哺乳期血清钙碱性磷酸酶尿钙排泄率及骨密度的测定与分析

目的 探讨哺乳对骨量及钙代谢的影响。方法 对未哺乳衰乳不同时间的６０例产后妇女，于产后３天及３、６、１２个月，测量腰椎骨密度，同时测定血清钙、碱性磷酸酶、尿钙排泄率。结果 哺乳导致腰椎骨密度降低（Ｐ〈０．０１），并与哺乳时间有关。碱性磷酸酶在孕晚期增高（Ｐ〈０．０１），血钙尿钙排泄率无变化。结论 哺乳排钙增加时主要运用了骨钙，而维持了血钙稳定。指导哺乳妇女掌握合理的哺乳时间和合理补钙，以减少骨丢失     

孕期不同钙摄入量对孕产妇钙代谢的影响

目的　研究孕期不同钙摄入量对孕产妇钙代谢的影响。方法　 36名孕妇通过膳食指导和监测按钙摄入量水平随机分为传统膳食组、膳食钙干预组和膳食加钙剂联合干预组 ,对孕产期有关钙代谢指标、骨钙素及产后 45天骨密度监测。结果　血清钙磷各期各组间无差异 ( P>0 .0 5) ,随孕期进展钙吸收率、钙贮留量、血清碱性磷酸酶和尿羟脯氨酸增加 ,孕末期达高峰 ,产后下降 ;骨钙素也增加 ,产后仍增加 ;粪钙和尿钙降低 ,产后粪钙略增加而尿钙明显降低。母体腰椎骨密度组间差异显蓍 ( P<0 .0 1 )。钙摄入量与尿钙、钙贮留量和骨钙素呈正相关 ( r>0 .53,P<0 .0 1 ) ,与钙吸收率呈负相关 ( r=- 0 .51 ,P<0 .0 1 )。结论　我国传统膳食导致孕期低钙摄入情况下 ,母体虽可通过降低尿钙和粪钙的排泄 ,增加肠道钙吸收率和骨钙动员等调节 ,维持胎儿钙需要和自身血钙稳定 ,产生对摄入低钙的适应 ,但这种适应是有限的 ,不能达到较高钙贮留来满足妊娠期钙需要 ,对自身骨健康和代谢有一定影响 ,因此孕期应强调富钙食物、钙剂和 VD的补充     

小儿脑性瘫痪钙与骨密度监测临床研究

目的:了解脑瘫患儿钙代谢水平及骨密度变化情况。方法:测定80例脑瘫患儿与正常儿童血钙、BALP及骨密度(BMD)。结果:脑瘫患儿血钙与对照组无差异(P>0.05),血清BALP显著高于对照组(P=0.01),骨密度明显低于对照组(P<0.05)。结论:脑性瘫痪患儿骨密度降低,骨碱性磷酸酶在脑瘫患儿中明显升高,表示脑瘫患儿骨矿化不足。     

产后早期骨密度及骨代谢的变化

[目的]探讨产后早期骨密度与骨代谢的变化及其原因。[方法]产后3～7d妇女25例,对照组30例,用双能X线骨密度仪测定L1～L4椎体及左髋部股骨颈、沃氏区、股骨粗隆的骨密度,测血钙(Ca)、尿钙/肌酐(Ca/Cr)比值、尿羟脯氨酸/肌酐(HY/Cr)比值,分别计算各组数值进行比较。[结果]产后早期妇女腰椎L1的骨密度显著低于对照组,差异有统计学意义(P﹤0.05),L2～L4骨密度与对照组相比差异无统计学意义(P﹥0.05)。髋部各部位的骨密度均低于对照组,差异有统计学意义(P﹤0.05)。产后早期妇女血钙低于对照组,差异有统计学意义(P﹤0.05),尿钙/肌酐(Ca/Cr)比值与尿羟脯氨酸/肌酐(HY/Cr)比值高于对照组,差异有统计学意义(分别P﹤0.05,P﹤0.01)。[结论]产后早期妇女存在不同程度的骨量降低及骨代谢异常。     

