血清TNF水平与2型糖尿病患者骨质疏松关系的初探

目的探讨血清肿瘤坏死因子(TNF)水平与2型糖尿病(T2DM)患者骨质疏松的关系。方法测定74例T2DM患者及46例年龄、体质量指数(BMI)相匹配的健康对照者的骨矿物质密度(BMD)、血清骨钙素(BGP)、抗酒石酸磷酸酶(TRAP)、尿羟脯氨酸(HOP)及TNF水平,2组进行比较。结果T2DM患者较对照组的BMD显著降低,血清BGP水平明显低于对照组(P<0·01);TRAP、尿HOP、TNF显著高于对照组(P<0·05),TNF与BMD呈显著负相关。结论T2DM患者BMD降低,其原因与TNF水平升高有一定关系。     

吡格列酮对2型糖尿病患者骨钙素、降钙素和骨密度的影响

目的探讨噻唑烷二酮类药物吡格列酮对2型糖尿病（T2DM）患者骨钙素、降钙素和骨密度的影响。方法89例T2DM患者,随机分为T2DM对照组56例和T2DM实验组33例,在口服降糖药治疗的基础上,实验组加服吡格列酮（30mg／日）,疗程3个月;正常对照30例。以双能X线吸收测量法（DXA）测量T2DM实验组、T2DM对照组治疗前后及正常对照组骨密度（BMD）,放射免疫分析法（RIA）测定T2DM实验组、T2DM对照组治疗前后及正常对照血清骨钙素（BGP）和降钙素（CT）水平,并进行比较。结果①T2DM组血清BGP和CT水平均低于正常对照组（P〈0．01）;②T2DM实验组经吡格列酮治疗后BGP和CT水平均降低,与治疗前比较差异有显著性意义（P〈0．01）;③T2DM组骨密度（BMD）低于正常对照组（P〈0．05）;④T2DM实验组经吡格列酮治疗后髋部及腰椎BMD均有所下降;⑤BGP与糖尿病患者年龄及空腹血糖负相关,与髋部及腰椎BMD正相关;CT与糖尿病患者年龄负相关。结论吡格列酮可致2型糖尿病患者血清BGP和CT水平明显降低,骨密度下降,其中对女性的影响尤为显著,提示该药可致骨量丢失加速,对骨代谢有不利影响。     

血清IL-33、Asprosin水平与2型糖尿病合并骨质疏松症的相关性

目的 探讨血清白细胞介素-33(IL-33)、白脂素（Asprosin）与2型糖尿病（T2DM）合并骨质疏松症（OP）的相关性。方法 选取T2DM患者98例,根据骨密度（BMD）测量结果分为T2DM+OP组56例,T2DM组42例,另选取同期体检健康者50例作为对照组,收集患者的临床资料。采用酶联免疫吸附法检测血清IL-33、Asprosin水平及骨代谢指标[血钙（Ca）、血磷（P）、碱性磷酸酶（ALP）、甲状旁腺激素（PTH）、骨钙素（BGP）和Ⅰ型胶原C端肽β降解产物（β-CTX）水平],采用Pearson相关法分析血清IL-33、Asprosin水平与患者BMD的相关性,采用多因素Logistic回归分析T2DM并发OP的影响因素。结果 T2DM组和T2DM+OP组BMD差异有统计学意义（P<0.05）;T2DM+OP组血清IL-33水平低于T2DM组和对照组（P均<0.05）;对照组、T2DM组和T2DM+OP组血清Asprosin水平依次升高（P均<0.05）;T2DM+OP组BGP、PTH和β-CTX水平高于T2DM组（P均<0.05）;血清IL-3...     

