维持性血液透析的CKD合并SHPT患者甲状旁腺次全切除术后骨密度变化

目的 评估合并继发甲状旁腺功能亢进（SHPT）的慢性肾脏病（CKD）维持性血液透析患者甲状旁腺次全切除术后骨密度变化。方法 收集CKD血液透析后因合并SHPT接受甲状旁腺次全切除术的33例患者（手术组）和37例单纯药物治疗的同类患者（药物组）的临床资料。所有患者治疗前后均接受胸部CT扫描,以胸骨为测量位置,观察CT测量的骨钙积分变化,比较2组血钙、血磷、甲状旁腺激素以及骨密度等数据,分析手术与否和骨密度变化的关系。结果 手术组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异有统计学意义（P均< 0.05）,骨密度升高;药物组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异无统计学意义（P均> 0.05）。控制了年龄因素后,手术与否和骨密度变化存在相关性（P < 0.05）。结论 对血液透析后出现SHPT的CKD患者实施甲状旁腺次全切除术有助于改善其骨密度。     

老年代谢综合征与骨代谢及骨密度的相关性研究

目的探讨老年代谢综合征(MS)与骨代谢及骨密度的关系。方法选择老年MS患者157例为MS组,健康体检者192例为对照组,测量腰围、空腹血糖(FBG)、血胆固醇(TC)、甘油三酯(TG)等,ELISA法检测血清骨钙素(OC)、甲状旁腺素(PTH)、骨碱性磷酸酶(B-ALP),双能X线骨密度测量仪检测骨密度。结果 MS组骨密度T值及OC、B-ALP均显著低于对照组,PTH显著高于对照组。各代谢指标正常组与异常组之间骨密度比较发现:血压、TG、腰围异常组患者骨密度显著低于正常组患者,其余代谢组分的正常组与异常组骨密度无统计学差异。结论 MS主要通过肥胖、血脂、血压代谢异常引起体内与骨代谢相关的因子如甲状旁腺素、骨碱性磷酸酶等的改变进而导致骨代谢异常、骨密度下降。     

Asymptomatic primary biliary cirrhosis. Presentation, histology, and results with D-penicillamine.

Of 103 patients with the syndrome of primary biliary cirrhosis (chronic, nonsuppurative destructive cholangitis) who entered a double-blind, randomized, controlled treatment trial with either D-penicillamine or placebo, 21 (20%) were asymptomatic with respect to their liver disease. Study of these 21 patients revealed that (1) 43% of patients with asymptomatic primary biliary cirrhosis had advanced histologic lesions (fibrosis or cirrhosis); (2) asymptomatic patients with advanced histologic lesions likely have had their disease for 10 years or more; (3) stage of primary biliary cirrhosis may remain unchanged for years; and (4) most asymptomatic patients receiving D-penicillamine, when compared with patients given placebo, had improved liver function tests at 1-year follow-up. However, the incidence of major toxicity with D-penicillamine for primary biliary cirrhosis in a maintenance dose of 1 g approximates 20%. Furthermore, one of our patients who was asymptomatic but who had advanced histologic changes died recently from D-penicillamine-associated bone marrow suppression. It remains to be determined whether the benefit-to-risk ratio of D-penicillamine in primary biliary cirrhosis justifies its use.     

Altered mineral metabolism in glucocorticoid-induced osteopenia. Effect of 25-hydroxyvitamin D administration.

Parameters of mineral and bone metabolism were studied in 17 patients treated chronically with supraphysiologic doses of glucocorticoids. When compared to 15 matched normal subjects, the patient group exhibited similar serum 25-hydroxyvitamin D (25-OHD) levels, decreased intestinal 47Ca absorption, increased serum immunoreactive parathyroid hormone, and decreased forearm bone mass. Iliac crest bone biopsies revealed a decreased bone formation rate and increased osteoclast number. Treatment with 25-OHD (mean dose 4.03 micrograms/d) and calcium (500 mg/d) in nine patients produced a 46% increase in 47Ca absorption (P less than 0.001) and a 54% decrease in serum immunoreactive parathyroid hormone (P less than 0.001) by 3 mo. In addition, by 12 mo the treatment group exhibited (a) a 13.2 +/- 5.1% increase in metaphyseal (P less than 0.001) and a 2.1 +/- 0.4% increase in diaphyseal (P less than 0.05) forearm bone mass, and (b) significant decreases in cortical and endosteal osteoclast number. Biochemical and bone mass changes persisted through 18 mo. No significant changes in any parameter occurred in eight control patients administered calcium 100 mg/d. It is concluded that treatment with 25-OHD and calcium can significantly improve parameters of mineral and bone metabolism in patients with glucocorticoid-induced osteopenia.     