骨密度联合骨碱性磷酸酶测定对出院后早产儿代谢性骨病的诊断价值

目的探讨骨密度联合骨碱性磷酸酶对出院后早产儿代谢性骨病的诊断价值。方法选取2017年3月—2018年9月于宝鸡市妇幼保健院儿保科就诊的早产儿98例为研究对象,依据是否患有代谢性骨病分为疾病组(21例)与正常组(77例),同时选择同时期在院进行体检的健康足月新生儿40例为对照组,比较3组新生儿的骨密度、骨碱性磷酸酶、血钙及血磷水平变化,采用接受者操作特性曲线(ROC)分析早产儿骨密度及骨碱性磷酸酶对其出院后发生代谢性骨病预测诊断价值。结果与对照组相比,疾病组、正常组新生儿出生时体质量、身长、胎龄、血钙、血磷及骨密度Z值均降低(P<0.05),而骨碱性磷酸酶增加(P<0.05);与正常组相比,疾病组新生儿的血钙、血磷及骨密度Z值均明显降低(P<0.05),骨碱性磷酸酶含量增加(P<0.05),而出生时胎龄、体质量及身长比较差异无统计学意义(P>0.05);ROC曲线分析结果显示,骨密度Z值联合骨碱性磷酸酶对早产儿出院后代谢性骨病预测诊断的ROC曲线下面积(AUC)为0.902明显高于骨密度Z值、骨碱性磷酸酶单独预测诊断的AUC(0.732、0.841),差异有统计学意义(P<0.05);logistic回归分析结果显示骨密度Z值<-0.83、骨碱性磷酸酶评分≥2.95分是早产儿出院后发生代谢性骨病的独立危险因素。结论超声骨密度联合骨碱性磷酸酶检查对出院后早产儿代谢性骨病的预测诊断价值高于其单一诊断价值。     

经产妇产后早期股骨近端骨密度研究

目的:探讨分娩次数、累计哺乳时间、此次分娩与前次分娩间隔时间及有无补钙对经产妇骨密度及骨代谢的影响。方法:准确记录2007年1月～2009年1月在广西医科大学第四附属医院产检及分娩的120例经产妇的年龄、身高、体重、有无症状,采用双能X线全身骨密度测定仪测定其产后早期股骨近端骨密度,检测尿钙(Ca)、肌酐(Cr)、血碱性磷酸酶(ALP),分别比较分娩次数、孕期补钙、分娩间隔时间及累计哺乳时间等对经产妇骨密度及骨代谢的影响。结果:①随着分娩次数增加,骨量减少发生率逐渐增加,差异有统计学意义;②近两次妊娠间隔时间大于4年者的股骨近端骨密度值较妊娠间隔小于4年者高,差异有统计学意义;③累计哺乳时间超过12个月者的骨密度显著降低,差异有统计学意义;④孕早期开始持续补钙的孕妇其股骨颈骨密度高于未持续补钙者,骨形成指标血ALP、骨吸收指标尿Ca/Cr低于未持续补钙者,差异有统计学意义。结论:随着分娩次数增加,骨量减少发生率增加。对于妊娠间隔时间短、哺乳时间长者,通过双能X线骨密度仪监测早期股骨近端骨密度值,并联合骨代谢生化指标指导适当延长妊娠间隔时间及合理补钙,可预防孕产妇骨量减少及骨质疏松的发生。     

重组人甲状旁腺素(1-34)对绝经后妇女骨质疏松症治疗的有效性及对骨代谢标志物水平的影响

目的观察重组人甲状旁腺素(1-34)[rhPTH(1-34)]联合凯思立D(碳酸钙D3咀嚼片)对绝经后妇女骨质疏松症(PMOP)的骨密度和骨代谢标志物的影响。方法将57例PMOP患者随机分为试验组和对照组,试验组皮下注射rhPTH(1-34)20μg每日1次治疗,对照组肌肉注射降钙素20 IU每周1次治疗。2组均给予凯思立D1片/日(每片含元素钙500 mg和维生素D3 200 IU),试验时间6个月。测定每组治疗前后腰椎L2~4、股骨颈骨密度、骨代谢物血钙、血磷及骨源性碱性磷酸酶(BALP)、血清Ⅰ型胶原交联C末端肽(CTX)等指标。结果试验组腰椎BMD治疗后较治疗前明显增加,差异有统计学意义(P0.01);对照组腰椎骨密度治疗前后比较差异无统计学意义(P0.05),组间比较差异无统计学意义(P0.05)。而2组股骨颈骨密度的变化治疗前后比较均无统计学差异(P0.05),组间比较差异无统计学意义。试验组CTX和BALP治疗后均较治疗前明显上升(P0.01)。而对照组CTX治疗后比治疗前下降(P0.05),BALP在治疗后较治疗前明显升高(P0.01)。结论重组人甲状旁腺素(1-34)能明显增加腰椎骨密度,升高骨转换指标,治疗绝经后妇女骨质疏松症安全有效。     

