老年男性甲状旁腺激素与骨密度的关系

本文的目的在于探讨在健康老年人中，甲状旁腺素（ＰＴＨ），钙（Ｃａ）、磷（Ｐ）、镁（Ｍｇ）、碱性磷酸酶（ＡＫＰ）、肌酐（Ｃｒ）与骨密度（ＢＭＤ）之间的关系。选择７０名健康老人，抽血查Ｃ－ＰＴＨ、Ｃａ、Ｐ、Ｍｇ、ＡＫＰ和Ｃｒ的水平。并在左侧桡骨远端１／３处，用单能光子骨密度测定仪测定ＢＭＤ。以正常参考值为标准（０．６２９７～０．７６９５ｇ／ｃｍ２），将对象分为ＢＭＤ降低组和ＢＭＤ正常组。结果显示：（１）在ＢＭＤ正常组（ＢＭＤ值为０．７３±０．０７ｇ／ｃｍ２）中，ＰＴＨ的水平为１５５．３６±９３．４５（ｎｇ／Ｌ），在ＢＭＤ降低组（ＢＭＤ值为０．５７±０．０４ｇ／ｃｍ２）中，ＰＴＨ的水平为２１４．１１±９１．９３（ｎｇ／Ｌ）。二组间差异有统计学意义。（２）在ＢＭＤ正常组中，血清钙的水平为２．１２±０．２２（ｍｍｏｌ／Ｌ），在ＢＭＤ降低组中，血清钙的水平为２．２３±０．１９（ｍｍｏｌ／Ｌ）。两组相比，差别有统计学意义（Ｐ＜０．０５）。实验结果提示：在老年男性与年龄有关的骨密度降低中，ＰＴＨ的分泌起到重要作用。     

胰岛素依赖型糖尿病肾病患者红细胞膜钠锂交换活性测定及意义

探讨红细胞膜钠锂交换活性（ＳＬＣＡ）与胰岛素依赖型糖尿病（ＩＤＤＭ）肾病之间的关系。方法采用Ｃａｎｅｓｓａ建立的方法，测定了１３例ＩＤＤＭ肾病，以及性别、年龄、糖尿病病程和体重指数（ＢＭＩ）等匹配的１２例正常白蛋白尿ＩＤＤＭ患者红细胞膜ＳＬＣＡ。结果ＩＤＤＭ肾病红细胞膜ＳＬＣＡ０．４６（０．３７～０．５４）ｍｍｏｌ·Ｌ－１·ＲＢＣ－１／ｈ显著高于正常白蛋白尿ＩＤＤＭ患者ＳＬＣＡ０．３０（０．２１～０．３９）ｍｍｏｌ·Ｌ－１·ＲＢＣ－１／ｈ（Ｐ＜０．００１）。结论ＳＬＣＡ可能是预测ＩＤＤＭ肾病最早的指标     

长期强的松治疗对系统性红斑狼疮患者骨代谢影响的研究

目的研究系统性红斑狼疮（ＳＬＥ）患者长期糖皮质激素（ＧＣ）治疗后钙、磷代谢及骨密度变化。方法测定健康对照组（Ａ组）、ＳＬＥ初诊组（Ｂ组）、ＳＬＥ强的松治疗组（Ｃ组）三组研究对象的血钙、磷、骨特异性碱性磷酸酶（ＡＬＰ）、骨钙素（ＢＧＰ）、全段甲状旁腺激素（ＩＰＴＨ）值。并测量腰椎２～４,髋关节的骨密度。结果结果显示Ｃ组的骨特异性ＡＬＰ、ＢＧＰ明显低于Ａ组及Ｂ组（Ｐ＜０．０１）,ＩＰＴＨ在Ｃ组显著高于Ａ组及Ｂ组（Ｐ＜０．０１）,Ｃ组腰椎、股骨颈、髋部的骨密度均明显低于Ａ组及Ｂ组（Ｐ＜０．０１）。结论长期服用强的松的ＳＬＥ患者存在多部位骨密度下降,其原因可能同ＧＣ抑制成骨细胞活性及促进ＰＴＨ的分泌和活性有关。     

