男性肝硬化患者钙调激素与性激素变化及其临床意义

探讨男性肝硬化患者钙调激素与性激素变化及其临床意义.男性肝硬化患者48例(按Child-Pugh分级分为A、B、C三组), 男性健康对照组43名, 均进行骨密度(BMD)测定, 用免疫放射法(IRMA)及放射免疫法(RIA)测定甲状旁腺激素(PTH)、降钙素(CT)、骨钙素(BGP)、雌二醇(E2)和睾酮(T), 生化检测肝功能、碱性磷酸酶(ALP)、骨性碱性磷酸酶(BLP)及血钙(Ca2 )、磷(P3 ).肝硬化患者与对照组比较血清PTH升高、CT降低、BGP大部分患者降低、E2上升、T降级、E2/T比值升高;血清ALP及BLP均上升,血Ca2 及血P3 均下降, 骨质疏松发病率增高,而且随着肝功能损害加重, 上述变化越显著.男性肝硬化患者钙调激素及性激素紊乱, 导致肝性骨病, 成人以骨质疏松为主, 并随病情发展而趋严重.     

Osteocalcin and bone alkaline phosphatase in the serum of women with liver disease

To identify the types of liver disease in which osteopenia is a prominent feature and to understand the mechanisms of bone loss, bone mineral density was measured in the lumbar spine and hip, bone alkaline phosphatase, osteocalcin, and biochemical markers of calcium homeostasis were measured in 42 women, aged 33 to 52, with chronic liver disease and in 299 healthy women of similar age. In control women, bone alkaline phosphatase and osteocalcin correlated negatively with bone density at all sites (p less than 0.05). In women with liver disease, osteocalcin correlated negatively with bone density in the lumbar spine (p less than 0.007), whereas bone alkaline phosphatase did not correlate with bone density at any site. Bone alkaline phosphatase correlated positively with osteocalcin in control women (p = 0.001) and negatively with osteocalcin in women with liver disease (p = 0.03). Serum bone alkaline phosphatase in women with liver disease was increased significantly over serum bone alkaline phosphatase of control women, probably because of decreased clearance owing to defective function or decreased numbers of hepatic asialoglycoprotein receptors. Bone density was lower in the lumbar spines and hips of women with primary sclerosing cholangitis, primary biliary cirrhosis, and chronic active hepatitis or fibrosis without cirrhosis than in the lumbar spine and hips of control women. However, the differences were not significant, possibly because of the small sample size. It is concluded that, in liver disease, osteocalcin is a more reliable marker of osteoblastic function than bone alkaline phosphatase. Although our results show that bone density may decrease in women with cholestatic liver disease, larger studies are needed to determine the degree of osteopenia.     

Bone mass in physicians: a Howard University Hospital pilot study

PURPOSE: This observational cross-sectional study was done to determine bone mass in physicians and to determine if variables, such as calcium intake and exercise, were related to their bone mass. METHODS: One-hundred physicians of different ethnicities (African, African American, Asian, Caribbean, and Hispanic) were studied. Using dual-energy x-ray absorptiometry (DEXA), bone mass (BMD) of the lumbar spine and hips was measured. A validated questionnaire was used to determine the daily calcium intake and exercise. Student t-test, logistic regression, and Pearson chi-square were used to analyze the data. RESULTS: The study population consisted of 52% men and 48% women, with a mean age of 42 years old and a body mass index of 18.5 to 39.9 kg/m2. Low BMD occurred in 68% of the physicians (osteoporosis in 12%, osteopenia in 56%). Low calcium intake was found in 71%-14% of whom had osteoporosis and 49% osteopenia. Two-thirds of the physicians had inadequate exercise; 57% of this group had decreased BMD (osteoporosis in 9%, osteopenia in 38%). There was no statistical significance between BMD and calcium intake or exercise. CONCLUSION: A high percentage of the physicians in this unique study had a reduced BMD. Most of the physicians with low BMD were less than 45 years of age. This study indicates the need to define BMD in a larger cohort of young, ethnically diverse clinicians, and other health workers.     