小剂量利维爱短期治疗对绝经后妇女骨质疏松的临床疗效观察

目的:探讨小剂量利维爱短期(3个月)治疗绝经后骨质疏松的临床效果。方法:应用利维爱治疗绝经后骨质疏松妇女45例,剂量为1.25mg/d,持续3个月。于用药前后观察包括血钙(Ca)、磷(P)、碱性磷酸酶(ALP)和尿Ca/Cr比值以及腰椎及股骨上端骨密度。结果:服用利维爱3个月后,腰椎及股骨上端骨密度较用药前显著增加(P<0.05),尿Ca/Cr比值显著下降(P<0.05)。结论:小剂量利维爱短期(3个月)治疗可有效预防绝经后骨质疏松。     

"生长痛"患者骨密度与血钙、磷及碱性磷酸酶研究

目的探讨生长痛与钙营养的关系.方法检测生长痛患者骨密度及血钙、磷、碱性磷酸酶.结果生长痛患者中骨密度比峰值减少13%～24%者及比峰值减少25%以上者(即骨质疏松者)分别占26%和63%,表明生长痛患者普遍存在骨钙营养不良;但血钙正常,甚至偏高,90%生长痛患者钙磷乘积大于40,90%患者碱性磷酸酶增高,提示其骨基质形成活跃及钙沉积过程正常.结论生长痛是一种骨钙营养不良,骨矿物质含量下降引起的骨痛;其钙沉积过程不存在障碍,可能是钙营养不良,钙沉积量长期存在不足所致;骨密度检查可作为其灵敏确诊手段.     

久正骨筋胶囊替代雌激素治疗骨质疏松症的实验研究

目的:观察中药久正骨筋胶囊对绝经后骨质疏松症(PMO)的影响,寻找一种能替代雌激素类药物的中药制剂,以避免雌激素治疗绝经后骨质疏松的副作用。方法:将雌性大鼠去卵巢后复制成PMO动物模型,并随机分为6组:即高、中、小剂量久正骨筋胶囊组、阴性对照组、尼尔雌醇组和假手术组。灌胃给药后,测定骨钙素(BGP)、血清钙、血清磷及骨源性碱性磷酸酶水平,测定大鼠腰椎(L3)和股骨的骨密度。结果:高剂量组较去卵巢组腰椎、股骨骨密度显著增加(P<0.05);骨源性碱性磷酸酶(BALP)与骨钙素(BGP)测定:久正骨筋胶囊低、中、高剂量组明显低于去卵巢组(P<0.05),但高于尼尔雌醇组(P<0.05)。结论:久正骨筋胶囊可以在一定程度上促进血钙向骨的沉积,抑制骨吸收,从而能在一定程度上治疗绝经后骨质疏松,但不及雌激素作用强。     

大豆异黄酮和钙对去卵巢大鼠骨密度及微量元素的影响

目的 :探讨大豆异黄酮和钙对去卵巢大鼠的骨密度及微量元素的影响。方法 :2 8只雌性SD大鼠随机分为假手术组、去卵巢组、去卵巢补钙组 [5 0mg/ (kg·d) ]和去卵巢加大豆异黄酮组 [大豆异黄酮 10 0mg/ (kg·d) ],10周后测骨密度和骨矿物含量及血清、尿液和骨骼钙、锌、铜、铁含量。结果 :实验结束后 ,去卵巢后大鼠的骨密度和骨矿物含量、骨骼钙、锌、铜、铁和血清锌、铁显著下降 ,血清钙、铜、ALP及尿钙、铜、铁显著性增高(P <0 0 1和P <0 0 5 ) ;与单纯去卵巢组比 ,大豆异黄酮组大鼠的骨密度、骨矿物含量、血清锌 ,骨骼中钙、锌、铜显著升高 ,血清钙、铜、ALP及尿钙、铜显著性下降 (P <0 .0 1和P <0 .0 5 ) ,而补钙组各指标都无显著性意义。结论 :大豆异黄酮可预防去卵巢大鼠骨钙、锌、铜丢失 ,预防骨质疏松。     

