小儿原发性膀胱输尿管返流的诊断与手术治疗(附39例报告)

目的：总结小儿原发性膀胱输尿管返流（PVUR）诊治经验。方法：回顾分析PVUR39例的诊治资料,1例4月龄婴儿做膀胱造口,2例患侧及1例对侧并发肾发育异常者共做3例肾切除,1例上尿路正常者用药物治疗,余35例均行膀胱内、外的横向推进抗返流输尿管膀胱再植术。结果：35例（92％）术后效果满意,2例双侧病变者第一次手术仅做严重的一侧,术后尿内持续有脓细胞,复查时原对侧Ⅰ、Ⅱ度返流增重,经再次手术治愈。1例手术后仍不能挖掘尿路感染,经患肾穿刺造瘘后好转。结论：外科矫治PVUR（Ⅳ-Ⅴ）的手术成功率,双 侧病变一期完成双侧手术。6月龄以内的PVUR（Ⅳ-Ⅴ）应做膀胱造口,周岁后应考虑抗返流的输 尿管膀胱再植术。     

Linkage of Gitelman syndrome to the thiazide-sensitive sodium-chloride cotransporter gene with identification of mutations in Dutch families

Gitelman syndrome is a mostly autosomal recessive disorder affecting the renal tubular function associated with hypokalemia and hypomagnesemia. Functional studies point to a defect in the distal renal tubule in the thiazide-sensitive, electroneutral sodium-chloride cotransporter (TSC). Based upon the localization of a 2.6 cDNA encoding the human TSC to chromosome 16q13, polymorphic markers spanning the region from 16p12 to 16q21 were tested for linkage to the Gitelman syndrome locus in three Dutch families with autosomal recessive inheritance of this disorder. Using two-point linkage analysis, a maximum LOD score (Z_max of 4.49 (at Θ = 0.00) was found for the marker D16S408. One crucial recombination event places the Gitelman syndrome locus distal to D16S419 at 16q12-13. Subsequently we have tested our group of Gitelman patients for mutations in the human TSC gene. Two mutations were identified in three Gitelman families. Our study confirms that the human TSC gene is involved in Gitelman syndrome. Patients from three Gitelman families reveal two identical human TSC mutations, suggesting these families share a common ancestor. Received April 19, 1996; received in revised form and accepted May 24, 1996     

Conservative treatment and anti-reflux surgery in adults with vesico-ureteral reflux: effect on urinary-tract infections, renal function and loin pain in a long-term follow-up study.

STUDY PURPOSE: To investigate the long-term effects in adults of conservative treatment and anti-reflux surgery for vesico-ureteral reflux on urinary-tract infections, renal function, and loin pain. METHODS: Of 115 adult patients with vesico-ureteral reflux diagnosed between 1968 and 1984, conservative treatment was given to 46 patients (36 women) and anti-reflux surgery was performed in 57 patients (52 women). The remaining 12 patients underwent nephrectomy or heminephrectomy and were excluded from the study. The anti-reflux surgical methods used were the Politano-Leadbetter procedure in 44 patients (73 ureters) and the Hutch procedure in 19 patients (25 ureters). Six of these patients were operated on with both methods. RESULTS: The frequency of acute pyelonephritis was significantly reduced after anti-reflux surgery (P < 0.0001) as well as after diagnosis of vesico-ureteral reflux in the group given conservative treatment (P or < 0.001). The frequency of lower-urinary-tract infections was not altered in either group. Surgery had no effect on significant albuminuria (Albustix > or = 2+) or on progressive renal functional deterioration. Forty-three patients reported recurrent loin pain at the time of diagnosis or anti-reflux surgery. Only one of the 12 patients in the conservative group, compared with 29 of the 31 patients in the anti-reflux surgery group, obtained relief from loin pain during the follow-up. Nine patients in the anti-reflux surgery group reported restitution of reduced general well-being after surgery. These patients had experienced weariness and/or headache before surgery. Vesico-ureteral reflux was eliminated more frequently (P < 0.01) in the patients operated on by the Politano-Leadbetter procedure (94%) than in those operated on by the Hutch procedure (68%). CONCLUSIONS: Loin pain is common in adults with vesico-ureteral reflux and is effectively eliminated by anti-reflux surgery. Anti-reflux surgery should be considered in adults with vesico-ureteral reflux and very frequent acute pyelonephritic attacks only if conservative treatment has failed to alleviate these symptoms. Anti-reflux surgery is not indicated with the aim of arresting renal functional deterioration.     