分娩前母血、脐血、新生儿血骨代谢相关激素水平及其意义

目的　测定新生儿血清骨代谢激素水平及探讨其临床意义。方法　采用放射免疫与免疫放射分析法测定８９ 例新生儿脐带血清,２２ 例出生３ 天婴儿血清骨钙素（ＢＧＰ）、降钙素（ｈ－ＣＴ）和甲状旁腺素（ｉＰＴＨ）水平。结果　新生儿脐带血ＢＧＰ、ｈ－ＣＴ 和 ｉＰＴＨ 水平分别为 １９．３±１６．８ μｇ／Ｌ、７８．９±５１．５ ｎｇ／Ｌ 和０．２２±０．１６ ｐｍ ｏｌ／Ｌ（ｘ±ｓ）,与分娩前母血比较,差异非常显著,Ｐ 值分别为Ｐ＜０．０１、Ｐ＜ ０．０１ 和Ｐ＜ ０．０１;出生３ 天婴儿血清ＢＧＰ、ｈ－ＣＴ 和ｉＰＴＨ 水平分别为７．４±２．３ μｇ／Ｌ、５７．８±１３．８ ｎｇ／Ｌ和５．６±１．６９ ｐｍ ｏｌ／Ｌ（ｘ±ｓ）,与新生儿脐带血比较差异非常显著,Ｐ 值分别为Ｐ＜ ０．０１、Ｐ＜ ０．０１ 和Ｐ＜ ０．０１。结论　本研究结果表明新生儿骨代谢激素的放射免疫测定是研究新生儿骨代谢变化的重要检测手段。     

LFA-1共刺激诱导狼疮性肾炎外周血单个核细胞IL-10表达的研究

目的：探讨淋巴细胞功能相关抗原－１（ＬＦＡ－１）对活动性狼疮肾炎（ＬＮ）外周血单个核细胞（ＰＢＭＣ）白介素 １０（ＩＬ－１０）的调节作用。方法：利用半定量 ＲＴ－ＰＣＲ技术观察 ＬＦＡ－ １共刺激对活动性 ＬＮ患者 ＰＢＭＣ ＩＬ－１０ ｍＲＮＡ表达的影响。结果：单独抗ＣＤ３抗体（３０ ｎｇ／ｍｌ）能诱导ＬＮ 患者ＰＢＭＣ ＩＬ－１０ ｍＲＮＡ轻微表达（０．４３＋０．０３ｖｓ ０．５５±０．４４,Ｐ＜０．０５）而在抗ＣＤ３抗体（３０ ｎｇ／ｍｌ）存在的情况下,抗ＬＦＡ－１抗体（２ μｇ／ｍｌ,相当于ＬＦＡ－１配体）共刺激时明显增加了ＰＢＭＣ ＩＬ—１０ ｍＲＮＡ表达（１．３１±０．０８ｖｓ ０．５５＋０,０４,Ｐ＜０．０１）。ＬＦＡ－１中和抗体明显抑制了这种共刺激诱导的ＩＬ—１０ ｍＲＮＡ表达（１．３１±０．０８ｖｓ ０．６４ ±０．０３,Ｐ＜０．０１）。抗ＬＦＡ－１抗体单独刺激时并不引起 ＩＬ－１０ ｍＲＮＡ表达变化（Ｐ＞０．０５）。结论：ＬＦＡ－１作为共刺激分子诱导 ＩＬ－ １０ ｍＲＮＡ表达可能是其参与 ＬＮ发病的机制之一。     

