维生素D对骨关节炎作用的进展

骨关节炎(OA)是我国中老年人常见病、多发病之一,疾病使软骨破坏、软骨下骨质病变和关节周围骨质增生,最终导致关节疼痛、功能障碍甚至是畸形,影响患者活动能力。维生素D具有参与钙磷代谢、改善成骨细胞的活性、促进骨基质的骨化、增加骨密度以及关节软骨的转化等功能,对骨骼健康十分重要。但人体维生素D水平对OA的影响尚未明确,本文就维生素D与OA发展、关节疼痛症状、关节置换术后功能恢复以及补充维生素D后治疗效果等方面相关研究作一综述。     

补充维生素D对膝关节骨关节炎的治疗效果Meta分析

目的提供关于补充维生素D对膝关节骨关节炎影响的证据。方法计算机检索The Cochrane Library、PubMed、中国知网、中国生物医学数据库与万方数据库,搜集补充维生素D治疗膝关节骨关节炎的临床随机对照试验,检索时间为建库至2017年10月。采用Rev Man 5.3软件进行系统评价和Meta分析。结果最终纳入文献4篇,共1130例膝关节骨关节炎患者。Meta分析结果显示:补充维生素D对缓解膝关节疼痛具有统计学意义[SMD=-0.32,95%CI:(-0.63,-0.02)],在亚组分析中,无论低25(OH)D水平[SMD=-0.57,95%CI:(-1.41,0.27)]研究对象或高25(OH)D水平[SMD=-0.12,95%CI:(-0.28,0.04)]研究对象中补充维生素D对膝关节疼痛都没有显著影响。补充维生素D对胫骨软骨体积无影响[SMD=0.12,95%CI:(-0.05,0.29)]。在关节间隙结构改善方面差异无统计学意义[SMD=0.07,95%CI:(-0.08,0.23)]。结论目前缺乏强有力的证据来支持补充维生素D在膝关节骨关节炎患者中能对病情起到根本性作用。还需要进行更精心化设计的、更高质量的、样本量更大的、更长随访时间的临床随机对照试验来进一步明确补充维生素D对膝关节骨关节炎患者病情的影响。     

维生素K2联合维生素D3治疗青壮年早期膝骨关节炎的研究

目的探讨维生素K2联合维生素D3治疗青壮年早期膝骨关节炎的作用。 方法2016年1月至2017年6月广州医科大学附属第二医院骨外科门诊因膝关节疼痛的患者共387例。符合早期膝骨关节炎(KOA)的青壮年患者132例,均给予相同剂量的维生素K2和维生素D3(VD)口服,随访6个月,通过观察服药前后血清25-OH-VD、血清总Ⅰ型胶原氨基端延长肽(P1NP)检测、视觉模拟评分(VAS)及股四头肌肌力的比较,维生素K2和维生素D3治疗前后各指标采用配对t检验评价治疗效果。 结果随访6个月后,血清25-OH-VD(t ＝ 2.664)、血清P1NP(t＝3.265 )的水平及股四头肌肌力(最大肌力t ＝3.005;平均肌力t ＝2.564)均较用药前增加(均为P<0.05),总体VAS评分较用药前下降( t＝3.762,P<0.05)。同时治疗前发现其中33例患者膝关节MRI检查中提示胫骨平台或股骨内侧髁存在不同程度的软骨丢失和骨髓水肿。 结论维生素K2和维生素D3联合应用能改善青壮年膝骨关节炎患者的骨营养代谢,并促进成骨作用从而改善膝关节疼痛症状和活动能力。因此对于青壮年KOA,应该早期干预治疗,从而起到抑制作用。     

血清25-羟维生素D浓度检测对膝骨关节炎临床诊疗意义

目的：研究与探讨血清25－羟基维生素D浓度检测对膝骨关节炎临床诊疗的指导意义。方法随机抽取2011年6月至2011年10月以及2012年6月至2012年10月期间骨科门诊主诉有膝关节疼痛患者1174名,采用罗氏诊断试剂盒检测患者血清中的25－羟基维生素D浓度。结果1174例患者平均年龄（53．61±15．10）岁,血清25－羟维生素D浓度平均值为15．55 ng／ml,维生素D缺乏者（＜20 ng／ml）占48．12％（524例）,其中严重缺乏者（＜10 ng／ml）占26．35％（287例）。2011年测得血清25－羟基维生素D浓度平均值为13．27 ng／ml（参考值为11．10～42．90 ng／ml）;2012年测得血清25－羟基维生素D浓度平均值为22．53 ng／ml（参考值为20～32 ng／ml）。结论血清25－羟基维生素D浓度检测在膝骨关节炎诊疗中具有重要指导意义。本次研究中应用的罗氏诊断血清25－羟维生素D3检测试剂参考值有波动,直接导致2011年度与2012年度同期所检测出的患者血清25－羟基维生素D浓度存在一定的偏差。     

