壮骨胶囊防治类固醇大鼠肾阳虚的实验研究

用泼尼松建立类固醇性大鼠骨质疏松模型并探讨壮骨胶囊对类固醇性骨质疏松模型的预防作用。方法　取醋酸泼尼松按４．５ｍ ｇ／ｋｇ 灌胃,每周２ 次,共９０ 天,同时设立对照组和壮骨胶囊和康力龙防治组。实验结束后取大鼠胫骨近端作骨组织形态计量学观察,并取血液作各项生化指标检查。　结果壮骨胶囊组对类固醇所致的大鼠骨量减少有明显的抵抗作用,还有明显的降血脂作用;研究还观察到壮骨胶囊有血钙下降及血锌明显增高表现。结论　壮骨胶囊对泼尼松所致的类固醇性骨质疏松有预防作用并有明显的降血脂作用。     

壮骨肾宝防治肾上腺皮质激素所致大鼠骨质疏松的实验研究

本文采用３月龄ＳＤ雄性大鼠２４只，随机分为对照组（Ⅰ组）、激素组（Ⅱ组）和预防组（Ⅲ组）。Ⅱ组喂醋酸泼尼松２次／周；Ⅲ组除喂泼尼松外，还同时喂壮骨肾宝０．２ｍｌ／天。３个月后对三组大鼠胫骨上段的骨片用图象分析仪进行测算和分析。激素组与对照组比较，由于骨吸收大于骨形成，出现骨小梁面积和数量减少，骨小梁之间的空隙增加。壮骨肾宝预防组的骨吸收率受到明显抑制，新骨形成增加，因而骨量明显增加。本研究提示，中药复方壮骨肾宝能预防激素所致的骨质疏松     

中药龟丝补骨片对绝经后早期妇女性激素和钙调节激素的影响

目的 观察中药龟丝补骨片对绝经后早期妇女性激素和钙调节激素的影响。以中医“肾虚”理论探讨其防治绝经后骨质心松症的作用机制，方法 将63例40岁以上的自然绝经1年以上但不超过5年的健康妇女，根据骨密度值T-Score低于-2.0为标准分为绝经后骨质疏松症组以上但不超过5年的健康妇女，根据骨密度值T-Score低于-2.0为标准分为绝经后骨质疏松症组（OP）和非骨质疏松症组（NO），并依就诊次序按1：2比率序贯进入尼尔雌醇组（n)和龟丝补骨片组（g)，单盲观察尼尔雌醉和龟丝补骨片的治疗作用6个月，治疗前和后第3、6个月分别完成中医肾虚证症状量化表调查，并检测血清性激素，促性腺激素和钙调节激素，成功随访率达93.65%。结果 龟丝补骨片对肾阴虚证和肾气虚证均有较好的改善作用，且似乎对减轻肾阴虚证更有效，同时发现龟丝补骨片具有类似雌激素样作用，同尼尔雌醇相似，可显提高E2/T比值；此外，龟丝补骨片对血清PTH和CT水平均有增加趋势，PTH/CT比值于治疗后第6个月时显下降；血清25-OH-VD3和钙水平明显增加，ALP水平明显下降，结论 龟丝补骨片具有促进钙代谢，调整钙调节激素的作用，可能是其发挥抗骨质疏松症的作用机制之一。     

中药龟丝补骨片对绝经后早期妇女骨转换指标和骨密度的影响

目的 从中医“肾虚”理论出发，观察中药龟丝补骨片对绝经后早期妇女骨转换指标和骨密度的影响。方法 将63例加岁以上的自然绝经1年以上但不超过5年的健康妇女，先完成中医肾虚证症状量化表调查、并采用DEXA测量BMD，根据骨密度值T-score低于-2．0为标准分为绝经后骨质疏松症组(OP)和非骨质疏松症组(NO)，依就诊次序按1：2比率序贯进入尼尔雌醇组(n)和龟丝补骨片组(g)。单盲观察尼尔雌醇和龟丝补骨片的治疗作用6个月。成功随访率达93．65％。治疗前和后第3、6个月分别检测骨转换标志物血清BGP和尿Dpd／Cr，治疗结束时复查BMD。结果 采用龟丝补骨片治疗后，第6个月无论NO组还是0P组，血清BGP水平均显著升高；尿Dpd／Cr比值更早、更显著地降低，在OP组治疗第3、6个月时降低分别有显著和极显著性意义，OP-g组尿Ca^2 ／Cr排出明显下降。干预治疗第6个月，龟丝补骨片和尼尔雌醇都有增加骨量的作用，各组BMD都有不同程度的升高；且发现对治疗的反应性似乎骨质疏松者比非骨质疏松者好，腰椎较股骨好，其中椎体部分最好，股骨颈最差。结论 龟丝补骨片具有保护绝经早期妇女的骨丢失作用，我们认为，这一保护作用主要与抑制骨吸收、促进骨形成有关。     