原发性闭经患者骨代谢及其骨调节因素水平的观察

目的　了解低雌激素性原发闭经患者骨代谢及其骨调节因素水平与正常同龄妇女之差异。方法　对 １０ 例原发性闭经患者进行桡骨骨矿含量（ＢＭＣ）和血清降钙素（ＣＴ）、甲状旁腺激素（ＰＴＨ）、雌二醇（Ｅ２）、碱性磷酸酶（ＡＬＰ）以及空腹尿钙与肌酐（Ｃａ／Ｃｒ）、羟脯氨酸与肌酐（ＯＨＰｒ／Ｃｒ）比值的测定。结果　原发性闭经组妇女ＢＭＣ的水平低于正常对照组,血清ＰＴＨ 的水平高于对照组,但均未见显著性差异（Ｐ＞ ０．０５）,空腹尿（Ｃａ／Ｃｒ）、ＯＨＰｒ／Ｃｒ 比值和ＡＬＰ的水平高于对照组、血清Ｅ２ 和ＣＴ 的水平低于对照组,并均有显著性差异（Ｐ＜ ０．０５、Ｐ＜ ０．０１ 或Ｐ＜ ０．００１）。结论　低雌激素性原发闭经患者骨矿含量的水平较正常同龄妇女降低。其骨代谢已呈高转换失钙状态,显示严重的骨质疏松易患倾向,故应及时予以防治。     

精浆酸性磷酸酶活性与抗精子抗体

目的：探讨男性不育症精浆酸性磷酸酶（ＡＣＰ）与精子密度、精子成活率、血清和精浆抗精子抗体（ＡｓＡｂ）之间的关系。方法：检测不育男性精子密度、精子活率、血清和精浆ＡｓＡｂ及精浆ＡＣＰ活性。结果：精子成活率＞５０％、３０％～５０％、＜３０％组的精浆ＡＣＰ活性逐渐降低,分别为（１６２．１２±８５．７７）Ｕ／ｍｌ、（１２３．０１±５２．５５）Ｕ／ｍｌ和（１１１．２１±５４．４２）Ｕ／ｍｌ;与成活率＞５０％的精浆ＡＣＰ相比,活率在３０％～５０％和＜３０％组的ＡＣＰ活性降低,具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）;精子密度＞２０×１０９／Ｌ、（１０～１９）×１０９／Ｌ和＜１０×１０９／Ｌ组的精浆ＡＣＰ活性依次下降,分别为（１６５．９９±８８．６７）Ｕ／ｍｌ、（１３９．１９±７０．７８）Ｕ／ｍｌ和（１１５．２１±６０．５１）Ｕ／ｍｌ;与密度＞２０×１０９／Ｌ组的ＡＣＰ活性相比,密度在（１０～１９）×１０９／Ｌ和＜１０×１０９／Ｌ的精浆ＡＣＰ活性降低,具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）;血清、精浆ＡｓＡｂ阳性病人的ＡＣＰ活性明显低于二者均阴性的病人,且ＡＣＰ降低具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）。结论：?     

三种大鼠骨质疏松模型的比较研究

用维Ａ酸、摘除卵巢及糖皮质激素诱导大鼠骨质疏松症，以血清碱性磷酸酶（ｓ－ＡＬＰ），血清钙（ｓ－Ｃａ）、磷（ｓ－Ｐ），尿钙／肌酐（ｕ－Ｃａ／Ｃｒ）及羟脯氨酸／肌酐（ｕ－Ｈｏｐ／Ｃｒ）等为指标，引入骨表观线密度（Ｗ／Ｌ）、面密度（Ｗ／Ｌφ）两个新的骨指数，对该三种较常用的大鼠骨质疏松模型进行了比较研究。结果显示大剂量维Ａ酸组（９０、１００、１２０ｍｇ／ｋｇ）及摘除卵巢组骨重（Ｗ）减轻，Ｗ／Ｌ、Ｗ／Ｌφ明显降低（ｐ＜０．０１，ｐ＜０．０５），形成典型的大鼠骨质疏松症；糖皮质激素组ｓ－ＡＬＰ、ｕ－Ｃａ／Ｃｒ及ｕ－Ｈｏｐ／Ｃｒ显著升高（ｐ＜０．０１，ｐ＜０．０１），但Ｗ／Ｌ、Ｗ／Ｌφ没有明显差异     

