抑郁症病人与正常人骨矿物质密度的对照研究

骨关节病理学的研究进展证实神经系统、内分泌、免疫系统与骨骼系统存在着密切的联系,影响着骨组织中各种细胞的功能及骨的钙化、吸收,从而影响骨矿物质密度［１,２］。为此本研究对抑郁症病人骨矿物质密度进行对照研究,试图探讨抑郁症病人是否存在骨矿物质密度的异常,现介绍如下。１　资料和方法１－１　一般资料：病例组来自本科门诊及住院病人,共３４例,男性１５例,年龄（５４－３±９－７）岁,病程（６９－３±５２－７）月;女性１９例,年龄（５４－３±８－７）岁,病程（５２－１±４５－８）月。病例均符合ＣＣＭＤⅡ…     

脊髓损伤早期及制动大鼠股骨干骺端的显微CT观察

背景：脊髓损伤后可引起损伤平面以下骨量大量丢失,导致骨质疏松。 目的：观察比较脊髓损伤及失用性制动模型大鼠股骨远端骨密度及骨微观结构的改变。 方法：将SD大鼠随机分为3组：对照组,切除T10椎板,不损伤硬膜及脊髓;脊髓损伤组,切除T10椎板后行Allen's法造成脊髓损伤;制动组,以大鼠双侧腿－尾缝合造成双下肢制动。10 d后取一侧尺、桡骨及股骨行骨密度检测,另一侧股骨行显微CT扫描。 结果与结论：脊髓损伤组与制动组大鼠股骨远端骨密度、骨矿物质含量、骨体积分数表、骨小梁厚度、骨皮质面积及厚度、骨小梁数量均低于对照组(P < 0.05 ),骨小梁结构模型指数、骨表面积体积比、骨小梁分离度均高于对照组;脊髓损伤组上述指标较制动组变化程度更显著(P < 0.05)。3组尺、桡骨密度差异无显著性意义。说明脊髓损伤及制动均可导致骨量丢失,在脊髓损伤早期损伤平面以下部位骨微观结构呈现骨质疏松明显改变,且程度比失用性因素严重。     

抑郁症患者REM睡眠研究

目的：探讨抑郁症患者快眼动睡眠的异常改变以及与临床的相关性。方法：对１８例抑郁症患者和１９名正常对照者进行睡眠脑电图检查,并予以比较。结果;抑郁症患者出现明显的ＲＥＭ潜零碎 期缩短和ＲＥＭ密度增加,且与抑郁严重程度显著相关。结论：ＲＥＭ睡眠的潜伏期缩短和密度增加可作为抑郁症诊断中具有参考价值的生物学指标。     

双相陶瓷样生物骨修复骨缺损

背景：已有研究表明课题组制备的双相陶瓷样生物骨符合骨组织工程支架或直接作为植骨材料的要求。实验将材料植入兔桡骨节段性骨缺损，以进一步了解双相陶瓷样生物骨修复骨缺损的能力。 目的：用双相陶瓷样生物骨来修复兔桡骨骨缺损，评价双相陶瓷样生物骨的成骨作用。 设计、时间及地点：随机对照动物实验，于2008-03/09在昆明医学院动物实验中心完成。 材料：将猪椎骨煮沸12 h，经系列乙醇脱水后于800 ℃条件下煅烧6 h后制得陶瓷化骨，完全去除有机成分，再将陶瓷化骨与适当浓度的焦磷酸钠溶液复合后于800 ℃煅烧1 h，经缓慢冷却后制得双相陶瓷样生物骨。 方法：成年日本大耳白兔36只随机分为3组：双相陶瓷样生物骨组、自体髂骨组、空白对照组，每组12只。在兔双侧桡骨造成1.0 cm骨缺损后分别植入双相陶瓷样生物骨材料、自体髂骨，空白对照组不做任何处理直接缝合切口。 主要观察指标：术后4，8，12，24周取出双侧尺、桡骨后摄X射线片，了解移植物的X射线变化情况。制备组织切片，光镜下观察移植物的组织形态特征及新骨形成情况。 结果：X射线片：双相陶瓷样生物骨组在术后4周可见材料密度较宿主骨高，与宿主骨分界清楚，8周后材料与宿主骨分界模糊，12周后大部分材料呈高密度影，24周后材料仍有部分高密度影。自体髂骨组在术后4周可见髂骨与宿主骨分界模糊，24周后植骨部位密度与宿主骨一致。组织学形态观察：双相陶瓷样生物骨组发现有新骨贴附材料生长，材料随着时间的推移逐渐降解吸收，新骨形成增多。24周后新骨形成明显增多，仍可见部分残余材料；自体髂骨组在12周后髓腔完全再通，24周后植骨部位与宿主骨结构没有差别；空白对照组未见骨连接或髓腔再通，随着时间的推移缺损两端逐渐封闭并硬化。 结论：实验初步表明双相陶瓷样生物骨可用于桡骨骨缺损的修复。     