Pathology and Genetics of Diffuse Gliomas in Adults

The current World Health Organization (WHO) classification of tumors of the central nervous system (CNS) is essentially a lineage-oriented classification based on a presumable developmental tree of CNS. A four-tiered WHO grading scheme has been successfully applied to a spectrum of diffusely infiltrative astrocytomas, but it is not fully applicable to other gliomas, including oligodendrogliomas and ependymomas. Recent genetic studies have revealed that the major categories of gliomas, such as circumscribe astrocytomas, infiltrating astrocytomas/oligodendrogliomas, and glioblastoma, roughly correspond to major genetic alterations, including isocitrate dehydrogenases (IDHs) 1/2 mutations, TP53 mutations, co-deletion of chromosome arms 1p/19q, and BRAF mutation/fusion. These genetic alterations are clinically significant in terms of the response to treatment(s) and/or the prognosis. It is, thus, rational that future classification of gliomas should be based on genotypes, rather than phenotypes, although the genetic features of each tumor are not sufficiently understood at present to draw a complete map of the gliomas, and genetic testing is not yet available worldwide, particularly in Asian and African countries. This review summarizes the current concepts of the WHO classification, as well as the current understanding of the major genetic alterations in glioma and the potential use of these alterations as diagnostic criteria.     

Polymorphisms of four bone mineral density candidate genes in Chinese populations and comparison with other populations of different ethnicity

 Studies on polymorphisms of candidate genes and their association with bone mineral density (BMD) have been reported in many populations, but few have been reported in Chinese populations. We investigated polymorphisms of the following five commonly used markers of four prominent BMD candidate genes with the purpose of identifying useful genetic markers for osteoporosis genetic research in Chinese: the Sp1 and RsaI polymorphisms of the collagen type 1 alpha l (Col1a1) gene, the −174G/C promoter polymorphism of the interleukin 6 (IL-6) gene, the Asn363Ser polymorphism of the glucocorticoid receptor (GR) gene, and the T → C polymorphism in intron 5 of the transforming growth factor β₁ (TGF-β₁) gene. We evaluated these polymorphisms using PCR-RFLP in samples of at least 124 random individuals. We compared the polymorphisms of these five markers with other populations using the χ² test and Fisher's exact two-tailed test. For the RsaI polymorphism, only three heterozygotes but no variant homozygote were identified. For the −174G/C polymorphic site, only one GC heterozygote and no CC homozygote were found. Alleles s, Ser, and A ₁ at the Sp1, Asn363Ser, and T → C marker sites that have been found to be polymorphic in other populations were not found in Chinese. Significant differences of allele and genotype frequency distributions were observed at these polymorphisms (P < 0.001) after comparing with other populations. Our results suggest that variant alleles of the five markers are absent or too rare to be useful genetic makers in Chinese, despite the fact that they have been commonly used as polymorphic markers in osteoporosis genetic research in other populations. Received: April 22, 2002 / Accepted: July 2, 2002 Acknowledgments. The study was partially supported by the Hunan Province Special Professor Start-up Fund (25000612), Chinese National Science Foundation (CNSF) Outstanding Young Scientist Award (30025025), CNSF Grant (30170504), a grant from Huo Ying-Dong Education Foundation, and a Seed Fund from the Ministry of Education of P.R. China (25000106). Some investigators (R.R.R., V.D., H.W.D.) were partially supported by grants from the Health Future Foundation of USA, grants of National Health Institute (K01 AR02170-01, R01 GM60402-01A1), grants from the State of Nebraska Cancer and Smoking Related Disease Research Program, and U.S. Department of Energy grant (DE-FG03-00ER63000/A00). We thank all the study subjects for volunteering to participate in the study. Offprint requests to: H.-W. Deng     

Mutations in the <Emphasis Type="Italic">ROBO2</Emphasis> and <Emphasis Type="Italic">SLIT2</Emphasis> genes are rare causes of familial vesico-ureteral reflux

Familial clustering of vesico-ureteral reflux (VUR) suggests that genetic factors play an important role in the pathogenesis of this condition. The SLIT2 protein and its receptor, ROBO2, have key functions in the formation of the ureteric bud. Two recent studies have found that ROBO2 gene missense mutations are associated with VUR. In the study reported here, we investigated the genetic contribution of the SLIT2 and ROBO2 genes in non-syndromic familial VUR by mutation screening of 54 unrelated patients with primary VUR. Direct sequencing of all 26 exons and the exon–intron boundaries revealed six ROBO2 gene variants, two of which were new. Direct sequencing of all 37 exons and the exon–intron boundaries identified 20 SLIT2 gene variants, two of which were new. One variant, c.4253C > T, which was found in two families, leads to an amino acid substitution in a relatively well-conserved amino acid, p.Ala1418Val, which was predicted to cause an altered secondary structure but to have little impact on the three-dimensional structure. This missense variant did not segregate with VUR in these two families and was not found in 96 control subjects. We conclude that gene variants in ROBO2 and SLIT2 are rare causes of VUR in humans. Our results provide further evidence for the genetic heterogeneity of this disorder.     

