中老年男性雄激素部分缺乏综合征患者的骨密度改变及其影响因素的研究

目的 探讨中老年男性雄激素部分缺乏综合征（partial androgen deficiency in the aging male,PADAM）患者的骨密度（bone mineral density,BMD）特点及其影响因素.方法 采用双能X线骨密度仪（dual energy X-ray absorptiometry,DEXA）测定186例中老年PADAM患者和125例年龄、体重指数（body mass index,BMI）相匹配的健康中老年人的腰椎及股骨颈骨密度,收集相关生化、性激素及骨代谢指标,并对其与年龄、身高、体重、BMI、性激素水平及部分骨代谢指标进行多元逐步回归分析.结果 （1）PADAM组患者腰椎BMD与健康对照组差异无统计学意义（P＞0.05）,但股骨颈各部位BMD均较健康对照组明显降低[Neck：（0.831±0.136）g/cm2 vs（0.954±0.143）g/cm2,Ward＇s：（0.712±0.127）g/cm2 vs（0.811±0.149）g/cm2,Troch：（0.697±0.124）g/cm2 vs（0.764±0.131）g/cm2,P＜0.05）].（2）PADAM组及健康对照组骨量减少的发生率分别为48.9%、36%,骨质疏松的发生率分别为33.3%、20.8%.（3）PADAM患者腰椎BMD与BMI呈正相关;而股骨颈各部位BMD均与年龄呈负相关,与BMI、雄激素水平呈正相关（P＜0.05）.结论 PADAM患者股骨颈各部位骨密度明显降低.高龄、低体重指数和低雄激素水平为PADAM患者BMD降低的危险因素.     

海岛中老年男性部分雄激素缺乏综合征调查

目的了解海岛地区中老年男性部分雄激素缺乏综合征(PADAM)的患病分布情况。方法采用多级抽样的方法,选取舟山市定海区612名45岁以上中老年男性进行PADAM自我症状评定量表和外周静脉血雄激素水平测定。结果PADAM自我症状评定结果显示:中老年男性PADAM患病率为39.9%(95%可信区间:36.0%~43.8%),不同年龄组差别有统计学意义(P<0.05),且各类症状得分值均随年龄的增高而上升;激素水平测定结果显示:舟山海岛中老年男性PADAM患病率为30.7%(95%可信区间:27.1%~34.4%),除黄体生成素水平和性激素结合蛋白随年龄增加而升高以外,总睾酮、游离睾酮、游离睾酮指数等都随着年龄的增加而下降。结论舟山海岛中老年人PADAM的患病率较高,各年龄组间分布存在差异。     

舟山海岛中老年男性部分雄激素缺乏综合征(PADAM)调查研究

目的：了解海岛地区中老年男性部分雄激素缺乏综合征（PADAM）的患病分布情况.方法：采用多级抽样的方法,选取舟山市定海区612例45岁以上中老年男性进行外周静脉血雄激素水平测定,并根据相应判断依据进行PADAM的诊断并用二项分布原理进行人群患病的估计.采用方差分析或卡方检验等方法比较不同年龄的差异.结果：舟山海岛中老年男性PADAM患病率为30.72%（95%可信区间：27.06%～43.75%）,除黄体生成素水平和性激素结合蛋白随年龄增加而升高以外,总睾酮、游离睾酮指数等都随着年龄的增加而下降.结论：舟山海岛中老年人PADAM的患病率较高,各年龄组分布存在差异,今后应进一步加强对PADAM的研究,为提高中老年男性的身心健康和改善生活质量提供科学的依据.     

舟山海岛中老年男性部分雄激素缺乏综合征调查研究

目的了解舟山海岛地区中老年男性部分雄激素缺乏综合征(PADAM)的患病情况。方法对定海区612例45岁以上中老年男性进行PADAM自我症状评定和测定外周静脉血雄激素水平,测定包括总睾酮(TT)、游离睾酮(FT)、性激素结合蛋白(SHBG)、黄体生成素(LH),并根据相应判断依据进行PADAM的诊断。结果PADAM自我症状评定结果显示:体能加心血管症状平均得分为(4.74±0.48)分,精神心理症状平均得分为(3.72±0.19)分,性功能症状平均得分为(7.83±0.52)分,各类症状得分均随年龄的增高而上升。根据自我症状评定,39.87%的老年男性患有PADAM,其中60岁以上高达55.56%。激素水平测定结果显示:总睾酮、游离睾酮、游离睾酮指数随着年龄的增加而下降,性激素结合蛋白和黄体生成素随年龄的增加而上升。根据激素测定结果,舟山海岛中老年男性PADAM患病率为30.72%。结论舟山海岛中老年人PADAM的患病率为39.87%(通过PADAM自我评定量表判断)和30.72%(通过激素测定判断)。今后应进一步加强对PADAM的研究,真正地提高中老年男性的身心健康,改善生活质量。     