心肝核素显影比值对门静脉高压症的诊断价值

作者采用经直肠心肝核素显影法判断门静脉高压症。９１例经直肠注入￣９９ｍＴｃ－ＭＩＢＩ后测定心肝核素显影比值（Ｈ／Ｌ），结果显示正常对照组（１５例）Ｈ／Ｌ。为０．２６７±０．１，病毒性肝炎组（８例）Ｈ／Ｌ轻度上升（０．４５５±０．１３），而肝硬变组（６８例）则显著升高。其中Ｃｈｉｌｄ－Ａ组患者的Ｈ／Ｌ为０．５７±０．１２，ｃｈｉｌｄ－Ｂ组为１．０±０．１９，Ｃｈｉｌｄ－Ｃ组为１．１９±０．２５。Ｈ／Ｌ。与Ｃｈｉｌｄ－ｐｕｇｈ分级呈趋势相关（Ｐ＜０．０１）。２３例在手术时测定的门静脉压力与Ｈ／Ｌ，呈显著相关（ｒ＝０．８７，Ｐ＜０．０１）。从公式Ｙ＝０．７８５±３．２４Ｈ／Ｌ可以推算出门静脉压力。以Ｈ／Ｌ，≥０．６２为阳性标准诊断肝硬变门静脉高压的敏感度为９６％，特异度为８９％，准确率为９４％。经直肠￣９９ｍＴｃ－ＭＩＢＩ测定是无创伤性诊断门静脉高压的可靠安全的新方法。     

绝经妇女骨代谢变化及雌激素对骨代谢的影响

目的 探讨绝经后妇女骨代谢的变化及雌激素对骨代谢的影响。方法 测定了绝经后妇女的血清促卵泡激素（ＦＳＨ）、促黄体生成素（ＬＨ）、雌二醇（Ｅ２）、骨钙素（ＢＧＰ）、碱性磷酸酶（ＡＬＰ）、尿／肌酶（Ｃａ／Ｃｒ）、羟脯氨酸／肌酐（ＨＯＰ／Ｃｒ）含量变化。结果 绝经后（Ｅ２）水平显降低（Ｐ〈０．０１）,而ＦＳＨ、ＬＨ、ＢＧＰ、ＡＬＰ、Ｃａ／Ｃｒ、Ｈｐｒ／Ｃｒ水平显增高,（Ｐ〈０．０１）。结论绝经后妇女     

肾移植患者骨矿含量的测定及临床意义

测量了６４例肾移植患者移植前后的骨矿含量及骨钙素（ＢＧＰ）、甲状旁腺激素（ＰＴＨ）、血液生化的变化，以探讨它们的相互关系及临床意义。结果术前血肌酐（ＳＣｒ）、尿素氮（ＢＵＮ）、磷（Ｐ）、ＰＴＨ、ＢＧＰ为高水平，血钙（Ｃａ）低，骨矿含量（０．７７７±０．０１５ｇ／ｃｍ２）明显低于对照组（０．８１１±０．０３５ｇ／ｃｍ２）。术后肾功能正常者，ＳＣｒ、ＢＵＮ、Ｃａ、Ｐ及ＰＴＨ、ＢＧＰ均恢复正常，骨矿含量半年后恢复至对照组水平。提示慢性肾功能衰竭及血液透析期间存在明显钙磷代谢异常，严重骨营养不良；肾移植成功后骨矿含量恢复，纠正了肾性骨病；肾移植后骨矿含量低者，往往提示预后不良。     

益肾健脾法对老年髋部骨折术后骨代谢的影响

目的运用益肾健脾法中药干预老年髋部骨折术后,观察其对骨代谢及骨密度等临床指标的影响。方法符合纳入标准的40例病例,随机分为治疗组和对照组,各20例。治疗组根据临床辨证,运用益肾健脾法给予中药口服,每日1剂,早晚分服;对照组不予干预,2月后复诊。术前和术后2月对比观察Ca、P、ALP、ACP、PTH、BGP、CT及骨密度指标,两次所得数据进行统计分析。结果最终资料收集完善的18例病例,治疗组8例,对照组10例。术前两组各项指标差异无统计学意义(P0.05),术后两组Ca、ALP、ACP、PTH、BGP、CT差异具有统计学意义(P0.05),术后P及骨密度两组差异无统计学意义(P0.05)。结论老年髋部骨折术后运用益肾健脾法进行中药干预,可以改善部分骨代谢指标。     