Testosterone enanthate therapy is effective and independent of SRD5A2 and AR gene polymorphisms in boys with micropenis

PURPOSE: We report penile length (PL) responses to testosterone enanthate (TE) therapy for micropenis, and the relevance of the V89L polymorphism of SRD5A2 encoding the 5alpha-reductase type 2 and CAG repeat length polymorphism of AR encoding the androgen receptor. MATERIALS AND METHODS: A total of 53 Japanese boys with micropenis (less than -2.0 SD) 0 to 13 years old who had no SRD5A2 or AR mutation were examined. TE was given at a dosage of 25 mg intramuscularly, and PL was measured at least 4 weeks after the injection. The 2 polymorphisms were determined by direct sequencing. RESULTS: PLs became -2.0 SD or greater in all the boys after TE therapy (1 injection in 4 boys, 2 in 28, 3 in 19 and 4 in 2), with a significant increase in the medians of PLs (from 2.5 to 3.5 cm, p <0.0001) and SD score, (from -2.6 to -0.7, p <0.0001). The increment in actual PL at the first injection ranged from 0.2 to 1.5 cm (median 0.6) and was independent of age (r = 0.22, p = 0.12) and body surface area (r = 0.11, p = 0.43), while that in PL SD score at the first injection ranged from 0.3 to 2.5 (1.0) and was inversely correlated with age (r = -0.33, p = 0.02) and body surface area (r = -0.37, p = 0.008). The actual PL increment at the first injection was also unrelated to initial PL (r = -0.03, p = 0.81). The median of actual PL increments at the first injection was similar among boys with V/V, V/L and L/L genotypes of SRD5A2 (0.6 cm in 18, 0.7 cm in 30 and 0.5 cm in 5, respectively, p = 0.77), and between boys with and without long CAG repeats (26 or greater) of AR (0.65 cm in 6 and 0.6 cm in 47, respectively, p = 0.77). In addition, there was no significant correlation between actual PL increment at the first injection and CAG repeat length (r = 0.06, p = 0.67). CONCLUSIONS: Our results suggest that administration of 25 mg TE is effective for micropenis in prepubertal boys with no SRD5A2 or AR mutation, with variable but significant PL increments, and that the penile responsiveness to TE therapy is independent of the V89L and the CAG repeat length polymorphisms.     

The cumulative incidence of significant gastroesophageal reflux in patients with congenital diaphragmatic hernia-a systematic clinical, pH-metric, and endoscopic follow-up study

Background

Gastroesophageal reflux (GER) is common in patients with congenital diaphragmatic hernia (CDH). Gastroesophageal reflux may occur early after the primary repair of CDH and require antireflux surgery (ARS). It is unknown how many patients will be severely affected later on. We conducted an objective long-term follow-up for the cumulative incidence of CDH-associated GER based on symptoms, pH-metry, and histology.

Materials and Methods

From March 1990 to July 2006, we admitted 33 newborn patients with CDH. Twenty-six patients (79%) (male 13, left-sided 21) survived. Extracorporeal membrane oxygenation was required in one patient and patch closure in 10 patients. The follow-up consisted of assessment of GER symptoms at 6 months, 1 year, 3 years, 5 years, and 10 years; endoscopy; and pH-metry for all patients at 1 year and to selected patients (with symptoms or complications of GER) from 3 to 10 years after the primary closure of CDH. Gastroesophageal reflux was considered significant (sGER) when a symptomatic patient required ARS, had endoscopic biopsies showing at least moderate esophagitis, or total and preprandial reflux index of more than 10% and 5%, respectively.

Main Results

The incidence of sGER (patients with sGER/total amount assessed) at 6 months, 1 year, 3 years, 5 years, and 10 years was 27% (7/26), 42% (11/26), 53% (8/15), 53% (8/15), and 55% (5/9), respectively. During a median follow-up of 60 months (range, 12-195 months), 12 (46%) of 26 patients had sGER and 4 (15%) required ARS. After the assessment at 1 year, only one new case of sGER appeared. Endoscopic and/or pH-metric assessment covered 100% of the patients at 1 year follow-up, but later on only 70%.