Bone mineral density and calcium metabolism of Hong Kong Chinese postpartum women--a 1-y longitudinal study

OBJECTIVE: This paper reports longitudinal changes in bone mineral density (BMD), calcium homeostasis and dietary calcium intake in a group of Hong Kong breastfeeding women during the first year postpartum. DESIGN AND SUBJECTS: Nine mothers who breastfed exclusively or almost exclusively for at least 3 months and 14 formula feeding mothers aged 20-40 y were interviewed after delivery, 2 and 6 weeks, 3, 6 and 12 months postpartum. BMD at L2-L4 lumbar spine (LS), trochanter (Tro) and femoral neck (FN), serum intact parathyroid hormone (iPTH), serum bone-specific alkaline phosphatase (b-ALP), urinary deoxypyridinoline (Dpd), serum and urinary calcium (Ca) and phosphorus (P) and dietary intake of macronutrients were assessed. RESULTS: Compared to the formula feeding group, BMD assessed at LS, Tro and FN decreased significantly in the breastfeeding group over the first 6 months, with rebound to approximate baseline values at 12 months for the latter two sites. Serum iPTH increased in both groups, whereas serum b-ALP was consistently higher in the breastfeeders. Urinary Ca and P excretion decreased early postpartum in both groups, but the breastfeeders had higher excretion at 3 and 6 months. Breastfeeding mothers consumed significantly more Ca than the formula feeding mothers in the early postpartum. CONCLUSIONS: Increased calcium requirement during early lactation is affected through mobilisation of bone and renal calcium conservation. Bone mineral loss during lactation is temporary. Further studies are warranted to investigate the effects of diet and other hormonal factors on the calcium homeostasis during lactation.     

口服碳酸钙制剂对孕产妇骨密度的影响

目的探讨孕产妇补充碳酸钙制剂对其骨密度的影响。方法36例孕第一胎妇女从孕20周开始通过膳食、膳食干预及碳酸钙补充摄入不同剂量的钙至产后45天。监测并比较孕中、孕末及产后期的血钙、碱性磷酸酶、尿羟脯氨酸、骨钙素及产后骨密度的差异。结果(1)传统膳食加40g／d奶粉补充的孕产妇产后骨密度虽优于传统膳食组,但明显低于奶粉加碳酸钙组;(2)奶粉加碳酸钙补充组的产妇腰椎骨密度明显高于奶粉组和传统膳食组,并维持至正常非常非孕同龄妇女的水平;(3)奶粉加碳酸钙补充组在孕末期、产后期的碱性磷酸酶活性、尿羟脯氨酸水均明显低于传统膳食组而骨钙素含量明显高于传统膳食组。结论(1)我国传统膳食钙摄入量约450mg／d,孕期的低钙摄入可导致产后骨密度下降;(2)孕期在传统膳食基础上补充40g奶粉／d,可使其产后骨密度优于传统膳食组,但不能维持骨密度至正常的水平;(3)奶粉加碳酸钙的联合补充,可使孕产妇产后骨密度明显高于传统膳食组和奶粉补充组,并维持其骨密度至正常水平。     