绝经后妇女维生素D状况与膝骨关节炎 相关性的研究

目的 探讨维生素D与膝骨关节炎之间的关系.方法 选取133例绝经妇女,通过拍摄负重的膝关节正位,采用Kellgren和Lawrence骨性关节炎的分级标准进行分级,检测血清25羟D[25(OH)D],同时检测血钙、磷、碱性磷酸酶、肝肾功能及空腹血糖以排除有影响维生素D的其他因素者.结果 本组133例患者,平均年龄(58.41±5.25)岁,血清25(OH)D平均值为14.00 ng/mL,维生素D缺乏者(<20ng/mL)占86%,其中维生素D严重缺乏者(<10 ng/mL)占23%,维生素D不足者(20～29 ng/mL)占13%,只有2例维生素D充足(>30 ng/mL)占2%.在通过拍摄负重的膝关节正位,采用Kellgren和Lawrence骨性关节炎的分级中显示,骨关节炎级别在4级的病人维生素D全部低于10ng/mL,骨关节炎级别在0级的病人维生素D全部大于20 ng/mL.结论 血清维生素D的水平可能与膝骨关节炎的影像学进展存在相关性,因此,通过改善年老患者的血清维生素D的水平可能有助于防治膝骨关节炎.但由于样本量小,我们认为尚需扩大样本进一步研究.     

维生素D与老年骨质疏松

目前维生素D缺乏巳成为一个世界性问题。近年来许多研究观察到很多国家的居民存在不同程度的维生素D( VitD) 缺乏,而老年人群又因为饮食因素、户外活动减少、胃肠吸收减少、肾功能减退等因素,使其成为VitD缺乏的最高危人群。目 前研究结论多来自国外研究,需要在中国开展不同人群VitD及其相关因素疾病的深人研究。本文旨在讨论老年人VitD与骨 质疏松的关系,进一步为老年人骨质疏松的防治和骨的健康提供理论依据。     

绝经后女性骨关节炎行全髋置换术人群中骨质疏松和维生素D缺乏情况

不少流行病学研究骨质疏松性骨折认为骨关节炎患者中骨折发生率低 ,有些研究认为骨关节炎患者存在骨质密度增高现象。新近的研究认为骨关节炎和骨质疏松症存在反关系。笔者研究了6 7例女性骨关节炎需作全髋置换的患者。通过患者问卷调查 ,骨密度测量及实验室检查等研究 ,意外地发现 17例(2 5 % )骨关节炎患者达到世界卫生组织的骨质疏松诊断标准。依此将患者分为骨质疏松组和非骨质疏松组 ,两组在年龄、绝经后年限和体重方面差异有显著性 ,两组血钙、2 5 OHVitD、甲状旁腺素水平差异无显著性。很显然 ,本研究结果否定了骨关节炎患者不存…     

维生素D与健康研究进展

虽然维生素D营养状况的划分标准还存在一些争议,但近年来许多研究观察到很多国家的居民存在不同程度维生素D缺乏,而适当的维生素D营养状况可对骨量、骨折及其他相关慢性病产生积极的影响。膳食维生素D摄入不足和皮肤合成有限,使部分人群可能需要适当补充维生素D。但上述结论多来自国外研究,需要在中国开展不同人群维生素D及其相关因素疾病的深入研究。     