尿脱氧吡啶啉对评价肾病综合征患儿泼尼松治疗后骨吸收异常的价值及肾康灵的干预作用

目的：（1）通过观察肾病综合征（NS）患儿尿脱氧吡啶啉（DPD）排泄率的变化,探讨用尿脱氧吡啶啉来评价泼尼松治疗肾病综合征患儿骨吸收异常的价值。（2）观察肾病综合征患儿肾康灵治疗前后DPD排泄率的变化,探讨肾康灵治疗激素性骨质疏松的疗效。方法：（1）以30例NS患儿为研究对象,在足量泼尼松治疗前及治疗后6周分别留取尿标本检测尿DPD排泄率。（2）30例患儿在泼尼松足量治疗后6周随机分为治疗组、对照组。对照组继续足量泼尼松治疗,治疗组在对照组的基础上加用中药复方肾康灵冲剂口服治疗,2周后留取尿标本检测尿DPD排泄率。结果：泼尼松足量治疗6周后尿DPD排泄率明显高于激素治疗前（P〈0.01）。（2）泼尼松足量治疗8周后治疗组与对照组相比较,尿DPD排泄率明显降低,两者比较有统计学差异（P〈0.05）。结论：（1）泼尼松治疗肾病综合征的患儿尿DPD排泄增加,支持了激素可导致骨吸收增加的观点。（2）肾康灵能显著降低肾病综合征的患儿尿DPD的排泄,提示其治疗激素性骨质疏松有一定益处,其抗骨质疏松作用可能通过多个途径而实现。     

胎肾细胞悬液对维甲酸所致骨质疏松大鼠部分钙调节激素的影响

目的探讨胎肾细胞悬液改善维甲酸所致大鼠骨质疏松的机理,为临床用药提供客观依据.方法通过静脉输注胎肾细胞悬液,采用放免分析法测定维甲酸所致骨质疏松大鼠血清雌二醇、降钙素、甲状旁腺素、骨钙素等钙调节激素含量,观察胎肾对上述指标和骨形态的影响.结果与维甲酸造模组比较,胎肾细胞悬液组大鼠血清雌二醇、降钙素、骨钙素水平升高,甲状旁腺素降低（P＜0.05）,胫骨骨重、灰重和骨基质均增加（P＜0.01）,胫骨骨长变化不大（P＞0.05）.骨病理形态计量中,胎肾细胞组大鼠骨小梁厚度、面积及密度均高于模型组,而骨小梁间隙明显缩小（P＜0.05）.结论胎肾细胞改善维甲酸所致大鼠骨质疏松机制与部分钙调节激素的变化有关.     

生骨再造散对激素性股骨头坏死家兔血脂的影响

目的：研究生骨再造散对激素性股骨头坏死家兔血脂水平的影响。方法：家兔45只,随机分为5组;空白对照组、模型组、生骨再造散组、生骨再造散加手术组和马氏补骨片组。用糖皮质激素造成家兔激素性股骨头缺血性坏死模型。造模6周开始,生骨再造散和骨再造散加和术组灌胃生骨再造散（3．2g.kg^-1.d^-1);马氏补骨片组灌注胃马氏补骨片（0．6g.kg^-1.d^-1);空白对照对照组和模型且灌胃等容量生盐盐水。于造模型等5周和给药第5周测各组家兔的胆固醇,甘油三酯和高密度脂蛋白。结果模型组与空白对照组相比,血清胆固醇、甘油三酯明显升高（P＜0．01）,高密度脂蛋白明显降低（P＜0．01）;三个治疗组与模型组比较,血清胆固醇、甘油三酯明显降低（P＜0．05）,高密度脂蛋白明显升高（P＜0．05）;生骨再造散两组与马氏补骨片组比较无显著性差异。结论：生骨再造散对股骨头坏死的治疗作用可能与其对血脂的调节作用有关。     