老年2型糖尿病患者血清IL-6、TNF及胰岛素与骨密度的关系

目的 探讨IL—6、TNF及Ins在老年2型糖尿病(DM)患者骨质疏松发病中的机制。方法 测定58例老年2型DM思者及30例年龄、体重指数相匹配的健康对照者的骨密度、血清骨钙素(BGP)、抗酒石酸酸性磷酸酶(TRAP)、尿径脯氨酸(HOP)、肿瘤坏死因子(TNF)、白细胞介素—6(IL—6)及胰岛素(Ins)，并进行比较。结果 老年2型DM思者较健康对照组骨密度显著降低。BGP及Ins显著低于对照组(P＜0.001，P＜0．05)；TRAP、尿HOP、IL—6、TNF显著高于对照组(P＜0．05)。IL—6、TNF与BMD呈显著负相关。结论 老年2型DM骨密度降低，其原因可能为TNF、IL-6分泌增多，从而促使骨吸收增多，骨密度降低，导致骨质疏松。     

IL-6及其可溶性受体与Grave's病及其骨代谢的关系

选择78例Grave’s病（GD）患者（GD组）和30例健康人（对照组）为研究对象,分别检测其血清IL-6及其可溶性受体Sgp80、Sgp130水平,血清FT3、FT4、Ca、P、骨钙素（BGP）及尿羟脯胺酸（HYP）浓度,同时采用双能X线骨密度测定仪测定骨密度（BMD）。结果GD组血清IL-6、Sgp130均明显高于对照组（P均〈0.05）,GD组未治疗、部分缓解者血清Sgp80明显高于缓解者和对照组（P均〈0.05）;血清Sgp80与血清FT3、FT4、P、BGP及HYP均呈正相关;GD组部分缓解者L2～L4、Ward’s三角BMD均明显低于对照组（P〈0.05）,腰L2～L4、Ward’s三角Z值〈-1SD者血清IL-6、Sgp80均明显高于Z值〉-1SD者。认为血清IL-6及Sgp80、Sgp130与GD发病及其骨代谢密切相关,深入研究可为临床早期发现、防治GD及其继发性骨病提供科学依据。     

男性2型糖尿病患者骨密度与血清TNF的关系研究

测定66例T2DM患者及62例年龄、BMI相匹配的健康对照者的BMD、血清TNF、骨钙素(BGP)、碱性磷酸酶(AKP)、血钙(Ca)、磷(P)、尿Ca/Cr、尿羟脯氨酸(HOP)/CrI、型胶原羧基末端肽(CTX)/Cr水平,2组进行比较。结果 T2DM患者较对照组的BMD显著降低,血清BGP水平明显低于对照组(P0 01);TNF、尿HOP、显著高于对照组(P0.01),TNF与BMD呈显著负相关。结论男性2TDM患者易并发OP,其原因与TNF水平升高有一定关系。     

中老年人骨密度骨代谢相关因素探讨

目的 探讨中老年人骨密度骨代谢相关因素.方法 选取159例骨质疏松（OP）患者及97例年龄、体重指数、身高等相匹配的健康对照者测量正位第二至第四腰椎（L2～4）、左侧股骨近端（Neek、Ward三角、Troch）的骨密度（BMD）;测定碱性磷酸酶（ALP）、骨钙素（BGP）、抗酒石酸酸性磷酸酶（TRAP）、尿Ⅰ型胶原降解产物（CTX）、肌酐（Cr）浓度.结果 骨质疏松患者正位L2～4、Neek、Ward三角、Troch骨密度低于对照组.骨质疏松组血中ALP、BGP、 TRAP浓度显著高于对照组（P＜0.05、P＜0.05、P＜0.05）;尿中CTX浓度显著高于对照组（P＜0.05）.结论 骨质疏松患者各部位BMD改变不同,其骨改变特点是骨吸收增加,骨转化率增加;TRAP、CTX 、BGP、ALP是反映骨质疏松患者骨代谢较敏感的生化指标.     

2型糖尿病患者骨密度水平及相关影响因素

目的探讨2型糖尿病（T2DM）患者骨密度（BMD）水平及相关影响因素。方法分别对204例T2DM患者（T2DM组）和108例健康体检者（对照组）进行腰椎前后位（L1-5）和左侧股骨近端BMD测定,对两组BMD水平、骨质疏松（OP）患病率进行比较,并对BMD的影响因素进行分析。结果男性T2DM患者除第L1、2外,其余部位BMD均低于对照组（P〈0.05）;女性T2DM患者除L1、4外,其余部位BMD均低于正常对照组（P〈0.05）。T2DM组中OP患病率为53.92%,正常对照组为36.11%（P〈0.05）。T2DM患者BMD与年龄、病程、糖化血红蛋白、绝经年限呈负相关,与BM I呈正相关。结论 T2DM患者BMD丢失较对照组高,OP患病率较对照组高,且病程越长、年龄越大、BM I越低、绝经年限越长,越易并发OP。     