Postmenopausal femur bone loss: effects of a low dose hormone replacement therapy

OBJECTIVES: Previous studies indicate that low-dose hormone replacement therapy (LD-HRT) can relieve vasomotor symptoms and prevent spine bone loss. METHODS: In the present study, we evaluated the effects of a low dose of conjugated equine estrogens (CEE; 0.3 mg) associated with different progestins in continuous combined scheme [2.5 mg of medroxyprogesterone acetate (n=25), 5 mg dydrogesterone (n=27), 2.5 mg nomegestrol (n=11)] as single group, on femur bone mineral density (BMD) and bone metabolism in young postmenopausal women (相似文献   

The effect of tibolone on bone mineral density in postmenopausal women with osteopenia or osteoporosis--8 years follow-up

OBJECTIVES: This longitudinal observational study evaluated the effect of 8 years of uninterrupted treatment of tibolone on bone mineral density (BMD) in postmenopausal women with significant osteopenia or osteoporosis. MATERIAL AND METHODS: Subjects were 66 postmenopausal women (29 with moderate or severe osteopenia and 37 with osteoporosis) who took tibolone (2.5 mg nocte) uninterruptedly for over 8 years and who attended for annual BMD assessments. Their mean age was 66.7 (0.86) years (range 50-86 years). BMD measurements at the lumbar spine and proximal femur were performed annually by dual-energy X-ray absorptiometry (DEXA). RESULTS: During the 8 years of treatment with tibolone there was a significant increase in BMD at the spine (P < 0.001) and at the hip (P < 0.001). Women who did not have previous oestrogen therapy had significantly greater response to tibolone than those who had previous treatment with conventional hormone replacement therapy (HRT). CONCLUSION: This long-term observational study provides evidence of the effectiveness of tibolone in postmenopausal women with moderate/severe osteopenia and osteoporosis in terms of a significant increase in BMD.     

Peripheral quantitative computed tomography (pQCT) is useful for monitoring bone mineral density of the patients who receive hormone replacement therapy

OBJECTIVE: A forearm fracture (Colles' fracture) is often the first sign of osteoporosis and should alert the patient and physician to the possibility of underlying skeletal fragility. Therefore, the establishment of a more accurate and reliable method for the measurement of bone mineral density (BMD) at the distal radius would be beneficial for the patients who suffer from osteoporosis. The objective of the present study was to evaluate the usefulness of peripheral quantitative computed tomography (pQCT) to assess the change of BMD at the distal radius in early postmenopausal women who receive hormone replacement therapy (HRT). METHODS: Twenty healthy early postmenopausal women who were diagnosed as osteoporosis or osteopenia were randomized to either HRT or placebo treatment. We analyzed BMD of the distal radius by pQCT, lumbar spine by dual-energy X-ray absorptiometry (DXA) and the biochemical markers of bone turn over (osteocalcin, deoxypyridinoline) every 6 months. RESULTS: The placebo group showed a significant decrease from the baseline in the trabecular BMD of the radius at 12 months (7.4+/-2.5%) (p<0.05), whereas the HRT group showed a slight increase (0.7+/-2.2%). The changes in the trabecular BMD of the radius between the HRT and placebo groups were statistically different at 12 months (p<0.05). On the other hand, in the cortical BMD of the radius, no significant differences were seen between the changes of bone densities in the HRT and control groups after 1 year of treatment. pQCT could detect a significant loss of BMD of the radius in early postmenopausal women after 1 year and HRT prevented its loss. CONCLUSION: Our preliminary clinical trial showed that pQCT might be useful for the early detection of bone loss in early postmenopausal women and for the monitoring BMD of the patients who receive HRT.     