Conclusion

One year after the primary closure of CDH, the incidence of sGER was 42%. After 1 year follow-up, only one new case of sGER was found, and ARS was not required. In patients who required ARS manifested before 6 months.     

Differential excretion of urinary proteins in children with vesicoureteric reflux and reflux nephropathy

We studied 40 children with a history of vesicoureteric reflux (VUR) without evidence of renal scarring, 93 children with a history of VUR and renal scarring and 10 children with previous urinary tract infections in whom the urinary tract was radiologically normal. Urine retinol-binding protein (RBP), albumin andN-acetyl--d-glucosaminidase (NAG) were measured in each child. All were free from infection at the time of the analysis. Urinary RBP and NAG levels were significantly elevated (P<0.001) in the group of children with renal scarring. Elevated RBP levels were detected in 51% of children with bilateral renal scarring compared with 7% of children with unilateral scarring. Urine RBP excretion increased progressively according to the type of scarring, best determined by the type of scarring of the less affected kidney. In children with renal scarring, elevated NAG levels were seen mostly in the 65 children with bilateral scarring and severe reflux. Urine albumin excretion was elevated in 10 children, 9 with bilateral scarring, all of whom had elevated RBP excretion. Urine protein excretion was unaffected by the presence or absence of persisting VUR. There was a strong negative correlation between glomerular filtration rate and RBP excretion (r=–0.69). We conclude that evidence of tubular dysfunction is common in children with bilateral renal scarring and usually precedes any glomerular protein leak. Tubular dysfunction may be the consequence of relative nephron hyperperfusion in the presence of bilateral scarring.     

图像处理和人工神经网络在肺癌细胞病理诊断中的应用

目的探求基于计算机图像处理和人工神经网络的“肺癌早期细胞病理电脑诊断系统”（lung cancer diagnosing system，LCDS）在肺癌临床细胞病理诊断中的应用价值。方法运用LCDS对512例经皮肺穿刺标本的细胞学涂片进行检测评判和综合分析，并对其中手术治疗的362例进行LCDS细胞病理诊断与术后组织病理诊断对比分析研究。结果LCDS能运用图像处理和专家系统完成对肺部病灶癌细胞和非癌细胞的识别诊断，进而运用人工神经网络能完成肺鳞癌、腺癌、小细胞癌等主要病理类型的细胞病理诊断，与临床组织病理或细胞病理诊断结果对比，总符合率为91．80％。其中362例接受外科手术者以术后组织病理诊断结果为标准，LCDS检测诊断的敏感性为94．79％（291／307例），特异性为90．91％（50／55例），准确性为94．20％（341／362例）。结论LCDS所采用的诊断模型是实用而有效的，具有诊断准确率高、易于操作培训等优势，有可能为肺癌早期细胞病理诊断提供又一实用有效的手段。     

Comparative study between trapezium resection and tendon interposition with and without ligamentplasty in the management of carpometacarpal arthrosis of the thumb

Purpose

Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty; arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are currently the most used in this treatment.

Methods

A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tenoarthroplasty) — 22 cases — and tenoarthroplasty associated to ligament plasty—24 cases. Objective evaluation was done by measuring opponence, movements of the metacarpophalangeal joint, pinch and grasp strength, radiographic measurement of the distance between the base of first metacarpal and the scaphoid, and measurement of the angle between the first and the second metacarpals. Subjective evaluation was done with a DASH questionnaire, visual analog scale to evaluate pain and patient satisfaction.

Results and conclusion

After application of the criteria described and using Student ‘t’ tests for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple resection and tendon interposition in carpometacarpal arthrosis of the thumb.     