Changes in calcium homoeostasis in patients undergoing liver transplantation: effects of a single infusion of pamidronate administered pre-operatively.

Bone turnover, bone loss and fracture risk increase after liver transplantation. It has been postulated that peri-operative administration of a bisphosphonate might prevent bone loss and reduce fracture rate. We studied the effects of a single pre-operative dose of pamidronate on biochemical parameters of skeletal metabolism in the first month after liver transplantation. In a randomized, single-blind study, six of 12 patients with chronic liver disease received 60 mg of pamidronate intravenously on a single occasion 1-30 days before transplantation. Six other patients undergoing transplantation received no pamidronate. We measured serum calcium, phosphate, albumin, bone-specific alkaline phosphatase, plasma parathyroid hormone and tartrate-resistant acid phosphatase before pamidronate infusion and at frequent intervals during the first 30 post-operative days. In treated patients, plasma parathyroid hormone increased 12-fold over baseline values and remained elevated in comparison with baseline at days 26-30; serum calcium and phosphate fell significantly, returning to normal at around day 14 post-operatively. There were no significant changes in any parameter in the untreated group. No changes in bone formation or resorption markers were observed in either group. The large increase in plasma parathyroid hormone concentrations in the treated group is probably secondary to the fall in serum calcium. The magnitude of the increase is much greater than that seen after pamidronate infusion in other patient groups. The lack of change in, or correlation of, serum calcium and plasma parathyroid hormone in the untreated group suggests that additional factors release calcium from bone after liver transplantation, presumably by increasing bone resorption.     

Metabolism of vitamin D in patients with primary biliary cirrhosis and alcoholic liver disease

The metabolism of isotopically labelled vitamin D2 and D3 has been investigated in eight patients with primary biliary cirrhosis and in five controls. The concentration of labelled vitamin D2 was lower than that of vitamin D3 in serum of patients with primary biliary cirrhosis on days 1 and 2 after intravenous injection (P less than 0.005 and P less than 0.05, respectively) but no difference was seen in controls. Similar amounts of labelled 25-hydroxyvitamin D2 and D3 were seen in serum of the control group; the same pattern was observed in the primary biliary cirrhosis group, and no significant differences were observed between the two groups. In both control and primary biliary cirrhosis groups, the serum concentration of labelled 24,25-dihydroxyvitamin D2 exceeded that of 24,25-dihydroxyvitamin D3 (significant for controls on day 2, P less than 0.02) but concentrations in the two groups were not different. Concentrations of labelled 25,26-dihydroxyvitamin D3 were significantly higher than those of 25,26-dihydroxyvitamin D2 in the primary biliary cirrhosis group at all times and in the control group on days 2 and 3. Both 25,26-dihydroxyvitamin D2 and D3 were higher in the serum of patients with primary biliary cirrhosis than in controls (significant on day 1; P less than 0.05). Urinary excretion over days 0-3 of radioactivity from both vitamins D2 and D3 was significantly higher in the primary biliary cirrhosis group than in controls: 12.03 vs 1.80% for vitamin D2 and 8.98 vs 1.76% for vitamin D3 (P less than 0.005). Vitamin D2-derived urinary radioactivity in primary biliary cirrhosis correlated strongly with serum bilirubin (P = 0.005). The metabolism of labelled vitamin D3 was studied in seven patients with alcoholic liver disease, three of whom showed low serum concentrations of labelled 25-hydroxyvitamin D3 suggesting impaired hepatic synthesis. The 25-hydroxylation response was quantified as the relative index of 25-hydroxylation and was significantly related to two other indices of liver function. It is concluded that impaired 25-hydroxylation of vitamin D may occur in alcoholic liver disease and results from hepatocellular dysfunction. Less than the predicted amounts of 1,25-dihydroxyvitamin D3 were produced in four of the seven patients with alcoholic liver disease; this defect may be attributable in part to decreased precursor 25-hydroxyvitamin D and to poor renal function.     