2型糖尿病患者性激素、细胞因子与骨密度相关性研究

为探讨2型糖尿病(DM)患者血清性激素、细胞因子的改变及与其骨密度(BMD)的相关性,对89例2型DM患者的BMD进行了检测,同时测定其血清卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)、雌二醇(E2)、睾酮(T)、孕酮(P)和IL-1β、IL-6、TNF-α、IGF-1水平,并与非DM患者作对照.结果显示,DM合并骨质疏松(OP)的男、女性患者的比例均高于对照组,且随增龄BMD下降;女性OP患者的FSH、LH水平高于非OP患者,E2、T、P及男性T水平低于非OP患者,DM患者又低于对照组,P＜0.05或＜0.01;OP患者的IL-1β、IL-6、TNF-α水平高于非OP患者,而IGF-1水平则低于非OP患者,且DM组与对照组间有显著性差异,P＜0.05或＜0.01;BMD与年龄、FSH、LH、IL-1β、IL-6、TNF-α水平呈显著负相关,与E2、T、P、IGF-1水平呈显著正相关,P＜0.05或＜0.01、＜0.001.提示IL-1β、IL-6、TNF-α是DM和OP的共同促成因子,女性E2、T、P和男性T减少是造成骨代谢紊乱和OP的重要因素.     

2型糖尿病患者胰岛功能与骨密度的探讨

目的研究2型糖尿病患者胰岛功能与骨密度的关系。方法应用骨密度仪测定了56例2型糖尿病（T2DM）患者和55例对照组L2-4及双侧股骨Ward区骨密度（BMD），根据BMD将T2DM患者分为无骨质疏松（0P）组（DM-A组）和并发OP组（DM-B组），并做比较。结果（1）T2DM患者的L2-4及左侧股骨Ward区骨密度（BMD）较健康对照组显著下降（P〈0．01或P〈0．05）。（2）DM-B组空腹胰岛素（Fins）、空腹C肽（FCP）与DM-A组低，差异有非常显著性（P〈0．01）。（3）DM-B组较DM-A病程长，差异有非常显著性（P〈0．01）。结论2型糖尿病患者骨密度较正常人低，骨密度降低与胰岛素缺乏及糖尿病病程有关。     

阿伦膦酸钠对老年女性2型糖尿病骨质疏松患者骨代谢标志物的影响

目的观察老年女性2型糖尿病（T2DM）骨质疏松患者应用阿伦膦酸钠（ALN）联合钙尔奇D治疗后骨密度（BMD）和骨代谢指标的变化。方法采用双能X线骨密度仪（DEXA）对34例老年女性糖尿病骨质疏松患者给予ALN联合钙尔奇D治疗6个月,对比治疗前后腰椎和髋部BMD及骨代谢标志物的变化。结果 ALN联合钙尔奇D治疗6个月后腰椎和髋部T值和BMD均增加,尤其L1、L3、L4及L总部位增加显著;血清抗酒石酸酸性磷酸酶5b、尿羟脯氨酸/肌酐比值和骨碱性磷酸酶水平较治疗前降低,血清降钙素水平较治疗前升高（P均〈0.05）。结论 ALN联合钙尔奇D治疗老年女性T2DM患者骨质疏松疗效明显,短时间内可显著改善骨代谢指标和提高腰椎BMD。     