中老年男子体育锻炼与部分性雄激素缺乏综合征的关系

中老年男子部分性雄激素缺乏综合征(Partial androgen deficiency in the aging male,PADAM)系指中老年男性血清中雄激素水平下降和(或)靶器官对睾酮及其活性代谢产物敏感性降低为特征的一系列临床症状,属于男性更年期范畴。随着我国进入老龄化社会,本病发病逐年增多,我国部分地区调查发现PADAM在45岁以上中老年男性     

安特尔联合绒促性素治疗中老年男子部分性雄激素缺乏综合征的临床研究

目的探讨安特尔与绒促性素(HCG)对PADAM患者的临床疗效。方法将60例PADAM患者随机分为2组,观察组:安特尔联合HCG,对照组:单用安特尔。观察2组治疗前后PADAM症状评分变化;实验室检查;性功能状态变化。结果2组用药后,PADAM评分、实验室检查及性功能的变化表明观察组疗效显著优于对照组。2组用药后均无严重不良事件发生。结论安特尔与HCG联合用药除拥有与TST对PADAM相同的益处外,尚能够提高患者性生活质量。     

男子雄激素缺乏如何防治

过去习惯称为男子更年期综合征,现在医学上有了专有名词“PADAM”,即“中老年男子雄激素部分缺乏”。顾名思义,这是由于中老年男子体内雄激素水平与质量下降而导致的一种病况。主要有如下四方面症状：     

调查显示：四十岁男性一半有雄激素缺乏症状

最新公布的一份调查显示：在接受调查的四十岁以上的男性中;55.42%可能有雄激素缺乏症状。     

雄激素治疗男性慢性心力衰竭的临床研究

目的 探讨雄激素治疗男性慢性心力衰竭(CHF)的临床疗效.方法 选择男性CHF患者100例,采用机械抽样法随机分为治疗组和对照组,每组各50例.两组患者均给予常规综合治疗,治疗组用丙酸睾丸酮注射液50 mg/次,对照组用0.9%氯化钠溶液2 ml/次,每10 d肌肉注射1次,连续2个月.测定两组患者治疗前后血浆睾酮浓度、室间隔厚度(IVST)、左室舒张末期内径(LVEDd)、左室短轴缩短率(LVFS)和6 min步行试验(6MWT)的步行距离.结果 两组患者治疗前各项指标比较差异均无统计学意义.治疗后治疗组6MWT、血浆睾酮浓度和LVFS与治疗前比较明显增加[(413±18)m比(290±33)m、(11.0±1.2)μg/L比(5.5±1.8)μg/L、(42±10)%比(30±10)%],差异均有统计学意义(P<0.05),并且与对照组治疗后[分别为(329±37)m、(6.7±1.6)μg/L、(33±9)%]比较差异也有统计学意义(P<0.05).结论 补充雄激素后可提高患者的血浆睾酮水平,增加心肌收缩力,改善心脏功能,而对心脏结构无明显影响.补充雄激素是一种行之有效的男性CHF辅助治疗方法.     

定量超声骨密度测定诊断老年性骨质疏松的临床价值

目的探讨定量超声骨密度测定诊断老年性骨质疏松的临床价值。方法从我院近两年收治的骨质疏松症患者中随机抽取90例患者作为对象进行研究,患者均接受定量超声骨密度测定诊断,观察诊断结果。结果随着年龄增加,患者超声波传导速度(SOS)、超声波振幅衰减(BUA)及硬度指数(QUI)水平相应下降,不同年龄段患者水平比较存在显著差异(p<0.05);患者QUI下降程度明显大于SOS、BUA(p<0.05)。结论定量超声骨密度测定老年性骨质疏松价值显著,能够作为老年性骨质疏松早期诊断的方法。     