血液透析联合血液灌流对肾性骨病患者血清钙 、血清磷和全段甲状旁腺激素的影响

目的 探讨血液透析联合血液灌流对肾性骨病患者血清钙 、血清磷和全段甲状旁腺激素的影响.方法 收集2017年6月至2019年6月在中国人民解放军第三〇五医院进行治疗的94例肾性骨病患者为研究对象,分为观察组和对照组,每组47例.对照组给予常规血液透析治疗,观察组在对照组基础上增加血液灌流治疗.连续透析治疗3个月后对2组患...     

脱氢表雄酮硫酸酯治疗老年男性骨质疏松症120例

目的：虽然已经有较多的证据提示脱氢表雄酮在骨质代谢中具有良性作用，但还需要更加合理和深入的实验来剔除其衍生激素的生物学效应，以更好地明确脱氢表雄酮对骨质代谢的作用。实验拟进一步验证脱氢表雄酮硫酸酯治疗老年男性骨质疏松症的疗效及安全性。 方法：①试验对象：选择2005—10／2006-10本院老年男性门诊及住院原发性骨质疏松症患者120例。诊断标准参照WHO新标准：所测骨密度值低于同性别骨峰值2．5个标准差以上诊断为骨质疏松，从未用过性激素。所有患者随机分为治疗组和对照组，每组60名。②试验方法：治疗组口服脱氢表雄酮硫酸酯100mg、钙尔奇D600mg；对照组口服钙尔奇D600mg。③试验评估：6个月后测定骨密度、血生化指标、骨吸收指标和骨形成指标以及副作用等方面的变化。 结果：纳入骨质疏松患者120例，均进入结果分析。①腰椎1、腰椎2-4、股骨颈、股骨上端部位骨密度与治疗前及对照组比较，差异显著（P〈0.01）。②治疗后治疗组脱氢表雄酮硫酸酯、胰岛素样生长因子Ⅰ、血清钙、碱性磷酸酶、尿吡啶啉、骨钙素较治疗前及对照组明显提高（P〈0．01，P〈0、05）。对游离睾丸酮、雌二醇、前列腺特异抗原、谷丙转氨酶、尿素氮、肌酐则无明显影响（P〉0．05）。 结论：脱氢表雄酮硫酸酯治疗老年男性骨质疏松症有较好疗效且安全可靠，无明显不良反应。     

Increased bone resorption in the proximal femur in patients with hemiplegia

OBJECTIVES: To investigate the relationship between the proximal femoral bone mineral density and bone resorption markers, determinants of calcium metabolism and vitamin D levels in elderly stroke patients. DESIGN: A total of 80 patients and 20 controls were enrolled in the study. Bone mineral density measurements were obtained at the proximal femur. In all subjects, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, intact parathyroid hormone, osteocalcin, deoxypyridinoline, and ionized calcium concentrations were measured. Barthel Index and Motricity Index Leg Score were recorded all patients. RESULTS: The serum concentrations of deoxypyridinoline, intact parathyroid hormone, and the mean serum ionized calcium levels were significantly higher in patients with stroke than that of the control subjects. The mean serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations in patients were significantly lower than those of the control group (P < 0.05). The bone mineral density of proximal femurs of paretic limbs was decreased significantly compared with those of the control group (P < 0.05). There were significant correlations between the Z score of the hemiplegic side and the patients' Barthel Index, Motricity Index Leg Score, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, calcium, and deoxypyridinoline. CONCLUSIONS: This study provides clear evidence that decreased mobility, vitamin D status, and bone turnover variables in patients after stroke are important factors in the greater bone loss in the paretic leg.     