Femoral neck osteopenia in patients with inflammatory bowel disease

Objective: The mechanism of bone loss in patients with inflammatory bowel disease (IBD) is not completely understood. The aim of this study was to assess indices of bone turnover and bone mineral density (BMD) in the lumbar spine and femoral neck in IBD patients.
Methods: Sixty-three patients with Crohn's disease and 41 with ulcerative colitis were studied. Serum bone-specific alkaline phosphatase (B-ALP), osteocalcin, parathyroid hormone (PTH), 25 hydroxyvitamin D, interleukin-6 (IL-6), and urinary N-telopeptide cross linked type 1 collagen (NTX) were determined. BMD of the lumbar spine and femoral neck was determined by dual x-ray absorptiometry in 59 patients.
Results: In the femoral neck 42% of the patients had osteopenia (−2.5 SD < BMD T score < −1 SD) and another 41% had osteoporosis (BMD T score < −2.5). In the spine 34% of the patients had osteopenia and additional 42% had osteoporosis. BMD T scores were lower in the femoral neck compared to the spine. Reduced BMD was unrelated to gender, disease type, lifetime corticosteroid dose, but inversely correlated with disease duration ( r =−0.36 , p < 0.05 ). Serum IL-6 was higher in IBD patients compared to controls. A reduced level of osteocalcin, a marker of bone formation, was present in 7% of patients and an increase in NTX, a marker of bone resorption, in 25% of them. Osteoporotic IBD patients (spine or hip BMD T score < −2.5) had increased serum IL-6, osteocalcin and PTH level compared to nonosteoporotic patients.
Conclusions: There is a high prevalence of reduced BMD at the spine and femoral neck in IBD patients, which is more severe in the hip. Bone turnover in osteoporotic IBD patients is associated with an increase in osteocalcin, PTH and IL-6. IL-6 may play a role in the pathogenesis of bone loss in IBD.     

Osteoclastic function is accelerated in male patients with type 2 diabetes mellitus: the preventive role of osteoclastogenesis inhibitory factor/osteoprotegerin (OCIF/OPG) on the decrease of bone mineral density

To clarify the pathogenesis of altered bone metabolism in diabetic state and its underlying mechanisms, the bone mineral content and fasting levels of serum intact parathyroid hormone (i-PTH), intact osteocalcin (i-OC), tartrate-resistant acid phosphatase (TRAP) and osteoclastgenesis inhibitory factor/osteoprotegerin (OCIF/OPG) were measured in male type 2 diabetic patients and their age-matched controls. In addition, urine levels of osteoclastic markers, C-telopeptide of type I collagen (CTx), deoxypyridinoline (DPD), and N-telopeptide of type I collagen (NTx) were simultaneously determined. Serum levels of i-PTH and i-OC in diabetic patients were significantly lower than those in the controls. Conversely, serum concentrations of TRAP were significantly elevated in diabetic patients. However, no clear correlation was observed between serum i-OC and TRAP. It was also observed that urinary excretion of CTx, DPD, and NTx was significantly increased in the diabetics as compared with the controls. Unexpectedly, serum levels of OCIF/OPG tended to be higher in the diabetic group, and these values exhibited a significantly positive correlation with those of serum TRAP. There was found a significantly negative correlation between serum TRAP and bone mineral density (BMD) and also between serum OCIF/OPG and bone mineral density. It seems probable that OCIF/OPG has a suppressive role on the increased bone resorption to prevent further loss of the skeletal bone mass in type 2 diabetic patients.     

绝经后2型糖尿病患者骨质疏松相关因素分析

目的 探讨绝经后2型糖尿病(T2DM)患者骨质疏松的相关因素.方法 采用双能X线骨密度仪测定79例绝经后T2DM患者的正位腰椎(L1-4)、左股骨颈与左股骨粗隆及左全髋骨密度,根据骨密度值分为骨质疏松组与非骨质疏松组,并对测定的相关化验指标、年龄、病程、绝经年龄、绝经年限及体质指数(BMI)等进行对比分析.结果 两组年龄、BMI、白细胞介素6(IL-6)、骨钙素、绝经年限差异均有统计学意义,直线相关分析显示IL-6与骨质疏松(r=0.260,P=0.020)及糖化血红蛋白(GHbAlc)(r=0.259,P=0.023)相关;Logistic多因素回归分析显示,绝经后T2DM患者骨质疏松的发生与年龄独立相关,与BMI独立负相关.结论 年龄与低BMI可能是绝经后T2DM患者骨质疏松发生的独立危险因素.     