抑郁症病人外周血T淋巴细胞内游离钙离子浓度

为了探讨抑郁症病人Ｔ淋巴细胞功能状况，应用ＡＲ－ＣＭ－ＭＪＣ阳离子测定系统，测定抑郁症病人外周血Ｔ淋巴细胞静息状态下及在植物凝集素（ＰＨＡ）和抗ＣＤ３单克隆抗体刺激下细胞内游离钙离子浓度。结果表明，在静息状态下，１０例抑郁症病人４０个Ｔ淋巴细胞内游离Ｃａ２＋浓度与正常对照没有差异，但在ＰＨＡ和抗ＣＤ３单克隆抗体刺激后，抑郁症病人Ｔ淋巴细胞胞内游离Ｃａ２＋上升到的最大值显著低于正常对照，且升高至２００ｎｍｏｌ／Ｌ及以上的细胞比例亦显著低于正常对照。提示抑郁症病人可能存在潜在的Ｔ淋巴细胞功能异常；由于Ｔ淋巴细胞与神经内分泌系统的复杂关系，结果亦可能揭示抑郁症的某些发病机制     

单、双相抑郁症临床特征的对照分析

据报告,双相抑郁症被误诊为单相抑郁症者高达40％,严重影响病人的预后。为此,作者对单、双相抑郁症的临床特征进行了对照分析,旨在有助于临床诊治,并报道于后。     

产后与非产后重症抑郁症的对照研究

产后与非产后重症抑郁症的对照研究徐松泉王东波卢喜金１．对象和方法：对１９８６年７月至１９９６年６月在我院连续住院的３６例产后重症抑郁症病人（产后组），与同期住院５０例女性非产后重症抑郁症病人（非产后组）的临床资料进行对照分析。两组病例均符合中国精神疾...     

5HT_2受体阻滞剂与抑郁症慢波睡眠[英]

作者以18例抑郁症病人与10例正常人作为对照,观察在单用利胆斯林(Ritanserin一种高度专一选择性的5HT_2受体阻滞剂)时的睡眠脑电活动。结果显示对抑郁症病人的慢波睡眠与正常人有不同影响。     

运动疗法治疗绝经后妇女骨质疏松症的荟萃分析

背景：运动疗法对预防绝经后妇女骨丢失的价值尚存在争议。 目的：评价运动疗法治疗绝经后妇女骨质疏松症的疗效。 方法：计算机检索PubMed，Embase，Cochrane Library，CBM，CNKI，VIP数据库关于运动疗法治疗绝经后妇女骨质疏松症的随机对照试验。纳入健康的绝经后妇女，种族、国籍、地域不限，年龄在50~70岁之间。排除合并有基础疾病的患者。采用Cochrane协作组提供的Revman 5.0软件进行统计分析。临床评价指标包括骨矿物质密度和骨折发生率。 结果与结论：共纳入9篇随机对照试验，Meta分析结果显示：与常规治疗比较，运动疗法联合常规治疗可明显提高绝经后妇女骨矿物质密度[WMD=0.96，95%CI (0.47，1.44)，P < 0.05]，但对其骨折发生率影响不明显(P > 0.05)。提示运动疗法可以增加绝经后妇女骨质疏松症的骨矿物质密度，但并不能减低骨折的发生率。     

妄想性抑郁症55例临床对照分析

对５５例妄想性抑郁症与９２例非妄想性抑郁症病人进行临床对照分析。结果表明：妄想性抑郁症幻听、焦虑、自责自罪、绝望、自杀行为等症状出现率较高，自杀率为非妄想性抑郁症的３．７倍，往往需要联合治疗。     

Bone mineral density, markers of bone turnover, and cytokines in young women with borderline personality disorder with and without comorbid major depressive disorder