碱性成纤维生长因子基因单核苷酸多态性与广西壮族男性骨质疏松的关系

目的 探讨碱性成纤维生长因子(bFGF)基因5个单核苷酸多态性（SNPs）与广西百色地区壮族男性骨密度（BMD）的关系。方法 选取壮族男性147例跟骨骨量减少患者和154例骨量正常对照进行病例对照研究,采用单碱基延伸的单核苷酸多态性分型技术对广西百色地区301例壮族男性的脂联素基因的5个位点（rs308379、rs12644427、rs3789138、rs308442和rs3747676）进行了基因分型,采用法国生产的Osteospace干式超声骨密度仪测量右侧跟骨超声振幅衰减（BUA）。结果 rs308379、rs12644427、rs3789138、rs308442和rs3747676多态性分布均符合Hardy-Weinberg遗传平衡定律（ P >0.05）。以5个多态性位点作为自变量的多元Logistic回归显示,仅rs308442多态性与跟骨骨量减少显著相关（OR =1.831,95% CI :1.075~3.116, P =0.026）。 结论 bFGF基因第1内含子rs308442多态性与壮族男性 BMD可能有一定关联,其中TT型可能对BMD具有一定的保护作用,TA型是BMD降低的危险因素。rs308379、rs12644427、rs3789138及rs3747676多态性与壮族男性BMD无相关性。     

Possible effect of calcitonin deficiency on bone mass after subtotal thyroidectomy

Bone mass is purportedly reduced by an excess of endogenous or exogenous thyroid hormone or perhaps by calcitonin deficiency. Patients who have undergone thyroidectomy could be subject to all of these effects. In the present study we tried to demonstrate, whether lack of calcitonin following thyroidectomy has a significant influence on bone density. We measured thyroid hormone levels, TSH and calcitonin and assessed the bone mass in the hip and lumbar spine of 55 patients (32 f, 23 m), who had undergone a subtotal thyroidectomy between 1938 and 1996 on the reason of a non-toxic goitre. TSH levels were suppressed in 16 patients. Serum concentration of total calcium, intact PTH, osteocalcin were normal in all subjects. The mean fasting calcitonin level was in the patient group 2.09 +/- 0.7 pg/ml and in the control group, age matched healthy volunteers, 2.8 +/- 1.2 pg/ml. However, the serum level of calcitonin was not significantly lower than in the control group. 43 patients had an osteopenia or osteoporosis. The interpretation of the results in this study is hampered by the fact, that in women results may be influenced by involutional osteoporosis. Therefore we focus on the potential for osteoporosis among the 23 men. The results of our study indicates, that there is a significant reduction in bone mass in male after thyroidectomy, no matter whether T4 therapy is given or not, and whether TSH is suppressed or in a normal range.     

Calcitriol and alendronate combination treatment in menopausal women with low bone mass

Serum calcitriol levels decrease with advancing age in relation to reduced dietary intake or poor intestinal absorption of vitamin D. These decreased levels affect the development of senile osteopenia, which can be effectively prevented by the administration of alendronate and calcium. To evaluate the effect of a combined treatment with alendronate and calcitriol on bone mineral density (BMD), we followed 152 osteopenic postmenopausal women, aged 55-75 years, for 9 months. They were divided into three groups. The first group was treated every other day with 0.25 microgram of synthetic 1,25-dihydroxyvitamin D3 plus 10 mg alendronate. The second group received the same dose of alendronate plus calcium (500 mg/day). The third group received only calcium (500 mg/day). BMD measurements were made at the level of the lumbar spine and the femoral neck. At the beginning and at the end of the period of treatment the same biochemical analyses of bone metabolism were made. There were no significant differences in the baseline values of the three groups in the biological parameters. Alendronate plus calcium treatment led to a significant reduction in total alkaline phosphatase and hydroxy prolinuria as well as to a significant increase in lumbar and femoral bone density. The same changes were observed in the group treated with alendronate plus calcitriol except that femoral BMD did not significantly improve. These results show that continuous treatment for 9 months with calcitriol or calcium in combination with alendronate significantly increases both vertebral and femoral neck density (from 3.8% to 4.5% and from 0.61% to 2.36% respectively) in osteopenic postmenopausal women. The effects of both combinations on bone mass are clearly greater than those achieved by calcium monotherapy.     