维生素D的最新研究进展

维生素D(Vitamin D,VD)是调节骨代谢的重要维生素,婴幼儿及儿童缺乏VD会导致佝偻病,成人及老人缺乏VD会导致骨质疏松症。近期研究表明,VD与高血压、2型糖尿病、血脂紊乱、代谢综合征、过敏性疾病及哮喘、免疫调节和抗炎、抗纤维化、心血管疾病、结核病、慢性肾脏病、各种癌症、感染、甚至死亡等方面密切相关。随着我国老龄化社会的到来和现代生活水平的提高,人们对VD的缺乏越来越重视,因此VD缺乏的患者越来越少。相反,因过量服用VD后中毒的病例却时有发生。安全始终是首要考虑的因素,在中毒剂量范围内补充人体需要的VD,应做好VD摄入水平及VD中毒的健康宣教。外源性途径摄入VD的同时,增加户外活动时间,多进行日光照射产生内源性维生素。在VD缺乏的预防和治疗过程中,应注意掌握VD摄入量和用药周期,密切观察,定期随访,避免VD中毒事件的发生,以期达到降低维生素D缺乏及维生素D缺乏性佝偻病的发生。     

钙剂，维生素D与骨质疏松症

充足的钙和维生素D摄入可以导致正钙平衡并且减少骨丢失的比率,联合服用钙剂和维生素D制剂可以减少骨折的风险,对于饮食摄入过低以及骨质疏松症的患者,推荐补充钙剂和维生素D是应该而且必须的。     

Cathepsin B and cysteine protease inhibitors in human osteoarthritis

The aim of this study was to determine the involvement of cathepsin B and its inhibitors in the proteolytic degradation of human osteoarthritic (OA) tissue. The characteristics of the cathepsin B found in both normal and OA cartilage and synovium were similar to those of the lysosomal cathepsin B. Two inhibitors of cysteine proteases were found with a molecular weight of 67,000 and 16,000 Da. The cartilage cathepsin B level of OA specimens (54.8 +/- 7.3 units/micrograms of DNA) was greater than the controls (39.8 +/- 3.2 units/micrograms of DNA). Mild-moderate graded samples (78.1 +/- 12.0 units/micrograms of DNA) had significantly higher levels of enzyme activity than the severely graded ones (31.4 +/- 3.9 units/micrograms of DNA, p less than 0.001) and controls (p less than 0.01). Compared to controls (2.3 +/- 0.4 units/mg of tissue w.w.), cysteine protease inhibitory activity in OA cartilage was decreased in specimens with severe lesions (1.5 +/- 0.2 units/mg of tissue). This was particularly noted in patients who had not received steroid injections (1.2 +/- 0.3 units/mg of tissue, p less than 0.05). In OA synovia, the cathepsin B level was greater (40.7 +/- 7.4 units/mg of tissue w.w., p less than 0.02) than in the controls (13.6 +/- 3.7 units/mg of tissue). The cysteine protease inhibitory activity was similar in OA synovium (1.7 +/- 0.2 units/mg of tissue w.w.) and in controls (1.5 +/- 0.3 units/mg of tissue). This data demonstrated an imbalance between the levels of cathepsin B and cysteine protease inhibitors in OA tissue. A decrease of specific inhibitors could be an important contributing factor, particularly in more severe lesions.     

Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country

Background

Vitamin D plays an important role in bone mineralization, remodeling, and maintenance and therefore its deficiency may be implicated in the pathogenesis of osteoarthritis (OA). Vitamin D status was evaluated in patients with knee or hip OA scheduled for joint replacement. The impact of anthropometric parameters such as gender, age, and body mass index on vitamin D levels was also examined. The study was conducted in a Mediterranean country (Greece).

Materials and methods

We included 164 patients with knee or hip OA scheduled for joint replacement in this study. Serum levels of 25-hydroxyvitamin D (vitamin D) were measured in routine blood samples taken from the patients at their pre-admission visit, a week before the operation, using radioimmunoassay.

Results

The majority of patients were vitamin D deficient (81.7 %); 15.2 % of them were vitamin D insufficient (hypovitaminosis). Only 3 % of patients were vitamin D sufficient. There was a significantly positive association between vitamin D levels and male gender.

Conclusion

These findings indicate a large percentage of vitamin D deficient patients with knee or hip OA, which is unexpected considering the high annual insolation in northern Greece. Many other possible predisposing factors for OA should be taken into consideration. Whether treatment with vitamin D supplements may provide beneficial effects to these patients and the stage of disease in which this treatment should commence remains an issue for further scientific investigation.

Level of evidence

Level IV.     

