不同骨量状态下绝经后初诊2型糖尿病患者血清中MMP-2水平及意义

目的通过检测不同骨量状态下绝经后初诊2型糖尿病(type 2 diabetes mellitus,T2DM)女性患者血清中25羟维生素D[25-hydroxyvitamin D,25(OH)D]、基质金属蛋白酶2(matrix metalloproteinases-2,MMP-2)水平,初步探讨它们在T2DM合并骨质疏松发生发展过程中的作用及意义。方法收集2016年10月至2017年10月我院内分泌科住院的绝经后T2DM患者130例,据骨密度分3组:T2DM骨量正常组(A组45例)、T2DM骨量减少组(B组40例)、T2DM骨质疏松组(C组45例),收集同期我院体检中心年龄、性别相匹配的健康体检者为正常对照组(NC组50例)。采用酶联免疫吸附(ELISA)法测定所有受试者血清MMP-2。Pearson相关分析绝经后T2DM合并骨质疏松(osteoporosis,OP)患者血清MMP-2与各指标的相关性;Logistic回归分析绝经后T2DM患者骨密度的影响因素。结果 (1)A组与B组比较,25(OH)D、PINP、HDL-C水平明显升高,而MMP-2、β-CTX、BGP、Hb A1c、HOMA-IR明显降低,差异有统计学意义(P0.05),FBG、LDL-C、TC、TG、FINS、病程比较,差异无统计学意义(P0.05);(2)C组与NC组比较,MMP-2、FBG、Hb A1c、HOMA-IR、LDL-C、TG、TC、β-CTX水平明显升高,而25(OH)D、HDL-C、PINP、BGP明显降低,差异有统计学意义(P0.05)。结论绝经后T2DM合并骨质疏松患者血清中MMP-2、β-CTX、BGP水平明显升高,而25(OH)D、PINP水平明显减低,提示高水平的MMP-2及低水平的25(OH)D可能共同参与了绝经后T2DM合并OP的发生发展。     

绝经后2型糖尿病患者血清25(OH)D、Leptin与骨代谢的相关性

目的探讨绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)女性患者血清25-羟维生素D(25-hydroxyvitamin D,25(OH)D)、瘦素(leptin,LEP)水平与骨代谢之间的关系。方法选取遵义医学院附属医院内分泌科住院的绝经后T2DM女性患者130例,根据骨密度分为骨量正常组(A组,n=40)、骨量减少组(B组,n=45)和骨质疏松组(C组,n=45),同期选取50名健康绝经后女性作为空白对照组(NC组,n=50)。收集所有受试者临床资料及生化指标,测定血清25(OH)D、LEP、β-胶原降解产物(β-Crosslaps,β-CTX)、I型胶原N-端前肽(N-aminoterminal propeptide of type I collagen,PINP)及骨钙素(bone gla protein,BGP)水平。Spearmen相关分析绝经后T2DM合并骨质疏松症(osteoporosis,OP)患者血清骨代谢指标的相关因素分析;Logistic回归分析绝经后T2DM患者合并OP的影响因素。结果①与NC组比较,A、B、C三组中25(OH)D、PINP、BGP水平均明显降低,而LEP、β-CTX水平明显升高(P0.05);②与A组比较,B组、C组中25(OH)D、PINP水平均明显降低,而LEP、β-CTX、BGP水平明显升高(P0.05);③与B组比较,C组中25(OH)D、PINP水平均明显降低,而LEP、β-CTX、BGP水平明显升高(P0.05);Spearmen相关分析显示,血清25(OH)D与PINP呈正相关,与β-CTX呈负相关,与BGP无明显相关性;血清LEP与PINP呈负相关,与β-CTX、BGP无关;Logistic回归分析显示BMI、HbA1c、25(OH)D、LEP、PINP与β-CTX均是绝经后T2DM患者合并骨质疏松的独立危险因素。结论血清25(OH)D水平的降低及LEP水平的升高,可能共同参与了绝经后T2DM女性患者OP的发生发展。     