芪藿肾宝与己烯雌酚对去卵巢大鼠骨代谢的影响

用３月龄去卵巢ＳＤ大鼠为模型，４．５ｍｇ．Ｌ－１己烯雌酚（ＤＥＳ）按５ｍｌ·ｋｇ－１ｉｇ，３３０ｇ·Ｌ－１的芪藿肾宝（含淫羊蕾，黄芪，白术）按５ｍｌ·ｋｇ－１ｉｇ，每周６次，持续１２周，胫骨近端不脱钙骨片测量。结果：己烯雌酚仅部分抑制去卵巢后的骨高转换，未能完全预防小梁骨的丢失（（％Ｔｂ．Ａｒ－２８％）；芪藿肾宝能完全预防去卵巢大鼠的骨质疏松，其作用机理同样是抑制去卵巢后的骨高转换，但以抑制骨吸收为主，从而防止了骨质疏松的发生。     

龟地散对骨质疏松大鼠骨代谢的影响

目的 本实验对龟地散在去卵巢大鼠所致骨质疏松大鼠骨代谢方面的影响进行了探讨。结果 实验显示，龟地散能明显降低骨质疏松大鼠尿羟脯氨酸和尿钙含量（P＜0．01，P＜0．05），并可明显增加血清碱性磷酸酶含量（P＜0．01）和骨钙素水平（P＜0．05）。结果还显示，龟地散对血清钙水平有显升高作用（P＜0．05），但对血清磷水平的影响却不明显。结论 提示龟地散能明显改善去势大鼠所致骨质疏松。     

三种丹参水提有效部位群对糖皮质激素性骨质疏松大鼠的影响

目的 对比三种丹参水提有效部位群对激素大鼠骨质疏松的影响,试图寻找丹参对抗激素大鼠骨质疏松的最佳有效成分.方法 4月龄SD大鼠灌服泼尼松3.5 mg·kg-1·d-1造成大鼠骨质疏松模,同时分别给予三种丹参水提有效部位群进行防治性用药,用药时间为12周.实验结束后,取左侧胫骨做骨形态学静态参数观察,取股骨进行骨密度和骨生物力学检测,随后检测骨钙、磷、镁和羟脯氨酸含量.结果 与正常大鼠相比,泼尼松模型组大鼠胫骨反应骨小梁结构、数量的四个参数均显著下降,股骨中段骨密度显著下降,而弹性载荷、最大载荷、刚性系数、最大强度和弹性模量等五个股骨的生物力学性能指标均显著降低,股骨中的钙和羟脯氨酸均成比例显著减少.与模型组相比,SAB组大鼠胫骨松质骨四个参数有显著改善,且能有效增加股骨中钙的含量,但对其他的参数无明显改善;DSⅠ组能显著改善激素大鼠胫骨和股骨的骨丢失破坏,且能有效提高其抗骨折的能力;DSⅡ组可有效改善大鼠松质骨改变,股骨骨密度以及骨中钙盐含量,但对于其他参数的改变无显著效果.结论 三种丹参水提有效部位群均可改善激素大鼠松质骨的改变,对其股骨的修复作用以DSⅠ组(丹参素∶原儿茶醛∶丹酚酸B=2∶1∶2)效果最佳.     

中老年2型糖尿病患者骨代谢特点及骨量丢失危险因素分析

目的 探讨中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨代谢特点及骨量丢失危险因素.方法 选择中老年T2DM患者612例(男296例,女316例),根据骨密度(bone mineral density,BMD)水平分为骨量正常组(108例)、骨量减少组(281例)、骨质疏松组(22...     