伊班膦酸钠联合甲状旁腺素治疗卵巢切除后的骨质疏松症

背景：注射用重组人甲状旁腺素可以显著增加骨质形成、骨质密度,并显著减少骨折发生率,在治疗绝经后骨质疏松症方面具有良好的疗效。目的：观察伊班膦酸钠联合重组人甲状旁腺素（1-34）治疗卵巢切除大鼠骨质疏松症的效果。方法：32只健康大鼠随机数字表法均分成对照组、模型组、伊班膦酸钠组和伊班膦酸钠＋甲状旁腺素组,除对照组外其他3组均进行卵巢切除,4周后分别皮下注射生理盐水或伊班膦酸钠或伊班膦酸钠＋甲状旁腺素。结果与结论：模型组大鼠骨钙含量明显低于其他3组,伊班膦酸钠＋甲状旁腺素治疗可提高大鼠骨钙含量和骨密度,降低血钙和碱性磷酸酶水平,联合用药的作用优于单独用药。说明伊班膦酸钠对卵巢切除骨质疏松模型大鼠骨量的丢失有显著抑制作用,伊班膦酸钠联合甲状旁腺素可以增加骨含量,为治疗妇女绝经后骨质疏松提供了合理用药依据。     

非那雄胺对老年良性前列腺增生患者骨代谢及骨密度的影响分析

目的 探讨非那雄胺对老年良性前列腺增生患者骨代谢指标及骨密度的影响.方法 回顾性分析我科住院老年良性前列腺增生患者的临床资料,按是否服用非那雄胺分为非那雄胺组及未服用非那雄胺组(对照组).其中非那雄胺组168例,对照组176例.采集两组患者下述临床资料:身高,体质量,计算体质量指数(BMI),血清钙(Ca),血清磷(P),甲状旁腺激素(PTH),25羟维生素D3(25(OH) VD3),骨代谢指标包括:总骨1型前胶原氨基端延长肽(TP1 NP)、Ⅰ型胶原交联羧基末端肽(β-CTX)、骨钙素(OC).骨密度(g/cm2)包括:腰椎(L1～4),股骨颈,股骨大粗隆,股骨全部.结果 ①与对照组比较,非那雄胺组在骨代谢指标,骨密度方面差异无统计学意义(P＞0.05).②非那雄胺组中,按年龄分组,各亚组中骨代谢指标、骨密度差异无统计学意义(P＞0.05).③非那雄胺组中,按应用非那雄胺时间分组,各亚组中骨代谢指标、骨密度差异无统计学意义(P＞0.05).结论 非那雄胺对于老年良性前列腺增生患者骨代谢及骨密度影响与对照组比较差异无统计学意义,且高龄患者及长期服用非那雄胺对骨代谢及骨密度亦没有影响.     

老年2型糖尿病合并髋部骨折患者骨代谢的变化

目的探讨老年2型糖尿病合并髋部骨折患者骨代谢的改变和机制,以了解2型糖尿病与老年人髋部骨折的关系。方法测定80例老年2型糖尿病合并髋部骨折患者、90例老年2型糖尿病患者及70例年龄、体重指数相匹配的健康对照者的骨密度(BMD),血清骨钙素(BGP)、甲状旁腺素(PTH)、降钙素(CT)等,组间进行比较。结果老年2型糖尿病合并髋部骨折患者与糖尿病组比较,骨密度及各项骨代谢生化指标差异无统计学意义。老年2型糖尿病合并髋部骨折患者、老年2型糖尿病患者分别与健康对照组比较,BMD、BGP、CT显著低于对照组(P<0.01),PTH显著高于对照组(P<0.01)。结论老年2型糖尿病患者较易患骨质疏松,其骨改变特点是骨吸收增加,骨形成下降。骨质量的改变不是老年2型糖尿病患者发生髋部骨折的直接原因。     

Changes in serum osteocalcin associated with parathyroid hormone infusion in X-linked hypophosphatemic rickets

Osteocalcin is a protein unique to bone that can be quantitated in serum by radioimmunoassay. While its function remains unknown, it appears to be a sensitive marker of changes in bone activity. To determine its relationship to parathyroid hormone action, we measured serum osteocalcin in blood samples obtained from patients with vitamin D-resistant rickets before and after administration of exogenous parathyroid hormone. Serum osteocalcin was decreased by 35% at 15 min after infusion and gradually returned toward normal levels by 75 min. We suggest that the acute decline in serum concentrations after infusion is an indication of inhibition of osteoblast activity. Thus, osteocalcin may be a useful means of assessing bone responsiveness to parathyroid hormone.     