血清Omentin-1水平与2型糖尿病并发骨质疏松症的相关性研究

目的探讨血清网膜素-1(Omentin-1)与2型糖尿病(T2DM)并发骨质疏松症的关系。方法选取30例T2DM伴骨质疏松患者(T2DM+OP组),30例T2DM不伴骨质疏松患者(T2DM组),30例正常健康体检者(正常组)。酶联免疫吸附试验(ELISA)法测定血清Omentin-1、RANKL、OPG、OCN、TRAP-5b水平,并测定空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)等指标;BMD采用双能X线吸收骨密度仪扫描腰椎(L1-L4)检测。结果 1血清Omentin-1水平在T2DM+OP组(31.90±2.95)μg/L、T2DM组(37.85±4.52)μg/L均明显低于正常人组(39.91±4.24)μg/L,T2DM+OP组较T2DM组明显降低(P0.05)。2血清Omentin-1与OCN、OPG呈正相关(P0.01),与FPG、Hb A1c、FINS、胰岛素抵抗指数(HOMA-IR)、RANKL及RANKL/OPG比值呈负相关(P0.01)。3Omentin-1是2型糖尿病骨质疏松的保护因素,而HOMA-IR及TRAP-5b为危险因素。结论血清网膜素-1在2型糖尿病并发骨质疏松的过程中逐渐降低,且伴有RANKL/OPG、TRAP-5b的增高。     

绝经后2型糖尿病患者Irisin水平分析

目的通过检测绝经后初诊2型糖尿病(type 2 diabetes mellitus,T2DM)不同骨量人群血清中鸢尾素(Irisin)、25羟维生素D[25-hydroxyvitamin D,25(OH) D]水平,初步探讨其在绝经后初诊糖尿病患者骨量流失过程中的作用及意义。方法选取在遵义医科大学院附属医院内分泌科住院的绝经T2DM女性病人150例,根据骨密度(bone mineral density,BMD)分为T2DM骨量正常组(A组,50例)、T2DM骨量减少组(B组,50例)、T2DM骨质疏松组(C组,50例),收集同期医院体检中心相匹配的绝经后健康女性体检者为正常对照组(NC组,50例)。采用酶联免疫吸附法(enzyme linked immunosorbent assay,Elisa)测定所有受试者血清Irisin水平。运用Pearson相关分析绝经后T2DM合并骨质疏松(osteoporosis,OP)患者血清Irisin与25(OH) D的相关性;通过Logistic回归分析绝经后T2DM病人骨密度的影响因素。结果 A组与B组相比,BMD(Neck,L1～4)、Irisin升高,LDL-C、FINS、Hb A1c、FPG、HOMA-IR明显降低,差异均具有统计学意义(P0. 05); Pearson相关分析显示,Irisin与Hb A1c、FPG、FINS、HOMA-IR、LDL-C均呈负相关,与BMD(Neck、L1～4)、25(OH) D呈正相关。结论血清中Irisin、25(OH) D水平随着骨量流失而逐渐减低,推测其可能共同参与了绝经后女性发生糖代谢紊乱及骨量流失的过程。     

2型糖尿病合并骨质疏松患者外周血中VDR mRNA表达与25(OH)D、甘油三酯的关系研究

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并骨质疏松(osteoporosis,OP)患者血浆中维生素D受体(vitamin D receptor,VDR)mRNA表达水平与25羟维生素D[25 hydroxyvitamin D,25(OH)D]、甘油三酯(triglyceride,TG)的关系。方法选取2016年6月至2017年5月就诊于遵义医科大学附属医院内分泌科门诊及住院治疗的初诊2型糖尿病患者100例,据骨密度(bone mineral density,BMD)测定结果分为:单纯T2DM组48例,T2DM合并骨质疏松组(T2DM+OP组)52例;选取遵义医科大学体检中心年龄及性别相匹配的健康对照者(NC组)90例。采用电化学发光法检测血清25(OH)D水平,全自动生化分析仪检测TG,采用实时荧光定量聚合酶链反应(Real Time-PCR)检测外周血中VDR mRNA表达水平。结果T2DM+OP组与单纯T2DM组相比,血浆中25(OH)D水平降低[(8.76±3.21)～(12.46±4.35) ng/mL,t=32.423,P=0.000],VDR mRNA表达水平降低[(0.35±0.12)～(1.07±0.23),t=15.365,P=0.001],而TG水平升高[(4.1±1.26)～(2.98±0.56) mmol/L,t=11.765,P=0.000];Pearson相关分析结果显示,血浆中VDR mRNA表达与25(OH)D水平呈正相关(相关系数r=0.717,P0.05),与HbAlc、HOMA-IR、Fins、FPG、2hPG、TG呈负相关(相关系数r分别为-0.342、-0.353、-0.361、-0.546、-0.426、-0.342,P0.05)。结论外周血中VDR mRNA表达、25(OH)D水平降低及TG水平的升高可能共同参与了T2DM、骨质疏松的发生发展。     