Association of polymorphisms of interleukin-6, osteocalcin,and vitamin D receptor genes,alone or in combination,with bone mineral density in community-dwelling Japanese women and men

We examined whether the -634C-->G, 298C-->T, and 2C-->T polymorphisms of the IL-6, osteocalcin, and vitamin D receptor (VDR) genes, respectively, were associated, alone or in combination, with bone mineral density (BMD) in community-dwelling Japanese women (between 1108 and 1113) or men (between 1116 and 1130) aged 40-79 yr. The -634C-->G polymorphism of the IL-6 gene and the 298C-->T polymorphism of the osteocalcin gene were associated with BMD in postmenopausal women, with the respective GG and TT genotypes representing risk factors for reduced bone mass. IL-6 and osteocalcin genotypes showed additive effects on BMD for postmenopausal women. The 2C-->T polymorphism of the VDR gene was associated with BMD in men, with the CT genotype contributing to reduced BMD. These results suggest that the IL-6 and osteocalcin genes are susceptibility loci for reduced BMD in postmenopausal women and that the VDR gene constitutes such a locus in men. The combined IL-6 and osteocalcin genotypes may prove informative for the assessment of osteoporosis in women.     

乙型肝炎肝硬化骨代谢异常的临床研究

目的探讨乙型肝炎肝硬化患者骨代谢异常的发病机制。方法用NM-300单光子骨密度测量系统检测61例乙型肝炎肝硬化患者的骨密度，空腹抽血检测血清钙调节激素：1，25二羟维生素D3[1，25（OH）2D3]、甲状旁腺素（PTH）、降钙素（CT）、骨钙素（BGP），白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF α）、尿骨胶原交联（Corsslaps），并与30名健康者对照。结果肝硬化组尺骨密度、桡骨密度、尺桡密度均较对照组明显降低。肝硬化组血清1，25（OH）2D3、BGP水平较对照组明显降低，其中骨质疏松（OP）组较无骨质疏松（NOP）组降低更明显，尿Crosslaps水平肝硬化组较对照组明显升高，其中OP组较NOP升高更明显。血清1，25（OH）2D3、BGP水平与尺桡密度呈正相关。OP组尿Crosslaps水平与尺桡密度呈负相关，而NOP组尿Crosslaps水平与尺桡密度无相关关系。肝硬化组血清IL-1β、IL-6、TNF α水平较对照组明显升高。血清IL-1β、IL-6、TNF α水平肝硬化OP组较NOP组显著升高。肝硬化组IL-1β、IL-6、TNF α水平与尺桡密度呈负相关，其中OP组较NOP组相关性更明显。结论乙型肝炎肝硬化患者存在着骨形成减少和骨破坏过多两种因素，从而引起肝性骨病，在骨形成减弱的过程中1，25（OH）2D3起了主要作用，在骨吸收增强的过程中IL-1β、IL-6、TNF α起到了重要的作用。     

Bone mass and dietary intake in children and adolescents with type 1 diabetes mellitus

ObjectivesTo evaluate the bone mineral density (BMD) in children/adolescents with type 1 diabetes mellitus (T1DM) and its association with the nutritional intake, metabolic control, and physical activity level of this population.MethodsStudy including 34 patients with T1DM and 17 controls. Assessments included the participants disease history, intake of macronutrient, calcium, phosphorus and magnesium, physical activity level, total body and lumbar spine BMD and serum levels of glycated hemoglobin, vitamin D, calcium, phosphorus, magnesium, osteocalcin and C-terminal telopeptide.ResultsTotal body and lumbar spine BMD z-scores were normal in all but two participants in the T1DM group. The T1DM group had significantly lower total body BMD z-score values (p < 0.001) and levels of osteocalcin, C-terminal telopeptide, calcium, phosphorus, and magnesium. Intake of macronutrients and calcium was inadequate in both groups. Participants in the T1DM group were more sedentary (88%) and had inadequate metabolic control (91%) and low vitamin D levels (82%). Bone mass in the T1DM group was influenced by body mass index (BMI), pubertal stage, disease duration, calcium intake, and physical activity level.ConclusionsBone mass in patients with T1DM was adequate but lower than controls and was influenced by BMI, pubertal stage, disease duration, calcium consumption, and physical activity level.     