Radial bone mineral density in hemodialysis patients with adynamic bone disease

Adynamic bone disease (ABD) has attracted attention as the most frequent type of renal osteodystrophy, but there are few reports about the bone mineral density (BMD) in ABD patients. This study investigated the BMD in hemodialysis patients with ABD and with relatively normal bone turnover. We measured the BMD of the distal one-third of the radius by dual-energy X-ray adsorptiometry. In the ABD group (intact PTH<65 pg/ml, intact osteocalcin<30 ng/ml), there were 19 men and 17 women with a mean age of 56.4 +/- 12.0 years. In the relatively normal bone turnover group (intact PTH: 120-250 pg/ml), there were 24 men and 16 women with a mean age of 57.1 +/- 14.7 years. Although there were no significant differences between the two groups with respect to age, gender, and duration of hemodialysis, a significant increase of the BMD and the calcium x phosphate product was observed in the ABD group (radial BMD: 0.648 +/- 0.137 g/cm2 versus 0.572 +/- 0.132 g/cm2, calcium x phosphate product: 57.53 +/- 14.92 mg2/dl2 versus 49.76 +/- 12.13 mg2/dl2). These findings suggest that an increase in radial BMD may not be a useful marker of the improvement in bone lesions in ABD patients.     

Secondary osteoporosis due to sickle cell anemia: do sex steroids play a role?

Background : The exact cause of osteoporosis in patients with sickle cell disease (SCD) is not known, and various hypotheses have been put forward. Aim: To assess the effect of sex steroids on bone mass in SCD patients. Settings and Design: In King Fahd Hospital of the university, Alkhobar, Saudi Arabia, a cross-sectional study was carried out. Materials and Methods : All patients known to suffer from SCD attending the hospital between August 2006 and August 2007 were subjects of the study. Blood was extracted for serum level of androgens, gonadotropins, thyroid stimulating hormone (TSH), calcium, phosphorus, and alkaline phosphatase. Measurement of bone mineral density (BMD) of hip and spine was done using dual-energy X-ray absorptiometry (DEXA). All tests were performed using SPSS (Statistical Package for Social Sciences), version 14.0, Chicago, Illinois, with P value of < 0.05 being statistically significant with confidence interval (CI) of 95%. Results : One hundred three consecutive patients with an average age of 27.83 years were studied. Forty-five were males; and 58, females. Low bone mass (osteoporotic/osteopenic) was found in 62.2% of the patients in the male group and 67.06% in the female group. In males, testosterone level was not significant between different groups, but total estradiol levels were significantly lower in the osteopenic and osteoporotic patients (P < 0.003 and < 0.01 respectively). In female patients, estradiol and testosterone levels were lower in osteoporotic patients in comparison to non-osteoporotic patients (P = 0.05 and 0.001). Conclusions : Our study indicates that sex steroids play a major role in the development of osteopenia and osteoporosis in patients with SCD.     

Comparison of the Effects of Alendronate and Alfacalcidol on Hip Bone Mineral Density and Bone Turnover in Japanese Men Having Osteoporosis or Osteopenia with Clinical Risk Factors for Fractures

Purpose

The comparative effects of alendronate and alfacalcidol on bone mineral density (BMD) and bone turnover have already been established in postmenopausal women with osteoporosis. An open-labeled prospective study was conducted to compare the treatment effects of alendronate and alfacalcidol on hip BMD and bone turnover in Japanese men with osteoporosis or osteopenia with clinical risk factors for fractures.

Materials and Methods

One hundred twelve men with osteoporosis or osteopenia with clinical risk factors for fractures (mean age: 71.4 years) were randomly divided into two groups of 56 patients each: the alendronate (5 mg daily) and alfacalcidol (1 µg daily) groups. The BMD of the total hip, urinary level of cross-linked N-terminal telopeptides of type I collagen (NTX), and serum levels of bone-specific alkaline phosphatase (BSAP) were measured during the 12-month-treatment period.