不同骨量状态下2型糖尿病患者外周血中PPAR-γmRNA表达水平及意义

目的 检测不同骨量状态下初诊2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清中骨保护素(osteoprotegerin,OPG)、25羟维生素D [25-hydroxyvitamin D,25(OH)D]水平及外周血单核细胞过氧化物酶体增殖物激活受体γ (peroxisome proliferator activated receptor gamma,PPARγ) mRNA表达,探讨它们在T2DM合并骨质疏松(osteoporosis,OP)发生发展过程中的作用及意义。方法 收集2017年2月至2018年1月于我院内分泌科住院的T2DM患者135例,根据骨量分为三组：T2DM骨量正常组(A组,45例)、T2DM骨量减少组(B组,45例)、T2DM骨质疏松组(C组,45例),收集同期我院体检中心年龄、性别相匹配的健康体检者为正常对照组(NC组,45例)。实时荧光定量PCR (real time PCR)法检测外周血PPAR-γ mRNA的表达。Pearson相关分析T2DM合并OP患者PPAR-γ mRNA水平与各指标的相关性;Logistic回归分析T2DM患者骨量的影响因素。结果 A组与B组相比,25(OH)D、PINP、HDL-C水平明显升高,而PPAR-γ mRNA、OPG、β-CTX、HbA1c、HOMA-IR明显降低,差异有统计学意义(P＜0.05)。外周血中PPAR-γ mRNA表达与25(OH)D、PINP、HDL-C呈负相关,与β-CTX、HbAlc、HOMA-IR、OPG水平呈正相关。Logistic回归分析示,PPAR-γ mRNA、β-CTX、HbAlc、OPG是T2DM患者合并骨质疏松的独立危险因素。结论 外周血中PPAR-γ mRNA表达升高及血清25(OH)D的降低,可能共同参与了糖尿病及骨质疏松的发生发展。     

不同骨量状态下初诊2型糖尿病患者外周血中PPAR-γmRNA表达水平及意义

目的检测不同骨量状态下初诊2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清中骨保护素(osteoprotegerin,OPG)、25羟维生素D [25-hydroxyvitamin D,25(OH)D]水平及外周血单核细胞过氧化物酶体增殖物激活受体γ(peroxisome proliferator activated receptor gamma,PPARγ) mRNA表达,探讨它们在T2DM合并骨质疏松(osteoporosis,OP)发生发展过程中的作用及意义。方法收集2017年2月至2018年1月于我院内分泌科和骨科住院的T2DM患者135例,根据骨量分为三组:T2DM骨量正常组(A组,45例)、T2DM骨量减少组(B组,45例)、T2DM骨质疏松组(C组,45例),收集同期我院体检中心年龄、性别相匹配的健康体检者为正常对照组(NC组,45例)。通过实时荧光定量PCR (real time PCR)法检测外周血PPAR-γmRNA的表达。Pearson相关分析T2DM合并OP患者PPAR-γmRNA水平与各指标的相关性;Logistic回归分析T2DM患者骨量的影响因素。结果 A组与B组相比,25(OH)D、PINP、HDL-C水平明显升高,而PPAR-γmRNA、OPG、β-CTX、HbA1c、HOMA-IR明显降低,差异有统计学意义(P0.05)。外周血中PPAR-γmRNA表达与25(OH)D、PINP、HDL-C呈负相关,与β-CTX、HbAlc、HOMA-IR、OPG水平呈正相关。Logistic回归分析示,PPAR-γmRNA、β-CTX、HbAlc、OPG是T2DM患者合并骨质疏松的独立危险因素。结论外周血中PPAR-γmRNA表达升高及血清25(OH)D的降低,可能共同参与了糖尿病及骨质疏松的发生发展。     