男性2型糖尿病患者病程与骨密度和骨代谢指标关系的研究

目的　评价男性 2型糖尿病患者病程与骨密度和骨代谢指标的变化的关系。方法　同时测定2 4例正常人和 6 2例男性 2型糖尿病患者的骨密度 (BMD)、血骨钙素 (BGP)、骨型特异性碱性磷酸酶 (BAP)、Ⅰ型胶原氨基末端肽 (NTx)、甲状旁腺素 (PTH)、血钙、血磷和血浆白蛋白。根据病程将糖尿病分为Ⅰ组 :病程 <5年 ,31例 ;Ⅱ组 :病程 5～ 10年 ,2 0例 ;Ⅲ组 :病程 >10年 ,11例。结果　与正常对照组 (K组 )比较 ,Ⅰ组和Ⅱ组患者BMD、BGP、BAP、PTH和NTx差异无显著意义 (P >0 0 5 ) ;Ⅲ组糖尿病BMD明显下降 ,P <0 0 5 ;BGP、BAP、NTx和PTH显著增高 ,P <0 0 1。结论　病程 (大于 10年 )是男性 2型糖尿病患者骨质疏松症的重要危险因素。     

A circadian rhythm of serum osteocalcin levels in postmenopausal osteoporosis

The serum levels of osteocalcin, a 49 amino acid bone matrix protein, have been found to be a specific biochemical parameter of bone formation. The aim of our study was to assess the variability of serum osteocalcin and parathyroid hormone levels in postmenopausal osteoporosis. In 16 patients with postmenopausal osteoporosis, serum levels of osteocalcin and parathyroid hormone were determined in 4-hourly intervals by radioimmunoassay. Whereas the serum parathyroid hormone levels were similar throughout the day, the serum osteocalcin levels showed a circadian rhythm, with lowest levels in the morning and maximal levels during the night. These findings might suggest a circadian variation of bone formation in patients with postmenopausal osteoporosis.     

唑来膦酸与伊班膦酸钠对老年男性骨质疏松患者骨代谢指标影响差异的研究

目的:探讨新一代二磷酸盐唑来膦酸与常用药伊班膦酸钠对老年男性骨质疏松患者骨代谢指标影响的差异。方法:60例老年男性骨质疏松患者在每日给予钙尔奇D 0.6 g和骨化三醇胶丸0.25μg的治疗基础上,均静脉滴注2 mg伊班膦酸钠1次。3个月后将患者随机分为两组,一组仍静脉滴注伊班膦酸钠2 mg,另一组静脉滴注5 mg唑来膦酸。于治疗3个月后比较两组患者治疗前后及治疗后两组间甲状旁腺激素、β-胶原分解片段、降钙素、骨钙素、血清磷、血清钙差异。结果:①两组治疗后甲状旁腺激素、β-胶原分解片段均较治疗前下降(P<0.05),降钙素、骨钙素、血清磷、血清钙则无明显差异。②治疗后唑来膦酸组甲状旁腺激素、β-胶原分解片段较伊班膦酸钠组低(P<0.05);血钙也较伊班膦酸钠组低,但比较差异无统计学意义。结论:与伊班膦酸钠比较,静脉应用唑来膦酸对老年男性骨质疏松患者的甲状旁腺激素、β-胶原分解片段可能具更强的短期抑制作用。     

老年人骨质疏松与动脉硬化的关系

目的通过对骨密度与冠状动脉钙化积分、颈动脉内中膜厚度及斑块关系的分析, 探讨骨质疏松与动脉硬化的关系.方法对66例老年冠心病、高血压或脑动脉硬化患者行双能X线骨密度仪测定腰椎、髋部、前臂的骨密度, 螺旋CT检测冠状动脉钙化积分及冠状动脉总钙化积分, 颈动脉超声检测颈动脉内中膜厚度及斑块,测定血甲状旁腺激素全段、骨钙素、血钙.据骨密度分骨质疏松组(A组),非骨质疏松组(B组).结果 A组患者的冠状动脉各分支钙化积分及冠状动脉总钙化积分、颈动脉内中膜厚度、颈动脉多发性硬斑发生率高于B组(P<0.01).冠状动脉钙化积分、颈动脉内中膜厚度与甲状旁腺激素呈正相关,与骨钙素、血钙呈负相关, 与各部位的骨密度呈负相关.结论骨质疏松症与动脉硬化有密切的关系, 骨质疏松时钙从骨中溶出增加,体循环中的钙可异常沉积在血管内膜中,造成血管壁动脉粥样硬化、钙化.     