FUT+FUE治疗大面积脱发60例

目的:探索一种治疗大面积脱发的理想方法。方法:分别用FUT(follicle unit transplantation)技术切取梭形头皮条,用FUE(follicle unit extraction)技术于枕部散在提取毛囊,然后分离毛囊周围多余组织,用宝石刀在脱发区打孔后,用移植笔将分离好的毛囊植入脱发区。结果:60例通过本方法治疗的患者均达到了理想的植发效果。结论:FUT+FUE治疗大面积脱发是一种较理想的方法,值得推广。     

Obesity and Gastroesophageal Reflux: Quantifying the Association Between Body Mass Index, Esophageal Acid Exposure, and Lower Esophageal Sphincter Status in a Large Series of Patients with Reflux Symptoms

Introduction  Obesity and gastroesophageal reflux disease (GERD) are increasingly important health problems. Previous studies of the relationship between obesity and GERD focus on indirect manifestations of GERD. Little is known about the association between obesity and objectively measured esophageal acid exposure. The aim of this study is to quantify the relationship between body mass index (BMI) and 24-h esophageal pH measurements and the status of the lower esophageal sphincter (LES) in patients with reflux symptoms. Methods  Data of 1,659 patients (50% male, mean age 51 ± 14) referred for assessment of GERD symptoms between 1998 and 2008 were analyzed. These subjects underwent 24-h pH monitoring off medication and esophageal manometry. The relationship of BMI to 24-h esophageal pH measurements and LES status was studied using linear regression and multiple regression analysis. The difference of each acid exposure component was also assessed among four BMI subgroups (underweight, normal weight, overweight, and obese) using analysis of variance and covariance. Results  Increasing BMI was positively correlated with increasing esophageal acid exposure (adjusted R ² = 0.13 for the composite pH score). The prevalence of a defective LES was higher in patients with higher BMI (p < 0.0001). Compared to patients with normal weight, obese patients are more than twice as likely to have a mechanically defective LES [OR = 2.12(1.63–2.75)]. Conclusion  An increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI. An erratum to this article can be found at     

Replicative study of GWAS TP63C/T,TERTC/T,and SLC14A1C/T with susceptibility to bladder cancer in North Indians

ObjectiveGenome-wide association studies have confirmed association of TP63C/T rs710521, TERTC/T rs2736098, and SLC14A1C/T rs17674580 gene variants with susceptibility to bladder cancer (BC) in European and White population. However, the risk conferred for BC for above gene variants in North Indians is unknown. We therefore, studied the association of TP63C/T, TERTC/T, and SLC14A1C/T single nucleotide polymorphisms (SNPs) with a risk of BC susceptibility in North Indian cohort.Material and methodsIn histologically confirmed 225 BC cases and 240 healthy controls, 3 SNPs were genotyped by real-time polymerase chain reaction. To evaluate the SNP effects on BC susceptibility, odds ratio (OR) and CI 95% were calculated.ResultsIn case of TP63C/T, the variant genotype (TT) showed significant reduced risk for BC (P = 0.045, OR = 0.53). Combining heterozygous and variant genotypes also demonstrated reduced risk for BC (P < 0.001, OR = 0.54). In case of TERTC/T, heterozygous genotype (CT) as well as variant genotype (TT) showed significant risk for BC susceptibility (P = 0.031, OR = 1.77 and P = 0.004, OR = 2.78, respectively) along with T allelic level (P<0.001, OR = 4.19). Furthermore, in case of SLC14A1C/T gene polymorphism, the variant genotype (TT) showed significant high risk for BC susceptibility (P = 0.006; OR = 3.01) along with variant T allelic level (P = 0.003, OR = 1.52). Interestingly, smoking was also found to modulate risks for BC in case of TERT and SLC14A1 variant genotype (TT). Further clinical confounding factor, namely, tumor grade/stage level of cases, supports the genotypic data with TERT and SLC14A1 showing a risk for BC susceptibility.ConclusionOur results suggested that polymorphism in TERTC/T and SLC14A1C/T confirmed high risk for BC in North Indian population. However, TP63C/T showed reduced risk of BC susceptibility. More replicate studies with large sample size and diverse ethnicity are required to validate these observations.     

严重烧伤患者早期短程应用高效抗生素的研究

目的探讨早期短程应用高效抗生素对严重烧伤后患者感染的防治效果。方法烧伤患者35例,烧伤面积50％～95％。根据高效抗生素使用时机分为早防组(20例,伤后6h内开始)和迟防组(15例,伤后48h开始)。动态检测血浆内毒素(lipopolysaccharide,LPS)、肿瘤坏死因子(TNFα)和白细胞介素-8(IL-8)的变化,严密观察脓毒症各项指标。结果大面积烧伤后血LPS、TNFα和IL-8明显升高,于伤后3～5d达高峰,但早防组明显低于迟防组(P＜0.05～0.001)。伤后2周内脓毒症、内脏并发症的发生率,早防组明显低于迟防组(P＜0.05);伤后4～7d痂下组织菌量,早防组明显低于迟防组(P＜0.01)。结论严重烧伤早期短程使用高效抗生素,能有效预防烧伤后感染,并可降低内脏并发症的发生。     