滑膜病变在骨关节炎中的表现

骨性关节炎是一种退化性关节疾病,以关节软骨的降解、关节边缘骨赘的形成和滑膜病变为特征,以往的研究和治疗重点在关节软骨病变,而最新研究显示滑膜的炎症在骨关节炎中起重要作用,滑膜炎症和滑膜相关的致炎因子诱导的关节软骨的降解和破坏,促进了骨关节炎的发展。滑膜病变在骨关节炎中的表现日益突出,而针对滑膜病变的治疗将成为一个新的靶点。     

跖趾关节软骨移植修复掌指关节面缺损

目的　利用自体跖趾关节软骨移植修复掌指关节缺损的软骨面,为掌指关节创伤性关节炎提供简便、可靠的方法。方法　1990 年以来,应用改良处理后的自体跖趾关节面软骨移植修复9 例11 侧掌指关节面,通过内固定、侧副韧带修复并提供适宜的生物力学和营养环境。结果　经6 个月7 年随访,关节活动度平均增加35-1°,供趾骨融合良好,成形术后关节活动度减少甚至强直,但无疼痛,对行走无明显影响。结论　软骨面匹配良好,可靠的内固定、重建韧带、供区薄的软骨面和少的骨量及适宜的生物力学环境是手术成功的关键     

膝关节骨关节炎滑液和软骨骨桥蛋白水平与其病变程度的相关性

目的 探讨膝关节骨关节炎(osteoarthritis,OA)患者滑液和关节软骨骨桥蛋白(osteopontin,OPN)水平及其与病变严重程度的关系.方法 随机选取50例膝关节OA患者[男15例,女35例;年龄48～81岁,平均(61.8±7.4)岁]和10名健康对照者[男4例,女6例;年龄59～68岁,平均年龄(63.2±6.0)岁]作为研究对象.采用Mankin评分评价疾病严重程度,Kellgren-Lawrence标准进行放射学分级,酶联免疫吸附法测定关节滑液OPN水平,免疫组化方法测定关节软骨OPN光密度值.结果 OA患者与对照者相比,关节滑液OPN水平[(4519.60±1830.37)pg/ml:(1179.70±303.39)pg/ml)和关节软骨OPN光密度值[(0.60±-0.06):(0.43±0.07)]均明显升高.关节滑液OPN水平与关节软骨OPN表达呈正相关(r=0.411,P=0.003).关节滑液OPN水平与OA病变严重程度(KL分级)呈正相关(r=0.581,P＜0.001).关节软骨OPN表达与OA病变严重程度(Mankin评分)呈正相关(r=0.675,P＜0.001).结论 关节滑液和关节软骨OPN水平与病变严重程度相关.     

Early skeletal mineralization and the role of Vitamin D: An electron probe microanalysis

Summary The effect of vitamin D on the calcium (Ca) and phosphorus (P) contents of metaphyseal trabecula bone (MT) and calcified cartilage (CC) were analyzed by electron probe microanalysis during the periweaning period in rats that had been divided into three groups: group N was fed a normal experimental diet, group R was fed a vitamin D deficient, low P diet, group D was fed the same diet as group R and also injected with 1α-hydroxyvitamin D₃(1α(OH)D₃) (0.2 μg/kg each day). In group R, the Ca and P contents of the CC gradually decreased from weaning until 14 days after weaning when the Ca and P had become minimal. However, in the MT, the Ca and P had decreased significantly at 7 days after weaning. In group D the serum concentrations of Ca and P were lower than in group N until 7 days after weaning, but the Ca and P contents in the CC were restored at 3 days after weaning. However, in the MT, the Ca and P contents in group D were not significantly different from those in group N. These results indicate that (1) vitamin D becomes progressively more important after weaning in mineralization of cartilage and bone and (2) the sensitivity of the CC to vitamin D deficiency is higher than that of MT.     

Vitamin D supplements in chronic kidney disease

Abstract

Chronic kidney disease (CKD) is a significant public health problem and Vitamin D deficiency is prevalent in CKD and might be associated with calcium and phosphate metabolism, cardiovascular disease, infections as well as the progress of kidney dysfunction. Emerging evidence implies that Vitamin D supplements may be of benefit to CKD. Based on existing laboratory and clinical evidence, this review intends to discuss the effectiveness of Vitamin D supplements and controversy in clinical practice. The effect of Vitamin D in CKD patients is summarized in detail from CKD–mineral bone disease, the progression of renal function, cardiovascular events and immune system. Considerable disputes exist for the Vitamin D supplements in CKD, and a growing amount of experimental evidence and some clinical evidence are now gathering from in vitro, animal and epidemiological studies.