Results

Forty-five patients in the alendronate group and 42 patients in the alfacalcidol group completed the trial. Alendronate increased BMD (+2.3% at 12 months) following reductions in the urinary level of NTX (-46.4% at 3 months) and serum level of BSAP (-34.1% at 12 months), while alfacalcidol sustained BMD (-1.9% at 12 months) as well as the urinary level of NTX (+13.2% at 3 months) and serum level of BSAP (+1.8% at 12 months).

Conclusion

The present study confirmed that alendronate has better efficacy than alfacalcidol (active control) in increasing hip BMD and reducing bone turnover in Japanese men with osteoporosis or osteopenia with clinical risk factors for fractures.     

Analysis of histological and immunohistochemical patterns of the liver in posthepatitic and alcoholic cirrhosis by computerized morphometry.

To assess the degree of fibrosis and the structural changes affecting parenchymal and extraparenchymal components in liver cirrhosis, a computerized morphometric model has been applied to liver specimens from patients with posthepatitic and alcoholic cirrhosis. All specimens have been stained with chromotrope-aniline blue method and monoclonal antibodies against cytokeratin 7, CD31, and VIII factor. Volume fractions of parenchymal compartment and fibrosis have been determined stereologically on CAB slices; moreover, volume fractions of portal bile ducts and proliferated bile ductules, hepatocytes with biliary metaplasia, capillary units, and vascular structures have been measured. Volume fraction of fibrosis was higher in alcoholic cirrhosis when compared with the case of posthepatitic cirrhosis. Volume fractions describing parenchymal compartment showed a similar trend in both viral groups. The main differences were related to immunohistochemical stainings. Volume fraction of hepatocytes with biliary metaplasia was higher in hepatitis C virus-related cirrhosis, whereas volume fractions of biliary structures were more prominent in hepatitis B virus-related cirrhosis. Capillary units were more prominent in posthepatitic cirrhosis than in alcoholic cirrhosis. Interestingly, both forms of posthepatitic cirrhosis show similar features when compared with alcoholic cirrhosis. Our computerized morphometric model well describes and quantifies the morphological alterations of the liver, and it could represent an adjunctive tool to evaluate the degree of dysplastic phenomena involving parenchymal and extraparenchymal components.     

Regenerative pattern of liver cells in primary biliary cirrhosis, alcoholic cirrhosis, posthepatitic cirrhosis (HBV-related) and hepatocellular carcinoma: Comparative analysis by computerized morphometry

Computerized morphometrical measurements were made of liver cells and their nuclei taken from biopsy specimens of primary biliary cirrhosis (PBC), alcoholic cirrhosis, posthepatttic cirrhosis (HBV-related), and hepatocellular carcinoma (HCC). The specimens were stained with hematoxylln-eosin (HE), Mallory's stain for collagen fibers, orcein method, periodic acid Schiff (PAS) reaction, and silver impregnation. Light microscopic views were then selected and original liver cells were magnified × 1000. The size of liver cell nuclei, distance between corresponding liver cell nuclei and distribution pattern of hepatocytes were calculated by computer. Variation in regenerative activity among the four disease groups was noted. Regenerative features of liver cells were mild in degree in PBC. In alcoholic cirrhosis, regenerative features of liver cells were less prominent than in posthepatitic cirrhosis. In posthepatitic cirrhosis, regenerative liver cells were well developed, showing remarkable pleomorphlsm of liver cell nuclei and expansive arrangement of liver cell cords. This tendency towards regenerative activity suggests that the possibility of HCC occurring Is greater In posthepatitic cirrhosis than in PBC or alcoholic cirrhosis. It was concluded that morphologically, there is a greater possibility of occurrence of HCC in posthepatitic cirrhosis than in any other type of cirrhosis, because of its high regenerative hepatocytic activity. Also etiological factors of liver diseases are more important in the developement of liver cell regeneration. Furthermore, regenerative activity can be measured by computerized morphometry as an established methodology.     