Bone turnover and bone mineral density in patients with congenital adrenal hyperplasia

BACKGROUND AND OBJECTIVE Glucocorticoid replacement is the most effective therapy for patients with congenital adrenal hyperplasia (CAH). It has been reported that excessive steroid therapy leads to bone loss and osteoporosis, but it is uncertain whether steroid replacement therapy affects bone turnover and bone mineral density (BMD) in adult patients with CAH. DESIGN Case-control study: patients with CAH were compared to normal subjects, individually matched for age and body weight. PATIENTS Eleven patients, aged 19–65 years, were evaluated in this study. The age at diagnosis of CAH was 0–26 years. Nine patients (6 females and 3 males) were diagnosed with 21-hydroxylase deficiency and 2 male patients with 11-hydroxylase deficiency. 17-Hydroxyprogesterone levels in patients had never been below the reference range in the previous 2 years. These patients were individually matched for sex, age and weight to 11 healthy controls. MEASUREMENTS Total body, lumbar spine and femoral neck BMD was measured by dual-energy X-ray absorptiometry. Serum bone Gla-protein (BGP, osteocalcin) and bone alkaline phosphatase (BAP) were measured to assess bone formation whereas serum tartrate-resistant acid phosphatase (TRAP) and urinary cross-linked N-telopeptides of type I collagen (NTx) were measured to assess bone resorption. NTx was expressed as a fraction of urinary creatinine excretion (NTx/Cr). Serum dehydroepiandrosterone sulphate (DHEA-S) and androstenedione levels were measured to assess adrenal androgen status. RESULTS Serum DHEA-S, androstenedione, BGP and BAP and urinary NTx/Cr were decreased in patients when compared with controls (paired t-test, P = 0.005, 0.0003, 0.002, 0.03 and 0.03, respectively). BMD was not significantly decreased in patients. The difference of total body BMD between patients and controls (i.e. BMD in patients minus BMD in controls) was negatively correlated with age. There was no correlation between androgen levels and either BMD or bone turnover. The total dose of steroid taken in the previous 2 years was not correlated with BMD, bone turnover or androgen levels. The was no correlation between BMD adjusted by age and bone turnover or initial age at diagnosis. CONCLUSIONS We conclude that (1) bone turnover is decreased in congenital adrenal hyperplasia, (2) bone mineral density is not decreased in congenital adrenal hyperplasia and (3) patients initially have higher bone mineral density but later have lower bone mineral density than controls, especially in women.     

Bone remodelling markers and serum cytokines in patients with hyperthyroidism

OBJECTIVE: This study was designed in order to evaluate bone turnover with bone formation and resorption markers in hyperthyroidism and its possible relationship with serum cytokines interleukin 6 (IL-6) and tumour necrosis-alpha (TNF-alpha), levels of thyroid hormones and thyroid autoantibodies. DESIGN AND PATIENTS: Twenty-six hyperthyroid patients including nine with Graves' disease, 14 with toxic multi-nodular disease and three toxic adenoma were studied. Twenty normal subjects served as the control group. MEASUREMENTS: Serum calcium, phosphorus, total and bone-specific alkaline phosphatase, procollagen type 1-C peptide (PICP), osteocalcin, IL-6 and TNF-alpha measurements were performed and deoxypyridinoline (free DPD), calcium, phosphorus and creatinine levels were measured in fasting morning urine specimens of all hyperthyroid patients and all controls. Also, serum total and free T3 and T4 and TSH were analysed and thyroid antiperoxidase and antithyroglobulin antibodies were determined in sera of hyperthyroid patients. Patients with hyperthyroidism received propylthiouracil treatment until the achievement of euthyroidism and then serum cytokine levels were remeasured. RESULTS: Mean serum values of osteocalcin, total and bone-specific alkaline phosphatase were all significantly higher in hyperthyroid patients than in normal controls. PICP levels were not significantly different between these two groups. Urinary deoxypyridinoline levels were markedly elevated in hyperthyroid patients compared to the control group. There was a significant positive correlation between urinary free DPD levels and serum free T3, free T4 and T4 levels. Serum free T4 levels also correlated with urinary calcium levels. Serum IL-6 values were significantly higher in hyperthyroid patients compared to control group. TNF-alpha levels were slightly lower in patients with hyperthyroidism. No significant correlation was found between bone remodelling markers and serum cytokines. Serum Il-6 levels were correlated positively with age. After the treatment period both IL-6 and TNF-alpha returned to levels comparable with euthyroid controls. CONCLUSION: Bone turnover is increased in favour of resorption and the rate of resorption is associated with the levels of thyroid hormones in hyperthyroidism. The increase in the levels of serum IL-6 in hyperthyroidism is not related directly with bone resorption seen in hyperthyroidism.