植物异黄酮对更年期妇女骨密度和骨代谢血清生化指标的影响

目的:研究植物异黄酮(葛根异黄酮和大豆异黄酮)对更年期妇女骨密度和骨代谢生化指标的影响。方法:将96例身体健康的更年期女性随机分为5组,安慰剂组、钙儿奇-D组、葛根异黄酮组、大豆异黄酮组和钙儿奇-D+大豆异黄酮组。服药3个月后,比较各处理组用药前后血清钙(Ca)、血清碱性磷酸酶(ALP)、骨钙素(BGP)和骨密度(BMD)等指标的变化情况。结果:服药后血清Ca有升高的趋势,其中钙儿奇-D和葛根异黄酮组的血清Ca比服药前显著升高(P<0.05);服药后血清ALP葛根异黄酮和大豆异黄酮组有上升趋势;服药后血清BGP(除了安慰剂组)各组有增加的趋势,其中钙儿奇-D组的血清BGP明显增加。结论:植物异黄酮可以使更年期妇女血清Ca升高,使血清ALP和BGP处于较活跃的水平。     

Effects of taurine supplementation on bone mineral density in ovariectomized rats fed calcium deficient diet

Taurine supplementation has been shown to have a beneficial effect on femur bone mineral content in ovariectomized rats. It therefore seemed desirable to find out whether the beneficial effect of taurine on ovariectomized rats fed calcium deficient diet could also be reproduced. Forty female Sprague-Dawley rats were divided into two groups. One group was OVX and the other group received sham operation (SHAM), and received either control diet or a taurine supplemented diet for 6 weeks. All rats were fed on calcium deficient diet (AIN-93: 50% level of calcium) and deionized water. Bone mineral density (BMD) and bone mineral content (BMC) were measured in spine and femur. The serum and urine concentrations of calcium and phosphorus were determined. Bone formation was measured by serum osteocalcin and alkaline phosphatase (ALP) concentrations. Bone resorption rate was measured by deoxypyridinoline (DPD) crosslinks immunoassay and corrected for creatinine. Urinary calcium and phosphorus excretion, osteocalcin in blood and cross link value were not significantly different among the groups. Within the OVX group, the taurine supplemented group had not higher femur bone mineral content than the control group. This study established the need for a study on the taurine effect on bone with different calcium levels.     

剖宫产术后镇痛对乳汁分泌及新生儿的影响

目的:测定剖宫产术后镇痛产妇乳汁、血清、尿液及新生儿尿液中镇痛药物含量,观察术后镇痛对乳汁分泌和新生儿的行为的影响。方法:选择88例足月妊娠剖宫产产妇,随机分为3组,曲马多静脉镇痛组(A组,n=34),吗啡硬膜外镇痛组(B组,n=34),空白对照组(C组,n=20)。采用高效液相色谱仪和质谱仪测定剖宫产术后24 h产妇乳汁、血清和尿液中以及新生儿尿样中镇痛药物含量。观察产妇开始泌乳和新生儿开始睁眼时间,记录48 h新生儿哺乳次数、呼吸和心率。结果:A组术后乳汁中未能检测出曲马多含量,34例新生儿术后24 h尿样中有3例检测出曲马多,检出率仅为8.82%。B组34例产妇乳汁中有7例检测出吗啡,检出率仅为20.6%,34例新生儿尿样中有3例检测出吗啡,检出率仅为8.82%。与C组相比,A、B两组产后开奶时间、泌乳时间和哺乳次数均有显著性差异(P<0.05);A、B两组新生儿的呼吸、心率和睁眼时间均无显著差异(P>0.05)。结论:剖宫产术后镇痛能促进乳汁分泌,镇痛药物吗啡和曲马多都能通过乳汁进入新生儿的体内,但进入新生儿体内的药量甚微,达不到有效血药浓度,故对新生儿无不良影响。     

Effect of training mode and calcium intake on bone mineral density in female master cyclist, runners, and non-athletes

The focus of this prospective, observational study was to determine the effect of sport-specific training and calcium intake on bone mineral density (BMD) in female master cyclists, runners and non-athletes. Thirty women (12 cyclists, 9 runners, 9 controls), mean age of 49.6 +/- 7.9 years, were assessed at baseline and 18 months for calcium intake (4-day records), current exercise activity (recall questionnaire), and BMD of the lumbar spine and hip (DXA). A three (cyclists, runners, controls) by two (0 and 18 months) repeated measures ANOVA demonstrated a significant interaction effect of sport and time at the femoral neck (p <.04). Tukey post hoc analysis indicated that the BMD of the femur was maintained in cyclists and runners but declined in controls (p <.05). A significant time effect was noted in BMD at the lumbar spine (p <. 001) and the trochanter (p <.003). BMD of the lumbar spine was maintained in runners but declined in cyclists (p <.007) and in controls (p <.03), while trochanteric BMD declined in all groups (p <.01). No significant interaction effect of sport and dietary calcium intake was noted for BMD at any site.     