Testosterone supplementation,glucocorticoid milieu and bone homeostasis in the ageing male

Male ageing is entwined with a continuous fall in free testosterone levels, which contributes to the pathogenesis of bone loss. Glucocorticoid excess, either dependent on the ageing process or iatrogenically induced, was found to additionally impair the bone structure and metabolism. Cautious testosterone supplementation in this respect may positively affect the glucocorticoid milieu and bone homeostasis, while testosterone‐induced changes in the glucocorticoid output could serve as a determinant of bone‐related therapeutic outcome. Namely, bone mineral content/density, the parameters of trabecular bone structure as well as bone strength are enhanced, serum calcitonin levels tend to increase, while serum osteocalcin, serum parathyroid hormone and urinary calcium decrease, all upon testosterone administration to the ageing male. In parallel, testosterone application decreases glucocorticoid secretion in the animal models of male ageing, while clinical data in this field are still inconsistent. Importantly, a physiological link exists between testosterone‐induced changes in glucocorticoid levels and the tendency of bone status improvement in the ageing male. We believe that the assessment of circulating adrenocorticotropic hormone concentrations together with glucocorticoid levels, reflecting the hypothalamic–pituitary–adrenal axis feedback loop operativeness during testosterone supplementation, represents a well‐balanced bone‐related therapeutic update.     

Collagen biosynthesis enzymes in serum and hepatic tissue in liver disease

Abstract. Serum immunoreactive prolyl hydroxylase protein was measured in sixty-five patients with liver disease, and liver prolyl hydroxylase activity, immunoreactive prolyl hydroxylase protein and collagen hydroxyproline in forty of these patients. Serum immunoreactive prolyl hydroxylase protein was above the 95% confidence limit of the controls in most patients with primary biliary cirrhosis, portal cirrhosis, acute hepatitis and cancer with liver metastases, but below this in most patients with fatty liver, chronic active hepatitis, extrahepatic cholestasis, cholangitis, cancer without liver metastases and other malignant diseases. Elevated serum immunoreactive prolyl hydroxylase protein decreased rapidly with time in acute hepatitis but not in primary biliary cirrhosis. Liver prolyl hydroxylase activity and immunoreactive prolyl hydroxylase protein were elevated in the same diseases as serum immunoreactive prolyl hydroxylase protein, and correlated significantly with the latter whereas no correlation was found between serum immunoreactive prolyl hydroxylase protein and collagen hydroxyproline. Serum immunoreactive prolyl hydroxylase protein correlated highly significantly with serum alkaline phosphatase and weakly with serum aspartate aminotransferase in primary biliary cirrhosis, but not in any other disease. No correlation was found between serum immunoreactive prolyl hydroxylase protein and other tests of liver function. The results suggest that changes in serum immunoreactive prolyl hydroxylase protein in liver disease primarily reflect changes in this enzyme in the hepatic tissue, and that assays of serum immunoreactive prolyl hydroxylase in liver disease may give useful information on the actual hepatic collagen synthesis.     

Bone metabolism during interferon-alpha treatment of essential thrombocythemia

In-vitro studies have demonstrated that interferon (IFN) has an inhibitory effect on bone formation. Changes in bone metabolism were investigated in 19 patients treated for essential thrombocythemia with IFN-alpha. Serum biochemical parameters of bone remodeling [total alkaline phosphatase, osteocalcin, type-I procollagen carboxy-terminal propeptide (PICP), cross-linked telopeptide type-I collagen (ICTP)] and mineral metabolism (total calcium, inorganic phosphate, parathyroid hormone, 25-hydroxyvitamin D) were measured before and after long-term IFN-alpha treatment. The effects of the cumulative IFN-alpha dose and duration of therapy on biochemical markers of bone metabolism were analyzed. No uniform trend or pattern was observed in the measured biochemical parameters except for ICTP, which decreased after treatment. Correlations indicated modulation of bone metabolism, i.e. remodeling with suppression of resorption, as a consequence of therapy with IFN-alpha.