维持透析时间对腹膜透析患者CKD-MBD的影响

目的 对维持腹膜透析患者的骨代谢指标进行横断面调查,并探讨腹膜透析时间对腹膜透析患者慢性肾脏疾病矿物质骨代谢异常(Chronic kidney disease-mineral and bone disorder,CKD-MBD)的影响.方法 以60例腹膜透析患者和30例健康体检者(对照组)作为研究对象,腹膜透析患者分为A组(腹膜透析时间＜24个月)和B组(腹膜透析时间≥24个月),比较各组间骨代谢指标,如血钙,血磷,25-羟维生素D3[25-hydroxyl vitamin D3,25 (OH) D3]、血清全段甲状旁腺素(intact parathyroid hormone,iPTH)和骨碱性磷酸酶(bone alkaline phosphatase,BALP)的变化.结果 与对照组相比,腹膜透析组的血磷升高,血钙降低且差异具有统计学意义(P1.40±0.29mmol/L vs 1.75±0.57mmol/L;Ca 2.33±0.19mmol/L 2.02±0.2mmol/L,P＜0.叭),iPTH,25 (OH) D3,BALP具有显著性差异[iPTH 436.41±368.28pg/mL vs 53.31±23.71pg/mL;25(OH)D3199.28±139.52ng/mL vs 36.04±14.17ng/mL;BALP80.24±39.41ng/mL vs 173.76±52.38ng/mL,P＜0.01].腹膜透析患者一项或多项骨代谢指标异常的发生率为100％.与对照组相比,A组、B组的血钙降低,血磷升高,且具有统计学意义;但A组与B组的血钙、血磷水平差异无统计学意义(P＞0.05).与对照组相比,A组、B组的iPTH显著升高(53.31±23.71pg/mL vs 596.57±449.91 pg/mL & 276.25±148.23pg/mL,P＜0.05);25(OH)D3显著减低[173.76±52.38ng/mL vs 58.99±25.79ng/mL & 101.48±39.67ng/mL,P＜0.05],A组BALP明显减低(36.04±14.18ng/mL vs 264.58±114.24ng/mL);与A组相比,B组的iPTH升高,25(OH)D3降低,BALP降低,且差异均具有统计学意义(BALP:133.97±133.90ng/mL vs 264.58±114.24ng/mL,P＜0.05).结论 腹膜透析患者存在明显的矿物质骨代谢异常.随着腹膜透析时间的增加,骨转化类型可能会发生变化,由于常规行骨活检较困难,需动态的检测患者的骨代谢血清学指标来辅助判断骨转化类型.腹膜透析患者矿物质骨代谢异常的治疗方案需根据骨转化类型进行调整.     

2型糖尿病视网膜病变合并骨质疏松患者血清25(OH)D与Betatrophin的关系

目的探讨2型糖尿病视网膜病变(type 2 diabetes mellitus retinopathy,T2DR)合并骨质疏松(osteoporosis,OP)患者血清25羟维生素D[25-hydroxy vitamin D,25(OH)D]与Betatrophin之间的关系。方法选取2016年11月-2017年9月在我院内分泌科就诊的2型糖尿病(Type 2 Diabetes Mellitus,T2DM)患者100例,通过非散瞳眼底检查将T2DM患者分为并发DR组35例和非DR组65例,再据骨密度测定结果将DR组分为合并骨质疏松组(T2DM+DR+OP组)15例及非骨质疏松组(T2DM+DR组)20例,将非DR组分为合并骨质疏松组(T2DM+OP组)25例及非骨质疏松组(T2DM组)40例。同期随机筛选健康体检中心不同年龄健康受试者60例为正常对照(normal control,NC)组。酶联免疫吸附(ELISA)法测定所有受试者血清中Betatrophin水平,电化学发光法测定25(OH)D水平。结果与非骨质疏松的2型糖尿病视网膜病变患者相比,合并骨质疏松的2型糖尿病视网膜病变患者血清25(OH)D水平降低,Betatrophin水平升高,差异具有统计学意义(P0.05)。结论血清中25(OH)D水平降低及Betatrophin水平升高,可能共同参与了2型糖尿病视网膜病变、骨质疏松的发生发展。     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.