长春市2005例妇女骨密度调查报告

目的:调查长春市2005例妇女骨密度,为长春市女性骨密度正常值提供数据资料,对不同年龄妇女的骨密度变化进行统计分析,获得骨密度峰值(BMDg/cm2),T值百分比及骨质疏松(OP)发病率。方法:采用OsteometerMediTech公司生产的DTX-200骨密度仪对长春市2005例妇女进行骨密度测量,将测量结果按10岁为1年龄段分组,使用SPSS13.0软件进行统计分析。结果:①长春市女性骨密度峰值出现在30岁年龄段,40岁开始缓慢下降,60岁开始明显下降;②50～59岁年龄段骨质疏松发病率为14.74%,60～69岁年龄段发病率为51.25%,70～79岁年龄段发病率为74.42%,80～89岁年龄段发病率为86.11%。结论:女性骨质疏松的发生与绝经关系密切,60岁以后骨质疏松发病率呈递增趋势,不同年龄段骨质疏松发病率差异显著(P<0.01)。     

鹿骨粉治疗大鼠卵巢摘除后所致的骨质疏松

目的:探讨鹿骨粉对卵巢摘除后骨质疏松症(0P)大鼠骨微结构及骨矿物质的影响.方法:Wistar大鼠行双侧卵巢摘除术,采用X线摄片确认发生OP之后,将模型大鼠随机分为假手术组、模型组、鹿骨粉低剂量(200 mg/kg)组(鹿骨粉低剂量组)、鹿骨粉中剂量(400 mg/kg)组(鹿骨粉中剂量组)、鹿骨粉高剂量(800 mg/kg)组(鹿骨粉高剂量组)、葡萄糖酸钙(160 mg/kg)组(葡萄糖酸钙组).术后模型大鼠给药治疗4个月后,利用X线摄片观察骨质微结构,采用小动物成像仪获取股骨全段骨密度(BMD)值,应用生化分析仪及ELISA试剂盒检测血清中钙、镁、磷离子浓度以及碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶(TRACP)含量.结果:与模型组比较,鹿骨粉低剂量组、鹿骨粉中剂量组、鹿骨粉高剂量组和葡萄糖酸钙组股骨骨松质减少,骨密质和骨小梁增多,股骨各段BMD均增高,钙、镁离子浓度增高、磷离子浓度以及ALP、TRACP含量降低,差异有统计学意义(P＜0.05).结论:鹿骨粉改善卵巢摘除所致的骨质微结构及血清学指标的变化,提示其能够预防及治疗雌激素下降所致的OP.     

Development and internal validation of the male osteoporosis risk estimation score

PURPOSE We wanted to develop and validate a clinical prediction rule to identify men at risk for osteoporosis and subsequent hip fracture who might benefit from dual-energy x-ray absorptiometry (DXA).METHODS We used risk factor data from the National Health and Nutrition Examination Survey III to develop a best fitting multivariable logistic regression model in men aged 50 years and older randomized to either the development (n = 1,497) or validation (n = 1,498) cohorts. The best fitting model was transformed into a simplified scoring algorithm, the Male Osteoporosis Risk Estimation Score (MORES). We validated the MORES, comparing sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve in the 2 cohorts and assessed clinical utility with an analysis of the number needed-to-screen (NNS) to prevent 1 additional hip fracture.RESULTS The MORES included 3 variables—age, weight, and history of chronic obstructive pulmonary disease—and showed excellent predictive validity in the validation cohort. A score of 6 or greater yielded an overall sensitivity of 0.93 (95% CI, 0.85–0.97), a specificity of 0.59 (95% CI, 0.56–0.62), and an area under the ROC curve of 0.832 (95% CI, 0.807–0.858). The overall NNS to prevent 1 additional hip fracture was 279 in a cohort of men representative of the US population.CONCLUSIONS Osteoporosis is a major predictor of hip fractures. Experts believe bisphosphonate treatment in men should yield results similar to that in women and reduce hip fracture rates associated with osteoporosis. In men aged 60 years and older, the MORES is a simple approach to identify men at risk for osteoporosis and refer them for confirmatory DXA scans.     