Role of Parathyroid Hormone in Bone Fragility of Postmenopausal Women with Vitamin D Insufficiency

Vitamin D insufficiency is related to an increase in PTH, which might be critical for an increase in bone fragility. However, the role of endogenous PTH in vitamin D insufficiency-induced fracture risk remains unclear. The present study was performed to examine the relationships among vitamin D insufficiency, bone fragility, and PTH in 202 Japanese postmenopausal women. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured. The percentages of subjects with 25(OH)D levels below 10, 15, and 20 ng/ml were 5.0, 41.0, and 80.7%, respectively. Serum 25(OH)D levels were negatively related to age and serum levels of Cr and PTH; they were positively related to bone mineral density (BMD). In multiple regression analysis, BMD was significantly related to 25(OH)D levels when adjusted for age, body mass index (BMI), and serum levels of Cr and PTH. Multiple logistic regression analysis showed that lower 25(OH)D levels were significantly related to prevalent fracture risk when adjusted for age, BMI, serum levels of Cr and PTH, as well as femoral neck BMD. The proportion of subjects with prevalent fractures was significantly higher in the group with lower PTH and lower 25(OH)D than in the group with lower PTH and higher 25(OH)D or higher PTH and higher 25(OH)D. In conclusion, vitamin D insufficiency was found to be related to prevalent fracture risk independently of PTH. Functional hypoparathyroidism, rather than functional hyperparathyroidism, might be a risk factor for bone fragility in vitamin D insufficiency.     

老年男性2型糖尿病患者各种钙调激素与骨密度改变的关系

目的测定老年男性2型糖尿病患者各种钙调激素及骨密度,探讨老年男性2型糖尿病患者骨质疏松的发病机理,为其防治提供理论依据。方法用双能X线吸收法测定70例老年男性2型糖尿病患者及60例年龄、体重指数相匹配的对照者的腰椎及髋部骨密度,并采用放免法测定血清骨钙索(BGP)、抗酒石酸酸性磷酸酶(TRAP)、甲状旁腺素(PTH)、降钙素(CT)、1,25(OH)2D3、25(OH)D3、尿羟脯氨酸(HOP)等,两组进行比较。结果 老年男性2型糖尿病患者较对照组骨密度显著降低。血BGP、CT、1,25(OH)2D3浓度低于对照组(P<0.05).TRAP、PTH、尿HOP显著高于对照组(P<0.05)。结论老年男性2型糖尿病患者PTH、CT、1,25(OH)2D3等钙调激素分泌及代谢失常,影响骨代谢,出现糖尿病性骨质疏松,表现为骨吸收增加,骨形成减少与缓慢,骨吸收过程大于骨形成。     

续苓健骨方对去卵巢骨质疏松模型大鼠血液钙磷代谢的影响

目的研究续苓健骨方对去卵巢骨质疏松模型大鼠骨密度、骨微结构和血液钙磷代谢的影响。方法将40只6月龄雌性SD大鼠随机分为假手术组、模型组、续苓健骨方组[12.71 g/(kg·d)]和碳酸钙组[104.19 mg/(kg·d)],假手术组仅切除卵巢周围脂肪,其余组行双侧卵巢切除术后建立骨质疏松模型。药物干预12周后取材,通过双能X线骨密度仪检测左侧胫骨骨密度,经Masson染色观察右侧胫骨组织显微结构,生化检测血清抗酒石酸酸性磷酸酶(TRAP)、血钙和血磷水平。结果与假手术组相比,模型组骨密度显著降低,骨小梁断裂稀疏、排列不规则,TRAP表达增加,血钙含量降低,血磷含量升高。与模型组相比,续苓健骨方组骨密度增加,骨小梁数量增加、排列较规则,TRAP表达降低,血钙含量升高,血磷含量降低。结论续苓健骨方可提高去卵巢骨质疏松大鼠胫骨骨密度并改善骨组织微结构,其机制可能与调控血钙磷代谢稳态有关。     

The Association between Parathyroid Hormone, Vitamin D and Bone Mineral Density in 70-Year-Old Icelandic Women