Influence of maternal bone lead burden and calcium intake on levels of lead in breast milk over the course of lactation

The authors studied 367 women who were breastfeeding their infants in Mexico City, Mexico, between 1994 and 1995 to evaluate the effect of cumulative lead exposure, breastfeeding practices, and calcium intake on breast milk lead levels over the course of lactation. Maternal blood and breast milk lead levels were measured at 1, 4, and 7 months postpartum. Bone lead measurements were obtained at 1 month postpartum. At 1, 4, and 7 months postpartum, respectively, the mean breast milk lead levels were 1.4 (standard deviation (SD), 1.1), 1.2 (SD, 1.0), and 0.9 (SD, 0.8) microg/liter and showed a significant decreasing trend over the course of lactation (p < 0.00001). The relations of bone lead and blood lead to breast milk lead were modified by breastfeeding practice, with the highest breast milk lead levels among women with a high level of patella lead who were exclusively breastfeeding. Dietary calcium supplementation increased the rate of decline in breast milk lead by 5-10%, in comparison with a placebo, over the course of lactation, suggesting that calcium supplementation may constitute an important intervention strategy, albeit with a modest effect, for reducing lead in breast milk and thus the potential for exposure by infants.     

Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes

BACKGROUND: Adolescent mothers may be at increased risk of irreversible bone loss during pregnancy and lactation, particularly when calcium intake is low. OBJECTIVE: Longitudinal changes in bone mass from lactation to postweaning were evaluated in 10 adolescent mothers aged 15-18 y who habitually consumed <500 mg Ca/d. DESIGN: Total-body bone mineral content (TBBMC), total-body bone mineral density (TBBMD), and lumbar spine bone mineral density (LSBMD) were measured at lactation (6-24 wk postpartum) and after weaning (12-30 mo postpartum). Serum hormones (intact parathyroid hormone, estradiol, and prolactin), serum calcium, and markers of bone turnover [urinary N-telopeptide cross-linking region of type I collagen (NTx) and plasma activity of bone alkaline phosphatase] were measured at lactation. RESULTS: TBBMC, total calcium content, TBBMD, and LSBMD increased from lactation to postweaning (P < 0.01). TBBMD and LSBMD were, respectively, 3.6% and 9.7% lower than predicted at lactation and 0.3% and 4.8% lower than predicted in the postweaning period. The increase in age-matched TBBMD adequacy was correlated with the time after resumption of menses (r = 0.86, P < 0.01). Calcium accretion from lactation to postweaning correlated negatively with estradiol (r = -0.86) and prolactin (r = -0.69) and positively with intact parathyroid hormone (r = 0.72) and NTx (r = 0.84) measured at lactation (P < 0.05). CONCLUSIONS: It appears that adolescent mothers with habitually low calcium intakes recover from lactation-associated bone loss after weaning. The rate of bone accretion, however, may not be sufficient to attain peak bone mass at maturity. Hormones regulating bone turnover during lactation may influence bone recovery in adolescent mothers.     

晚期妊娠妇女与所生婴儿骨矿含量相关关系的研究

本文86对母婴骨矿含量(BMC)及血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、总蛋白(TP)、白蛋白(ALB)的对应研究,测定结果显示:母婴骨矿含量测定的一级数据BMC、骨宽(BW)无明显正相关,而二级数据骨密度(BMC/BW)的相关系数为0.288(P<0.01),两者呈高度正相关。在母婴骨密度相关性方面,BMC/BW比BW、BMC灵敏。孕母的BMC/BW,能灵敏反映婴儿骨矿化程度,可作为判断胎儿宫内生长发育的指标之一;血清Ca、ALP、TP的相关系数分别为0.326、0.229、0.445,两者均呈正相关。表明孕母血清Ca、ALP、TP的含量,直接影响胎儿血清内的含量,孕母营养物质摄入不足,会直接影响胎儿的宫内发育。