Differential expression of genes and receptors in monocytes from patients with cystic fibrosis

IntroductionWe previously reported defective alternative polarization (M2) of macrophages and early expression of classically polarized (M1) macrophage markers in unpolarized monocyte-derived macrophages (MDMs) in patients with cystic fibrosis (CF). The present study assessed whether the mechanism(s) underlying defective macrophage polarization resided in circulating monocytes.MethodsMonocyte subsets (classical, intermediate and non-classical), markers for monocyte activation (CD163) and recruitment (CD195), receptors/genes associated with macrophage differentiation and polarization were analyzed in CF and compared with healthy individuals.ResultsNo differences were observed in the monocyte subsets or in the expression of CD163 or CD195. Expression of the M-CSF receptor, TLR4, γC, IL-4Rα, IL-13Rα1, TIMP-1 and Cox-2 were higher in CF monocytes, albeit at low levels, whereas, LRP1, MMP9, MMP28 were downregulated compared to mooncytes from healthy individuals.ConclusionsOur data suggest that differences in CF monocytes may contribute to the reported CFTR-dependent defect in macrophage differentiation, polarization and function.     

岳阳地区50岁以上人群25经维生素D水平及其与骨密度的关系

目的 通过测定269名岳阳地区50岁以上人群血清25经维生素D(25(OH)D)和骨密度(BMD)水平,分析岳阳地区50岁以上人群的维生素D ( VitD)状况,并探讨其与BMD的关系。方法 采集受试者的血清后,用电化学发光法测定血清25(OH)D水平,并同时应用双能X线吸收仪测定腰椎及髓部BMD。结果 所有受试者中,VitD严重缺乏者占24. 2 %,缺乏者占45. 0%,不足者占24. 5 %,充足者占6. 3。男、女性受试者的25(OH)D水平、腰椎及髓部的BMD间有统计学差异(P<0.001),男性高于女性。男性各年龄段间25(OH)D水平及各部位BMD无统计学差异(P=0. 101 ,P = 0. 261 ,0. 055 ,0. 170 ,0. 108 ,0. 051 ) ;女性各年龄段之间25(OH)D水平及腰椎BMD无统计学差异(P = 0. 364 , 0. 063 ) ;髓部BMD有统计学差异(P < 0. 001 ),随着年龄的增长而逐步减低。男性受试者中,不同25(OH)D水平组间股骨颈、转子间区及整髓BMD无统计学差异(P = 0. 076 , 0. 425 , 0. 122 );腰椎、大转子区BMD水平间有统计学差异(P=0. 027 , 0. 017 ) , VitD充足组腰椎BMD高于其他各组(P = 0. 005 , 0. 025 , 0. 009 );不足组、严重缺乏组大转子区BMD高于缺乏组(P = 0. 021, 0. 005 )。女性受试者中,不同25(OH)D水平组各部位BMD均无统计学差异(P = 0. 616 , 0. 739 , 0. 559 ; 0. 608 , 0. 641)。结论 在湖南岳阳地区50岁以上人群存在严重的维生素D缺乏及不足;对于维生素D状况与骨密度之间可能无直接关联,需加大样本量进一步观察。     

中老年2型糖尿病患者肌少症相关因素研究

目的通过研究中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者肌少症(Sarcopenia)发生的危险因素,为预防和治疗肌少症提供思路。方法收集2018年5~11月于郑州大学第一附属医院内分泌科住院的289例中老年T2DM患者作为研究对象,以同期该院57名正常体检人群作为对照组,比较两组患者一般资料、血生化、HbA1c、肌力等指标的差异及两组肌少症的检出率。对两定量资料进行Pearson相关分析及Logistic回归分析,分析肌少症发生的危险因素。结果T2DM组中肌少症的检出率(22.83%)大于正常对照组(12.28%)(P<0.05)。T2DM组中,全身骨骼肌肌肉含量与体重、体质量指数(body mass index,BMI)、全髋部骨密度、腹部脂肪面积、25(OH)D3含量呈正相关,与空腹血糖、糖尿病病程呈负相关。低BMI、低全髋部骨密度、低25(OH)D3、长糖尿病病程是肌少症发生的危险因素。结论2型糖尿病患者是肌少症发生的危险人群,针对T2DM患者发生肌少症的相关危险因素采取干预措施,可减少跌倒、骨折、致残、致死事件的发生。