Relationship between blood pressure levels and bone mineral density in postmenopausal Turkish women

Introduction

We investigated the association between bone mineral density (BMD) detected by dual-energy X-ray absorptiometric (DXA) method and blood pressure (BP) in a large sample of postmenopausal women.

Material and methods

The current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 ±8.8 years, who were screened for osteopenia or osteoporosis by DXA. Patients with hypertension (HT, n= 306) were compared with normotensive (NT, n = 290) individuals. Bone mineral density results for the femur neck and spine were classified into 3 groups according to World Health Organization criteria: normal (T score > –1.0 SD), osteopenia (T score –1.0 to –2.5 SD) and osteoporosis (T score < –2.5 SD). Patients with osteopenia or osteoporosis (T score < –1.0 SD) were grouped as having low bone mass (LBM).

Results

There were no significant differences in femur T score, femur BMD, femur Z score, spinal T score, spinal BMD and spinal Z score between hypertensive and normotensive groups. The group of patients with low bone mass calculated from femur T scores had higher age, systolic BP, duration of hypertension and duration of menopause, but lower BMI. Similarly, patients with low spine BMD had higher age and duration of menopause, but lower BMI. Linear regression analysis showed a significant correlation between systolic BP and femur BMD and T score values. Furthermore, logistic regression analysis revealed that hypertension is an independent predictor of spinal osteopenia and osteoporosis.

Conclusions

The presence of hypertension is an independent predictor of spinal low bone density in Turkish women after menopause.     

Bone tissue metabolism in men with ankylosing spondylitis

PurposeThe aim of the study was the composite estimation of bone tissue metabolism in ankylosing spondylitis (AS) after having taken into account such factors as a high risk of incidence of osteoporosis in patients with AS and potential danger of permanent immobility.Material and MethodsSixty- six patients with established diagnosis of AS and 63 healthy individuals in the control group were included into the study. To measure bone mineral density (BMD) the dual energy X-ray absorptiometry (DEXA) method was used. Additionally, biochemical markers of osteoporosis such as bone fraction of an alkaline phosphatase (BALP), osteocalcin (BGP) and deoxypyridinoline (Dpd) as well as many inflammatory markers of disease activity have been determined.ResultsIn our study with AS had significantly diminished bone mineral density, as compared with health controls. The presence of osteopenia/osteoporosis was associated with longer duration of the disease and with higher age. In the overall group of AS patients bone degradation marker, Dpd, correlated with serum concentration of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and C-reactive protein (CRP), and inversely with BMD measured in the forearm. However, no direct association could be revealed between lower bone density and markers of inflammation or inflammatory cytokines, except of IL-6 witch was significantly higher in AS patients with osteoporosis/ osteopenia than those without.ConclusionsOur results indicate that disease duration and higher age are risk factors for osteoporosis in patients with AS. Inflammation might contribute to the accelerated bone loss in AS through stimulation of bone degradation.     

