health in women with rectal cancer – A prospective cohort study

IntroductionPelvic radiotherapy (RT) increases the risk of pelvic insufficiency fractures. The aim was to investigate if RT is associated with changes in serum bone biomarkers in women with rectal cancer, and to examine the incidence of radiation-induced bone injuries and the association with bone biomarkers.Material and methodsWomen diagnosed with rectal cancer stage I-III, planned for abdominal surgery ± preoperative (chemo) RT, were prospectively included and followed one year. Serum bone biomarkers comprised sclerostin (regulatory of bone formation), CTX (resorption), BALP and PINP (formation). A subgroup was investigated with annual pelvic magnetic resonance imaging (MRI). The association between RT and bone biomarkers was explored in regression models.ResultsOf 134 included women, 104 had surgery with preoperative RT. The formation markers BALP and PINP increased from baseline to one year in the RT-exposed group (p < 0.001, longitudinal comparison). In the adjusted regression analysis, the mean increase in PINP was higher in the RT-exposed than the unexposed group (17.6 (3.6–31.5) μg/L, p = 0.013). Sclerostin and CTX did not change within groups nor differed between groups. Radiation-induced injuries were detected in 16 (42%) of 38 women with available MRI. At one year, BALP was higher among women with than without bone injuries (p = 0.018, cross-sectional comparison).ConclusionsPreoperative RT was associated with an increase in the formation marker PINP, which could represent bone recovery following RT-induced injuries, commonly observed in participants evaluated with MRI. These findings should be further explored in larger prospective studies on bone health in rectal cancer patients.     

Ficus deltoidea promotes bone formation in streptozotocin-induced diabetic rats

Context Diabetes mellitus increases the risk of bone diseases including osteoporosis and osteoarthritis. We have previously demonstrated that Ficus deltoidea Jack (Moraceae) is capable of reducing hyperglycaemia. However, whether F. deltoidea could protect against diabetic osteoporosis remains to be determined.Objective The study examines the effect of F. deltoidea on bone histomorphometric parameters, oxidative stress, and turnover markers in diabetic rats.Materials and methods Streptozotocin (STZ)-induced diabetic Sprague-Dawley rats (n = 6 animals per group) received one of the following treatments via gavage for 8 weeks: saline (diabetic control), metformin (1000 mg/kg bwt), and methanol leaves extract of F. deltoidea (1000 mg/kg bwt). A group of healthy rats served as normal control. The femoral bones were excised and scanned ex vivo using micro-computed tomography (micro-CT) for histomorphometric analysis. The serum levels of insulin, oxidative stress, and bone turnover markers were determined by ELISA assays.Results Treatment of diabetic rats with F. deltoidea could significantly increase bone mineral density (BMD) (from 526.98 ± 11.87 to 637.74 ± 3.90). Higher levels of insulin (2.41 ± 0.08 vs. 1.58 ± 0.16), osteocalcin (155.66 ± 4.11 vs. 14.35 ± 0.97), and total bone n-3 PUFA (2.34 ± 0.47 vs. 1.44 ± 0.18) in parallel with the presence of chondrocyte hypertrophy were also observed following F. deltoidea treatment compared to diabetic control.Conclusions F. deltoidea could prevent diabetic osteoporosis by enhancing osteogenesis and inhibiting bone oxidative stress. These findings support the potential use of F. deltoidea for osteoporosis therapy in diabetes.