加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症临床研究

目的:观察加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症(PMOP)的临床疗效。方法:选取150例肾阳亏虚型PMOP患者,按随机数字表法分为对照组和观察组各75例。对照组给予口服阿仑膦酸钠片治疗,观察组在对照组基础上加服加味温经汤,2组均治疗6个月。对比2组总体疗效、治疗前后碱性磷酸酶(ALP),血钙(Ca)、磷(P),雌二醇(E2),促卵泡雌素(FSH),促黄体生成素(LH)水平,记录治疗过程中不良反应发生情况。结果:观察组总有效率96.0%,对照组总有效率80.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组ALP水平均较治疗前降低(P<0.05),血Ca含量均较治疗前增加(P<0.05);观察组ALP水平低于对照组(P<0.05),血Ca含量高于对照组(P<0.05)。治疗后,2组E2水平均较治疗前升高,FSH及LH水平均较治疗前降低,差异均有统计学意义(P<0.05);观察组E2水平高于对照组,差异有统计学意义(P<0.05)。2组血常规异常、肝肾功能异常、消化道症状、皮肤过敏发生率比较,差异均无统计学意义(P>0.05)。结论:加味温经汤治疗肾阳亏虚型PMOP,能有效改善患者的临床症状和性激素水平,用药安全性高。     

Screening for Metabolic Bone Disease of prematurity

Metabolic bone disease (MBD) of prematurity remains a significant comorbid condition in preterm, low birth weight infants. As the majority of in utero calcium (Ca) and phosphorus (Phos) accretion occurs during the third trimester, many of these children have inadequate mineral stores and are at risk for deficiencies of Ca and Phos. While fortification of formula has allowed for increased mineral delivery to premature infants, intestinal immaturity prevents optimal absorption. This is compounded by immobilization, delayed establishment of enteral feeds, long term parenteral nutrition and medications that may alter mineral levels. Over time, biochemical changes occur and accompany MBD, with poor bone mineralization during this period increasing the risk for complications such as osteopenia, rickets and fractures. Screening is largely based on risk factors, but despite the 2013 AAP Consensus Statement, there remains significant variation in screening practices across institutions. A combination of laboratory and radiologic testing is often used to diagnose and manage MBD of prematurity, but there exists a lack of consensus on which screening tests and thresholds to use. This is in part related to a lack of normative data and clinical trials for preterm infants, and a result, a lack of evidence-based guidelines on the diagnosis and timing of potential treatment. Biochemical markers, such as serum Phos, alkaline phosphatase (ALP) and parathyroid hormone (PTH), have shown some benefit in the diagnosis of MBD in some studies, but have not always been reproducible. Radiographs may identify different degrees of skeletal changes, but these changes may not be detected until later in MBD development. Other modalities, such as DXA and ultrasound, have also been used, but these may be limited by lack of standards in preterm infants or lack of availability in some centers. Further research, more specifically clinical trials, are needed to determine which combination of tests can detect MBD at its earliest, in order to promote early treatment and prevent short- and long-term complications of MBD.     

不同年龄组和病损牙氟磷含量比的变化

随机采集口腔科门诊拔牙患者的离体牙７０个，按年龄分３组（儿童组、中青年组、老年组）；按病变分３组（正常组、龋齿组、氟斑牙组）。各组牙齿均经１０％甲醛浸泡。清除结石，用优级纯硝酸冷消化处理后，分别采用电化学分析法和分光光度法测定离体牙氟和磷的含量并计算氟磷含量比（Ｆ／Ｐ）。结果表明，中青年组Ｆ／Ｐ值是儿童组的１１８倍，是老年组的１．８倍；而正常组牙齿Ｆ／Ｐ值则是龋齿组的１．６倍，氟斑牙组的１．１倍。     

磷结合剂对于血液透析高磷血症患者成纤维细胞生长因子23水平的影响

目的比较碳酸镧和碳酸钙对于血液透析高磷血症患者血清成纤维细胞生长因子23（fibroblast growth factor-23,FGF-23）水平的影响。方法选择我科56例慢性肾衰竭维持性血液透析患者,入选患者血磷〉1．77mmol／L,血钙〈2．38mmol／L,25-OH—VitDTk平〉30ng／ml,血白蛋白水平〉30g／L。患者限制饮食磷摄人量为1000mg／d左右,将患者随机分为2组,分别接受碳酸镧或碳酸钙治疗16周。每2周常规检测血钙、血磷水平,滴定磷结合剂的使用剂量,使血磷水平达标。在治疗的第0、4、16周检测血清FGF-23及iPTH水平。结果碳酸钙和碳酸镧均能降低血磷水平。2组中,血清校正钙离子水平、甲状旁腺素水平均无明显变化。与碳酸钙相比,碳酸镧能有效降低FGF-23水平,且血磷水平的改变与血清FGF-23水平的改变呈正相关。结论在血液透析患者中应用碳酸镧可以有效降低血磷及血清FGF-23水平,而应用碳酸钙并不能减少血清FGF-23水平。     