Identification of the risk factors for osteoporosis among postmenopausal women

ObjectivesThe aim of this study was to determine the effect of different durations of menopause at the time of bone mineral density (BMD) measurement and of different age at menopause intervals on the prevalence of osteopenia and osteoporosis among untreated postmenopausal women. We also assessed related factors leading to low BMD.MethodsA total of 2769 postmenopausal women who had not taken any anti-osteoporosis treatment and/or hormone replacement therapy were divided into three groups according to duration of menopause at the time of BMD measurement. The women were also evaluated in four different age groups according to their age at menopause onset. Multinomial logistic regression analysis was used to determine related factors leading to low BMD. Investigated parameters include demographic characteristics, plasma glucose, lipids, and lipoproteins.ResultsAccording to World Health Organization (WHO) criteria, among 2769 patients, 449 (16.2%) were identified as having osteoporosis, 1085 (39.2%) as having osteopenia, and 1235 (44.6%) as having normal BMD. Osteoporosis was determined in 10.6% and 16.2% of women with menopause duration of 0–3 years and 4–7 years, respectively, whereas this rate was 31.9% in women with menopause duration of over 7 years (p = 0.001). The percentages for osteopenia remained constant among the three different menopause durations (0–3 years: 37.2%, 4-7 years: 42.1%, and >7 years: 40.9%). Thirty percent of women with age at onset of <40 years were osteoporotic. However, the percentages of women with osteoporosis among the other age groups were similar (40–46 years: 18.3%, 47–52 years: 14.1%, and >52 years: 15.4%). The percentages for osteopenia remained relatively constant among the four age groups (36.7, 40, 39.1 and 39%). According to the multinomial logistic regression analysis, duration of menopause at the time of BMD test and parity were positively correlated with both osteoporosis and osteopenia, while glucose level was negatively correlated with both osteoporosis and osteopenia. Age at menopause was negatively correlated only for osteoporosis. Low-density lipoprotein cholesterol (LDL-c) level may be accepted as a clinically significant factor for osteopenia (OR: 1.01; CI_95%: 1.00–1.02). No differences were determined in the prevalence of osteopenia and osteoporosis in women with menopause duration of >7 years when evaluated according to the four menopause age groups as described before (p = 0.74). Contribution to the regression model was 0.8% by age at menopause, 5.6% by menopause duration at time of BMD measurement, 5.8% by both factors.ConclusionAccording to our results, osteoporosis is related more to the duration of menopause at the time of BMD measurement rather than the age at menopause among untreated postmenopausal women. High parity was determined as another risk factor for low BMD.     

中老年女性亚甲减症与骨密度的相关性分析

目的 探讨中老年女性亚临床甲状腺减退症与骨密度(bone mineral density,BMD)的相关性.方法 收集中老年女性亚临床甲状腺减退症(亚甲减)及健康体检者的骨密度及部分生化指标的检测结果,并进行对比分析.结果 中老年女性亚甲减组与正常对照组相比,亚临床甲减组的骨密度测定中T值下降(P＜0.05);生化指标中25羟基维生素D3水平低于对照组(P＜0.05),ALP和PTH无统计学意义(P＞0.05);甲状腺功能检测FT4和T4在正常范围内有一定程度的下降(P＜0.05).结论 亚甲状腺功能减退症可能引起骨量丢失,骨密度降低,亚临床甲状腺功能减退患者的骨密度受血清促甲状腺激素(TSH)的影响.     

Lactose malabsorption is a risk factor for decreased bone mineral density in pancreatic insufficient cystic fibrosis patients

As decreased bone mineral density (BMD) is a common problem in cystic fibrosis (CF) and milk products may have pivotal dietary role affecting BMD, we aimed to assess the potential influence of adult-type hypolactasia (ATH) and lactose malabsorption (LM) on BMD in adolescent and young adult patients. In 95 CF pancreatic-insufficient patients aged 10-25 years (without liver cirrhosis, steatosis and cholestasis, diabetes mellitus, systemic glucocorticoid therapy), lumbar BMD, the nutritional status, pulmonary function, vitamin D3 concentration, calcium intake and single-nucleotide polymorphism upstream of the lactase gene were assessed. In subjects with the -13910 C/C genotype predisposing to ATH, the presence of LM was determined with the use of a hydrogen-methane breath test (BT). BMD and calcium intake were significantly lower in patients with the C/C genotype (P<0.028 and P<0.043, respectively). The abnormal BMD was stated more frequently in patients with the C/C genotype (P<0.042) and with LM (P<0.007). BMD, daily calcium intake and serum vitamin D concentration were significantly lower in LM subjects than in the other patients (P<0.037, P<0.000004 and P<0.0038, respectively). In logistic regression analysis, the relationship between examined parameters and BMD, was found to be statistically significant (P<0.001). However, only standardized body weight and LM were documented to influence BMD (P<0.025 and P<0.044, respectively). In conclusion, LM seems to be an independent risk factor for decreased BMD in CF patients.