Parathyroid hormone (PTH) may be an important determinant of cortical bone remodeling in the elderly. Vitamin D status is one of the determining factors in this relationship. The aim of this study was to quantify the relationship between serum PTH, vitamin D and bone mineral density (BMD) in elderly women in Reykjavik (64° N), where daily intake of cod liver oil is common and mean calcium intake is high. ln PTH correlated inversely with 25(OH)D (r=−0.26, p<0.01). In multivariate analysis PTH correlated inversely with whole body BMD (mostly cortical bone) (R ²= 2.2%, p = 0.04) but not with the lumbar spine BMD, reflecting more cancellous bone. No association was found between 25(OH)D levels and BMD at any site in univariate or multivariate analysis. Osteocalcin, a measure of bone turnover, was negatively associated with BMD and this association remained significant when corrected for PTH levels. In summary, in this fairly vitamin D replete population with high calcium intake, PTH was negatively associated with total body BMD. We infer that suppression of PTH may reduce cortical bone loss, but other factors are likely to contribute to age-related bone remodeling and osteoporosis. Received: 3 January 2000 / Accepted: 10 April 2000     

血清25( OH )VD水平在2型糖尿病患者中的状况

目的 糖尿病患者骨质疏松以及骨折的风险较非糖尿病患者增加,在1型糖尿病患者中表现明显,但对于2型糖尿病患者骨折的风险和骨密度的变化存在争议.本研究探讨25(OH)VD和骨转换指标在2型糖尿病患者的变化,分析其对骨代谢的影响.方法 收集2007.12至2011.10于我院就诊的437例未接受维生素D补充治疗的病程不超过5年的2型糖尿病患者(T2DM),同时收集非糖尿病的对照组(NDM)414例,测定各组患者骨生化指标,并收集临床资料以备数据分析使用.结果 与非糖尿病组患者相比,2型糖尿病患者血清25(OH)VD水平明显降低(P=0.001),骨特异性碱性磷酸酶(BAP)、抗酒石酸酸性磷酸酶(TRAP)水平升高,骨转换活跃;男性、女性2型糖尿病患者血清25(OH)VD水平均较非糖尿病组降低(P均＜0.001);相关分析显示,2型糖尿病患者血清25(OH)VD水平与空腹血糖呈负相关,而与糖化血红蛋白、HOMA-IR等无明显相关性.结论 2型糖尿病患者血清25(OH)VD水平明显低于非糖尿病者,且与空腹血糖呈负相关,糖化血红蛋白与25(OH)VD的相关性不如空腹血糖明显.     

Posttransplant bone disease: evidence for a high bone resorption state

Loss of bone is a significant problem after renal transplant. Although bone loss in the first post transplant year has been well documented, conflicting data exist concerning bone loss after this time. It is equally unclear whether bone loss in long-term renal transplant recipients correlates with bone turnover as it does in postmenapausal osteoporosis. To examine these issues, we conducted a cross-sectional study to define the prevalence of osteoporosis in long-term (> 1 year) renal transplant recipients with preserved renal function (mean creatinine clearance 73 +/- 23 ml/min). Bone mineral density (BMD) was measured at the hip, spine and wrist by DEXA in 69 patients. Markers for bone formation (serum osteocalcin) and bone resorption [urinary levels of pyridinoline (PYD) and deoxypyridinoline (DPD)] were also measured as well as parameters of calcium metabolism. Correlations were made between these parameters and BMD at the various sites. The mean age of the patients was 45 +/- 11 years. Eighty eight percent of patients were on cyclosporine (12% on tacrolimus) and all but 2 were on prednisone [mean dose 9 +/- 2 mg/day)]. Osteoporosis (BMD more than 2.5 SD below peak adult BMD) at the spine or hip was diagnosed in 44% of patients and osteopenia was present in an additional 44%. Elevated levels of intact parathyroid hormone (i PTH) were observed in 81% of patients. Elevated urinary levels of PYD or DPD were present in 73% of patients and 38% had elevated serum levels of osteocalcin. Levels of calcium, and of 25(OH) and 1,25(OH)2 vitamin D were normal. In a stepwise multiple regression model that included osteocalcin, PYD, DPD, intact PTH, age, years posttransplant, duration of dialysis, cumulative prednisone dose, smoking, and diabetes: urinary PYD was the strongest predictor of bone mass. These results demonstrate that osteoporosis is common in long-term renal transplant recipients. The data also suggest that elevated rates of bone resorption contribute importantly to this process.