SLC34 A1和 RGS14单核苷酸多态性与阿德福韦酯治疗的慢性乙型肝炎患者血磷浓度的相关性

目的：探讨SLC34A1（rs6420094）和RGS14（rs4074995）单核苷酸多态性与长期服用阿德福韦酯治疗的慢性HBV感染者血磷浓度的相关性。方法选取2012年10月至2013年8月河北医科大学第三医院连续服用阿德福韦酯（10 mg／d）单药或联合治疗至少2年的慢性HBV感染者91例,其中低磷血症患者31例,血磷正常患者60例。应用聚合酶链反应-限制性片段长度多态性分析法测定两位点的基因型,应用χ^2检验分析两位点等位基因分布频率与血磷浓度的关系。结果低磷血症组中,rs6420094基因A／A、A／G和G／G型的例数分别为13,13和5例,而血磷正常组上述基因型的例数分别为35,24和1例。此位点的等位基因A在血磷正常组出现的频率高于低磷血症组（78．3％∶62．9％）,两组比较差异有统计学意义（χ^2＝4．947,P＜0．05）。低磷血症组中,rs4074995基因A／A、A／G和G／G型的例数分别为2,11和18例,而血磷正常组上述基因型的例数分别为1,21和38例,等位基因分布频率在两组间差异无统计学意义（χ^2＝0．625,P＞0．05）。结论 rs6420094多态性可能会影响长期服用阿德福韦酯治疗的慢性HBV感染者的血磷浓度。     

放射性核素磷近距离治疗小儿皮肤血管瘤的近期疗效

目的:探讨放射性核素磷(32P)近距离治疗小儿皮肤血管瘤的临床疗效及辐射损伤。方法:173例小儿皮肤血管瘤患儿随机分为治疗组92例,对照组81例,采用32P敷贴器以不同的剂量、不同的治疗疗程行近距离治疗,观察其临床疗效及辐射损伤。结果:32P敷贴器放射性面密度的估算值与实测值误差为5.4%±0.9%;治疗组和对照组患者经32P治疗1个～4个疗程后病灶总治愈率均为100%;两组病例治疗后均出现皮肤辐射损伤,且与皮肤血管瘤病变的面积密切相关,治疗组的辐射损伤比对照组轻(P<0.05),皮肤血管瘤病变较厚者疗效较低,增加治疗疗程可提高疗效(P<0.05)。结论:多疗程、低剂量的32P近距离治疗小儿皮肤血管瘤可取得更佳的临床治疗效果。     

Impact of hepatitis virus infection on arterial calcification among incident hemodialysis patients

BackgroundThe impact of hepatitis virus infection on arterial calcification (AC) was not studied.ObjectiveTo study the prevalence, severity and distribution of AC in incident hemodialysis patients with hepatitis B and C viral infection.Cases and methods172 stage 5 CKD adults (98 male and 74 female) were included; 58 of them were seronegative for both hepatitis B and C (SN group), 48 were positive for hepatitis B virus infection (HBV group) and 66 were hepatitis C virus positive (HCV group). Beside histopathology of the obtained arterial samples, all these cases were examined for body mass index (BMI), serum calcium (Ca), phosphorus (P), alkaline phosphatase (AP), serum albumin, uric acid (UA), alanine transaminase (ALT), parathormone (PTH), fibroblast growth factor 23(FGF23), interleukin 6 (IL6), and 25 hydroxy vitamin D (25 (OH) vit D), hemoglobin concentration, and serum ferritin.Results86 (50%) of the cases had AC; 11 of them were in SN group (19%), 9 in HBV group (18.8%) and all the 66 HCV group (100%). In SN group, 4 had intimal calcification, 5 had medial calcification, and 2 had both intimal and medial calcification. In HBV group, 9 had intimal calcification, while no cases were encountered with either medial or both site calcifications. In HCV group, 16 had intimal calcification, 31 had medial calcification, and 19 had both intimal and medial calcification. Calcification was in the form of spots in one case in SN group, and 6 cases in HBV group, a single plaque of calcification in 5 cases of SN group, 3 cases of HBV group, and 16 cases of HCV group, multiple plaques were detected in 4 cases in SN group, and 31 cases in HCV group, and diffuse calcification in one case in SN group, and 19 cases in HCV group.In HBV group, calcification was only detected in patients with high viremia, while all patients with low or moderate viremia were devoid of calcification. In HCV group, all patients with low viremia had intimal solitary plaque of calcification, all patients with moderate viremia had multiple plaques of medial calcification, while all patients with high viremia had diffuse intimal and medial calcification. Both groups of viral hepatitis were significantly different in comparison to SN group in either distribution or calcification score (P < 0.001 in all).HBV group had significantly lower serum P, CaxP and PTH in comparison to SN group (4.6 ± 0.66 vs. 5.45 ± 0.77 mg/dL, 36.4 ± 7.2 vs. 44.1 ± 8.69, and 348 ± 65.4 vs. 405.9 ± 83.2 pg/mL, P < 0.001, <0.001, and 0.035 respectively). On the other hand, HCV group did not show any significant difference in any of the studied parameters compared to SN group.ConclusionHCV positive patients are more prone to develop AC that is more extensive. HBV positive patients were less likely to have arterial medial calcification, probably related to lower serum phosphorus, CaxP product and PTH. HCV infection should be added as risk factor for AC among CKD patients. Further studies are needed to confirm these findings.     

Hypophosphatemia accompanying blastic crisis in a patient with malignant lymphoma

Summary A patient with malignant lymphoma showed severe hypophosphatemia during a blastic crisix. x-Ray microprobe analysis of the cells at this stage revealed a high phosphorus content. Following treatment and a decline in the white cell count the serum phosphorus increased, whereas the cellular phosphorus decreased. The potential prognostic value of serum and cellular phosphorus determinations during the course of malignant disorders of the hematopoietic system is discussed.