OBJECTIVE: The pathogenesis of bone loss in major depressive disorder is a matter of debate. Studies of bone loss in nonpsychiatric medical disorders have found an association between the activation of osteoclastic cells and an imbalance of pro- and antiinflammatory cytokines. Since major depressive disorder is also associated with alterations in serum cytokine concentrations, the authors hypothesized that bone loss in patients with major depressive disorder and comorbid borderline personality disorder may be associated with cytokines capable of activating osteoclastic cells. METHOD: Twenty-two patients with borderline personality disorder and comorbid current or lifetime major depressive disorder were compared with 16 patients with borderline personality disorder who did not have major depressive disorder and 20 healthy volunteers. Bone mineral density was assessed by means of dual-energy x-ray absorptiometry. Markers of bone turnover as well as endocrine and immune measures were determined. RESULTS: The bone mineral density of 10 patients with borderline disorder plus current major depressive episode was significantly lower than that of the healthy subjects and the patients with borderline personality disorder without depression. Values of crosslaps, osteocalcin, serum cortisol, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 were significantly higher in the patients with borderline disorder plus current major depressive episode than in the healthy subjects. Crosslaps correlated positively with TNF-alpha but negatively with bone mineral density at the lumbar spine. Patients with borderline personality disorder who did not have current or lifetime depression displayed no alterations of either bone mineral density or the immunological and hormonal measures examined. CONCLUSIONS: Young women with comorbid borderline personality disorder and major depressive disorder have an elevated risk for osteoporosis. Borderline personality disorder per se is not associated with low bone mineral density. These data suggest that the immune and endocrine disturbances associated with depressive disorders in the context of borderline personality disorder may play a role in the pathophysiological process underlying bone loss in the patients studied.     

Adverse effects of antiepileptic drugs on bone mineral density

The aim of this study is to determine the frequency of changes in biochemical markers of bone metabolism in children who are receiving valproic acid, carbamazepine, and oxcarbazepine. Thirty healthy children and 68 children with idiopathic epilepsy treated with either carbamazepine (n = 23), valproic acid (n = 31), or oxcarbazepine (n = 14) for more than 1 year were enrolled into the study. Blood samples were obtained in order to determine biochemical parameters (calcium, phosphorus, alkaline phosphates, parathormone, and 25-hydroxyvitamin D). Bone mineral density was measured with the dual-energy x-ray absorptiometry method. There were no significant differences in the serum concentrations of calcium, phosphorus, aspartate aminotransferase, alanine aminotransferase, and albumin levels between the four groups. However, serum alkaline phosphatase concentrations were higher in the patient group as compared with the control subjects. In patients receiving antiepileptic drugs, bone mineral density values were significantly lower than the healthy control group. In conclusion, long-term antiepileptic drug treatment either with valproic acid, carbamazepine, or with oxcarbazepine which has unknown effects on skeletal mineralization, induces a state of decreased bone mineral density.     

Risperidone,but not olanzapine,decreases bone mineral density in female premenopausal schizophrenia patients

BACKGROUND: The hyperprolactinemia induced by conventional antipsychotics often leads to osteoporosis. The commonly used atypical antipsychotics risperidone and olanzapine vary in their hyperprolactinemic properties. Therefore, we compared hormone profiles and bone properties in female premenopausal schizophrenia patients treated with either risperidone or olanzapine. METHOD: In a cross-sectional study, consecutive premenopausal, female, DSM-IV schizophrenia patients who were treated with either risperidone (N = 12) or olanzapine (N = 14) for at least 2 years were included. Dual energy X-ray absorptiometry evaluated bone mineral density, and multisite quantitative ultrasound measured bone speed of sound. In addition, profiles of urinary excretion of deoxypyridinoline and circulating levels of hormones and lipids were assessed. RESULTS: Serum prolactin levels were higher in the risperidone-treated group as compared with the olanzapine subjects (123 +/- 144 and 25.9 +/- 25.7, p <.05). Whereas bone mineral density was similar in the treatment groups, bone speed of sound was lower in the risperidone group as compared with the olanzapine-treated group. Expressed as age-adjusted Z score, bone speed of sound at the radius was -0.31 and 0.58, respectively, p <.05, and at the phalanx, -1.41 and 0.04, respectively, p <.05. The bone speed of sound in the risperidone-treated patients inversely correlated with urinary deoxypyridinoline excretion (r = 0.73, p <.05). CONCLUSION: Risperidone treatment, as opposed to olanzapine, for female premenopausal schizophrenia results in hyperprolactinemia and clinically relevant decrease in bone mineral density. The calculated relative risk for fragility fracture of women treated with risperidone as compared to those treated with olanzapine is 1.78 when bone speed of sound was measured at the phalanx and 1.23 when measured at the radius.     