Determinants of bone gamma-carboxyglutamic acid-containing protein in plasma of healthy aging subjects

The gamma-carboxy glutamic acid (Gla)-containing protein of mammalian bone (BGP, also called osteocalcin) is a 49 amino acid polypeptide containing two to three residues of gamma-carboxyglutamic acid. BGP is synthesized by osteoblastlike cells, and plasma BGP in laboratory animals is derived principally from recently synthesized BGP. These data, taken together with observations that plasma BGP levels are elevated in patients with disorders of high bone turnover, suggest that plasma BGP is a marker of osteoblast activity. Since low bone formation rates may play an important role in the loss of bone mass with age, we have examined the determinants of plasma BGP levels in aging subjects, using a region-specific radioimmunoassay for human BGP based on the synthetic C-terminal peptide hBGP37-49. In 147 carefully screened healthy subjects, aged 23-91, BGP did not change with age, whereas alkaline phosphatase (AP) showed a significant positive correlation (r = 0.30, P less than 0.001). Creatinine clearance (GFR) declined by 0.9 ml/min/yr and correlated with both BGP (r = -0.21, P less than 0.001) and AP (r = -0.21, P less than 0.001). However, correlation of AP with age persisted after controlling for GFR. BGP was not correlated with serum PTH, urine Ca/GFR, or urine cAMP/GFR. In 48 patients with known parenchymal renal disease studied for comparison, plasma BGP was increased at a serum creatinine of greater than or equal to 1.8 mg/dl. Our results indicate that plasma BGP, a specific marker of bone metabolism, is not predictably related to age per se. This result is in contrast to the age-related rise in total AP. Subtle changes in renal function can affect plasma BGP levels.     

肾移植术后患者骨代谢的改变

目的:研究肾移植术后患者骨代谢生化指标的改变.方法:采用竞争性放射免疫分析法测定30例肾移植患者和25例健康献血者的血清骨代谢生化指标:骨钙素(BGP)、降钙素(CT)、甲状旁腺激素(PTH)和25羟基维生素D(25-OH-D)、Ⅰ型胶原羧基端交联肽原(ICTP)和Ⅰ型前胶原氨基端伸展肽(PINP)水平.结果:肾移植术后患者的BGP、PINP和ICTP水平明显高于正常对照组(P＜0.01),但两组的CT、25-OH-D和PTH水平差异无统计学意义(P＞0.05).结论:肾移植术后患者出现明显的骨代谢紊乱,主要表现为血清成骨细胞活性增强,同时伴有破骨细胞功能增强,骨转换活跃,其发病机制可能主要与术后长期使用免疫抑制剂有关.     

血清睾酮与老年男性原发性骨质疏松症的关系

目的 探讨血清睾酮与老年男性原发性骨质疏松的关系，为防治老年男性原发性骨质疏松症提供理论依据。方法 双能X线骨密度仪测定腰椎(L1-4)骨密度；全自动生化分析法测定尿钙、肌酐；AKP用比色法，Ca、Mg用MTB法，P用磷酸亚铁胺法；放射免疫法测定血清E2、T、BGP、CT、PTH-m。获得的参数骨质疏松组与正常对照组比较。结果 男性原发性骨质疏松组骨代谢生化指标与同年龄同性别的对照组比较，血清Ca、P、Mg、Cu以及PTH-m、E2、AKP、BGP两组差异无显著性；血清降钙素显著降低；尿钙与肌酐比值非常明显地增多；男性主导性激素睾酮骨质疏松组非常明显地低于对照组。结论 老年男性原发性骨质疏松的发病因素虽然是多方面的，但血清睾酮水平的降低是老年男性骨质疏松症发病的一个非常重要的原因。     

Urinary deoxypyridinoline excretion for the evaluation of bone turnover in chronic renal failure

BACKGROUND: The urinary excretion of deoxypyridinoline (DPD) was evaluated in predialysis chronic renal failure (CRF), together with intact PTH and several classic markers of bone turnover in order to assess whether urine free and total DPD excretion are equivalent parameters of bone turnover in CRF, and to evaluate the relationship between urine DPD excretion, PTH and the other bone markers. METHODS: The study was carried out in 94 patients with different degrees of renal failure due to various kidney diseases. Besides urinary DPD expressed as free DPD, total DPD, free/total DPD, free DPD/Cr and total DPD/Cr, the following determinations were made: intact PTH, bone alkaline phosphatase (BALP), total alkaline phosphatase (AP), osteocalcin (BGP), serum C-terminal telopeptide of collagen type I (ICTP) and hydroxyproline (OHpro). The patients were divided into 3 groups according to the increasing severity of renal failure (Ccr >40, 40-20, <20 ml/min). RESULTS: The ratio free/total DPD decreased (NS) with advancing renal failure, and was inversely correlated with total DPD excretion. While PTH increased progressively to about four times the values observed in the Ccr >40 group, there was a parallel increase only in BGP and ICTP, parameters retained in the serum with decreasing renal function, while AP, BALP, total DPD and OHpro did not change. However, significant correlations between total DPD/Cr and PTH, BALP, BGP and ICTP were also found. CONCLUSIONS: In CRF free DPD is an unreliable index of bone turnover due to a probable interference in its production from the peptide-bound DPD. Total DPD or total DPD/Cr are better used. In spite of the significant correlations observed in advanced renal failure between PTH and most of the parameters examined, a resistance of bone tissue to PTH action in CRF must be considered.     

Osteoprotegerin and bone mineral density in hemodiafiltration patients

A newly identified cytokine, osteoprotegerin (OPG) appears to be involved in the regulation of bone remodeling. In vitro studies suggest that OPG, a soluble member of the TNF receptor family of proteins, inhibits osteoclastogenesis by interrupting the intercellular signaling between osteoblastic stromal cells and osteoclast progenitors. As patients with chronic renal failure (CRF) often have renal osteodystrophy (ROD), we investigated the role of osteoprotegerin (OPG) in ROD, and investigated whether there was any relationship between serum OPG, intact parathyroid (PTH) (iPTH), vitamin D, and trabecular bone. Serum OPG combined with iPTH might be a useful tool in the noninvasive diagnosis of ROD, at least in cases in which the range of PTH values compromises reliable diagnosis. Thirty-six patients on maintenance hemodiafiltration (HDF) and a control group of 36 age and sex matched healthy subjects with no known metabolic bone disease were studied. The following assays were made on serum: iPTH, osteocalcin (BGP), bone alkaline phosphatase, 25(OH)-cholecalciferol, calcium, phosphate, OPG, IGF-1, estradiol, and free testosterone. Serum Ca++, P, B-ALP, BGP, IGF-1, iPTH, and OPG levels were significantly higher in HDF patients than in controls, while DXA measurements and quantitative ultrasound (QUS) parameters were significantly lower. On grouping patients according to their mean OPG levels, we observed significantly lower serum IGF-1, vitamin D3 concentrations, and lumbar spine and hip bone mineral density in the high OPG groups. No correlation was found between OPG and bone turnover markers, whereas a negative correlation was found between serum OPG and IGF-1 levels (r=-0.64, p=0.032). Serum iPTH concentrations were positively correlated with bone alkaline phosphatase (B-ALP) (r=0.69, p=0.038) and BGP (r=0.92, p<0.001). The findings made suggest that an increase in OPG levels may be a compensatory response to elevated bone loss. The low bone mineral density (BMD) levels found in the high OPG group might have been due to the significant decrease in serum IGF-1 and vitamin D3 observed. In conclusion, the findings made in the present study demonstrate that increased OPG in hemodiafiltration patients is only partly due to decreased renal clearance. As it may partly reflect a compensatory response to increased bone loss, this parameter might be helpful in the identification of patients with a marked reduction in trabecular BMD.     