Changes in skeletal maturation and mineralization in children with cerebral palsy and evaluation of related factors.

Sixty-nine (28 females, 41 males) children with spastic cerebral palsy and 26 (13 females, 13 males) healthy children were included in the study. Total- and partial-body bone mineral content and bone mineral density values of patient and control subjects were measured by dual-energy x-ray absorptiometry. Left hand and wrist radiographs of all patients and right hand and wrist radiographs of 39 randomly selected patients were taken, and the bone ages of all radiographs were determined. In both female and male tetraplegics, bone mineralization values of lower extremities, where the mobility disorder and effects of absence of weight-bearing activity were maximal, were lower than those of controls and hemiplegics (P < .05). In 47 (68%) patients, left-side bone age values were below normal ranges for their ages, and the difference was statistically significant (P < .01). Our results indicate that motor function handicap affects skeletal mineralization adversely, and skeletal maturation is frequently delayed in children with cerebral palsy. We speculated that this delay might be a result of disrupted embryologic skeletal development due to hypoxic attack, which also causes the disease.     

Low bone mineral density and decreased bone turnover in Duchenne muscular dystrophy

This cross-sectional study examined bone mineral density, bone turnover, body composition and calciotropic hormones in 24 boys with Duchenne muscular dystrophy (DMD) (2.3-19.7 years), most of whom were being treated with prednisolone, and 24 age-matched healthy boys. Our study demonstrated lower bone mineral density in the DMD group for total body, spine, hip, heel and forearm measurements. These differences between DMD patients and controls increased with increasing age. Biochemical markers of both bone formation and resorption revealed reduced bone turnover in DMD patients. The fracture rate was not higher in DMD patients. The DMD group had low vitamin D levels but high leptin levels in comparison with the control group. Muscle strength correlated with bone mineral density assessed at the hip and heel in the DMD group. Interventions that increase bone formation should be considered, as DMD patients have reduced bone turnover in addition to their low bone mineral density.     

利培酮治疗首发精神分裂症患者1年骨密度变化的病例对照研究

背景长期非典型抗精神病药利培酮治疗对骨密度的影响尚不清楚。假设长期利培酮治疗会对精神分裂症患者的骨密度有不利影响。方法28例符合中国精神障碍分类与诊断标准的首发精神分裂症患者接受1年的利培酮治疗,分别于服药前及服药后第3、6、12月进行骨密度检测,结果以T值来表示。设立32例年龄、性别和种族匹配的健康对照,于入组时和1年后进行骨密度检测。结果基线时,首发精神分裂症组的年龄、性别以及骨密度与健康对照组之间的差异无统计学意义。与对照组相比,接受利培酮治疗12个月的精神分裂症组的骨密度降低（F=15．21,P〈0．001）。精神分裂症组利培酮治疗的前6个月内骨密度下降无统计学差异,在利培酮治疗的后6个月内骨密度显著下降。在20例完成12个月利培酮治疗的患者中,分别有1例（5％）和8例（40％）符合世界卫生组织关于骨质疏松和骨量减少的标准。结论长期的利培酮治疗可能会降低精神分裂症患者的骨密度,这种骨密度变化在治疗6个月后最明显。因此,少于1年的随访往往无法发现这种与抗精神病药治疗相关的骨密度变化。     

Bone density in chronic schizophrenia with long-term antipsychotic treatment: preliminary study

Objective

Decreased bone mineral density has been found in the chronic schizophrenic patients who have been given a long-term administration of antipsychotics. Hyperprolactinemia from the antipsychotics and the negative symptom of schizophrenia were considered as the causes for this finding. In this study, the effect of hyperprolactinemia and the negative symptom of schizophrenia on bone mineral density was investigated on male schizophrenic patients.

Methods

The cross-sectional study was carried out with the subjects of 45 male schizophrenic patients who have undertaken the monotherapy with risperidone, olanzapine and clozapine for at least one year. The demographic factors, clinical symtoms, bone mineral density and hematological test were examined for all the subjects.

Results

No significant relationship was found between hyperprolactinemia and the decreased bone mineral density in the subjects. The negative schizophrenia symptom of the subjects showed a significant effect on the decreased bone mineral density.

Conclusion

The decreased bone mineral density finding in the male schizophrenic patients may be caused by the negative schizophrenia symptom rather than the hyperprolactinemia due to the antipsychotics. Additional studies are further required regarding other factors that may affect the decreased bone mineral density such as activity, calcium intake and exposure to sunlight.     

Bone metabolism markers and bone mineral density in children with neurofibromatosis type-1

Some experimental studies suggested that there may be a bone formation defect rather than a disorder in bone resorption in patients NF1. The aim of this study was to determine bone mineral density (BMD) with dual-energy X-ray absorptiometry (DEXA) and investigate specific bone formation and bone resorption and bone turnover markers in children with NF1. Thirty-two children and adolescents (16 boys, 16 girls; 16 prepubertal, 16 pubertal) with NF1 were recruited. Their age ranged from 3 to 17 years. They were compared with matched healthy children. Dual-energy X-ray absorptiometry were applied to 26 patients and 27 controls. Nine of 32 subjects with NF1 had a skeletal abnormality. BMD of the lumbar spine, and femoral neck in NF1 patients significantly decreased compared to that of healthy subjects. They were also significantly decreased in pubertal patients when compared to pubertal controls and in prepubertal patients when compared to prepubertal controls. Patients with skeletal abnormalities were found to have significantly lower level of osteocalcin when compared to patients without skeletal abnormality. Other biochemical markers did not exhibit any difference between the groups. In conclusion, our findings suggest that bone formation markers rather than DEXA could be good predictors of skeletal abnormalities among NF1 patients. However, in our study the number of the NF1 patients with skeletal abnormality and the number of bone formation markers studied were all limited. It is appropriate to perform larger studies with other bone formation markers beside osteocalcin.     

Body weight in patients with Parkinson's disease.

There is some evidence suggesting that Parkinson's disease (PD) patients exhibit lower body weight when compared to age-matched healthy subjects. Low body mass index (BMI) is correlated with low bone mineral density, both of which are major risk factors for hip fractures. Possible determinants of weight loss in PD patients include hyposmia, impaired hand-mouth coordination, difficulty chewing, dysphagia, intestinal hypomotility, depression, decreased reward processing of dopaminergic mesolimbic regions, nausea, and anorexia as the side effects of medication, and increased energy requirements due to muscular rigidity and involuntary movements. It is unclear whether PD patients in general, or only a subgroup of those affected, definitely show lower BMI in the advanced stages of the disease. We therefore recommend that the body weight of PD patients be monitored monthly as the disease progresses, and that a patient's nutrition should be supplemented with sufficient amounts of vitamin D and calcium to reduce the risk of hip fractures and strengthen bone density. Because meal times may coincide with unpredictable off periods associated with akinesia and impaired hand-mouth coordination, PD patients also need flexible food schedules that accommodate the associated symptoms of this disease.     

The influence of psychotropic drugs and releasing hormones on anterior pituitary hormone secretion in healthy subjects and depressed patients

Pharmacoendocrinological studies have shown that psychotropic drugs with different actions have different effects on anterior pituitary hormone secretion in man. Substances with different effects on the central nervous system are characterized by a different pharmacoendocrinological profile. Studies with various receptor blockers have shown varying influences on the DMI-induced growth hormone, prolactin, and ACTH/cortisol secretion. Growth hormone stimulation was shown to be mediated by alpha 2-receptors and inhibited by beta-receptors. Investigations in male and female endogenous depressive patients demonstrated a significantly blunted growth hormone response to DMI compared with age- and sex-matched healthy subjects. A comparative study in male endogenous depressive patients showed a significantly diminished growth hormone stimulation both after DMI and after growth hormone-releasing hormone compared to healthy male subjects. In further tests a simultaneous application of four releasing hormones (GHRH, CRH, GnRH, TRH) was used. These investigations showed a significantly lower GH stimulation in endogenous depressive patients compared with age- and sex-matched healthy subjects, but not in neurotic depressive or schizophrenic patients. Cortisol stimulation was similar in all groups of patients and healthy subjects. TSH stimulation was significantly lower in endogenous depressive and schizophrenic patients than in healthy subjects. Somatomedin-C concentrations were significantly elevated in endogenous depressed patients compared with healthy subjects. The blunted growth hormone response in endogenous depression could be explained by inhibitory influences such as increased somatomedin-C concentrations or a hyperactivity of central beta-adrenergic-receptors.