Diagnostic evaluation of plasma free gamma-carboxyglutamic acid in maintenance hemodialytic patients with renal osteodystrophy

The levels of serum Bone Gla Protein (BGP) and plasma free gamma-carboxyglutamic acid (free gamma-Gla) were measured in 36 patients on maintenance hemodialysis and compared with conventional parameters of renal osteodystrophy (ROD), such as C-PTH, intact PTH, Al-PIII and hydroxyproline levels in serum, and sigma GS/D. Even though the values of BGP were significantly elevated in patients group, 64.5 +/- 1.74 ng/ml, but the low values within normal range could be found in 3 of 36 patients, also. On the other hand, plasma levels of free gamma-Gla were markedly elevated in all cases as high as 10.40 +/- 3.10 nmol/ml in average compared to 1.29 +/- 0.37 nmol/ml (n = 15) in healthy controls. Comparative analysis of BGP with other parameters showed exclusively significant correlation as follows, C-PTH: r = 0.833 (p less than 0.01), intact PTH: r = 0.702 (p less than 0.01), Al-PIII: r = 0.771 (p less than 0.01), hydroxyproline: r = 0.462 (p less than 0.01), sigma GS/D: r = -0.407 (p less than 0.05). Respective for its higher levels, comparative analysis of plasma levels of free gamma-Gla with other parameters failed to show a significant correlation except for correlation with C-PTH (r = 0.459, p less than 0.01). Based upon these results, we could confirm a marked elevation in plasma levels of free gamma-Gla in all patients, but couldn't point out its clinical value in ROD in this study.     

多发性骨髓瘤骨代谢指标的改变

本文测定了１０例多发性骨髓瘤患者的血钙、磷、ＡＫＰ、ＢＧＰ、２４小时尿ＨＯＰ及腰椎２～４正位ＢＭＤ，并且经化疗完全缓解后再次复查。结果（１）多发性骨髓瘤患者血Ｃａ、Ｐ、ＡＫＰ与正常对照无显著差异，化疗前后也无显著差异。（２）血ＢＧＰ低于正常对照，２４小时尿ＨＯＰ高于正常对照，化疗后ＢＧＰ增高，ＨＯＰ下降。（３）ＢＭＤ改变：１０例患者中有３例骨量减低，６例骨质疏松，化疗后ＢＭＤ有所增加。因此，血ＢＧＰ、尿ＨＯＰ和ＢＭＤ对观察多发性骨髓瘤治疗效果有一定的临床指导意义。还初步探讨了破骨细胞因子对骨质破坏的机理。     

Bone GLA protein in predialysis chronic renal failure. Effects of 1,25(OH)2D3 administration in a long-term follow-up

Serum bone GLA protein (BGP) was measured by radioimmunoassay in 42 patients (age, 47.5 +/- 16.6 years; serum creatinine, 4.32 +/- 1.9 mg/dl) with predialysis chronic renal failure (CRF). Nineteen patients were studied within a short period of time, while 23 were followed with repeated measurements of serum BGP, creatinine, iPTH, and alkaline phosphatase (AP) for a mean period of 17.1 +/- 8.1 months. Eleven of these patients were treated with 1,25(OH)2D3 for a mean of 16.8 +/- 6.4 months. In 23 patients at various stages of CRF, a transiliac bone biopsy was performed for histomorphometric evaluation. In the untreated patients, serum BGP was higher than normal and showed a positive correlation with creatinine levels (P less than 0.001). Serum BGP was also positively correlated with iPTH, AP, serum phosphate, active resorption surface, active osteoblastic surface, osteoid surface, and volume. During treatment with 1,25(OH)2D3, BGP, iPTH, and AP were significantly lower than in the untreated patients. The reduction in iPTH and BGP was proportional, while BGP and AP no longer correlated. Repeated measurements of BGP during the long-term follow-up showed a progressive rise in the untreated patients and a downward course of BGP levels during treatment. In conclusion, serum BGP increases progressively in CRF, rising with advancing renal damage in close correlation with iPTH, AP, and the severity of renal osteodystrophy. Treatment with 1,25(OH)2D3 causes a parallel decline in BGP and iPTH levels and dissociation between BGP and AP can be observed. Compared to AP, BGP seems to be a more reliable index of secondary hyperparathyroidism and potentially more useful in the long-term monitoring of treatment with 1,25(OH)2D3.