Risk factors for low bone mineral density among a large group of Norwegian women with fractures

The objectives of this study were to determine factors related to fractures and bone mineral density (BMD) in a large group of Norwegian women. In a cross-sectional study, 3803 women aged 50–75, all with a history of fractures, were included in the study. BMD was measured with Dual energy X-ray absorptiometry at both hip (neck) and spine (L1–L4), while information on other factors thought to influence BMD were obtained through a questionnaire. In multivariate analysis, the strongest positive predictor of both hip and spine BMD was current body weight, while weight loss since the age of 25 and number of years since menopause were the strongest inverse predictors. In addition, use of cortisone and maternal history of fractures were associated with lower BMD, as was loss of height since the age of 25. Physical activity was positively correlated with BMD. These results show the complexity of factors involved in the etiology of osteoporosis, with several factors acting in synergism. This points to the need for multifactorial prevention strategies, which most effectively need to be instituted at an early age, before peak bone mass is achieved.     

Association between lifestyle habits and bone mineral density in Japanese juveniles

Objectives

We explored the relationship between bone mineral density (BMD) and lifestyle in juveniles to identify factors leading to higher peak bone mass and prevention of osteoporosis in later life.

Methods

Juveniles (1,364 students: 770 boys and 594 girls, aged 6–18 years) attending school in Hokkaido prefecture, Japan, were asked to complete a brief self-administered diet history questionnaire for 10-year-olds (BDHQ10y) providing information about personal history, lifestyle, and intake of nutritional elements. In addition, BMD and grip strength were measured. We analyzed the relationship between BMD and lifestyle factors.

Results

The difference in BMD for boys was larger among the junior and senior high school groups. The difference in BMD for girls was larger among older elementary and later school children. Anthropometric variables and grip strength were strongly correlated with BMD. Having a nap-time routine was significantly correlated with BMD, but sleep time and sports club activities were not. BMD among juveniles who attained secondary sexual characteristics was significantly higher than that of juveniles of the same age who had not attained these characteristics. Calcium intake was significantly lower in senior high school students compared with other grades. Consumption of milk by senior high school boys and junior high school girls was weakly correlated with BMD.

Conclusions

Our findings encourage educational interventions to counsel students to avoid weight loss and calcium deficiency. This effective intervention should begin before the higher elementary school, when juveniles have the greatest likelihood for preventing lower peak bone mass and osteoporosis.     

阿仑膦酸钠治疗老年女性骨质疏松性桡骨远端骨折的临床效果及其对骨代谢和骨密度的影响

目的 探讨阿仑膦酸钠治疗老年女性骨质疏松性桡骨远端骨折的临床效果及其对骨代谢和骨密度的影响.方法 选择老年女性骨质疏松性桡骨远端骨折患者90例,按照随机数字表法分为治疗组和对照组,每组45例,两组均于行外固定支架术后第3天开始口服药物治疗,对照组给予口服维D钙治疗,治疗组给予阿仑膦酸钠联合维D钙治疗,两组疗程均为6个月.检测两组患者治疗前后的骨密度和骨代谢生化指标[骨碱性磷酸酶(BALP)、抗酒石酸盐酸性磷酸酶异构体5b(TRACP-5b)],评价两组腕关节功能.结果 治疗组和对照组治疗前骨密度分别为(0.472±0.157)、(0.519±0.173)g/cm2,差异无统计学意义(P＞0.05);治疗后分别为(0.893±0.298)、(0.571±0.184) g/cm2,治疗组骨密度显著升高,与治疗前和对照组治疗后比较差异均有统计学意义(P＜0.05);而对照组治疗前后比较差异无统计学意义(P＞0.05).治疗组和对照组治疗前BALP、RACP-5b水平分别为(53.76±17.92)、(5.61±1.87) U/L和(51.86±17.29)、(5.54±1.85) U/L,差异无统计学意义(P＞0.05);治疗后分别为(38.04±11.89)、(4.02±1.26) U/L和(47.21±14.75)、(5.64±1.76) U/L,治疗组患者BALP、TRACP-5b水平显著下降,与治疗前和对照组治疗后比较差异均有统计学意义(P＜0.05);而对照组治疗前后比较差异无统计学意义(P＞0.05).治疗组患者腕关节功能评估优良率为91.1％(41/45),显著高于对照组的51.1％(23/45),差异有统计学意义(x2=17.524,P＜0.01).结论 阿仑膦酸钠具有抑制骨吸收和促进骨形成的作用,并能促进老年女性骨质疏松性桡骨远端骨折患者术后腕关节功能的恢复.     

Effect of dietary calcium deficiency on bone matrix-induced ectopic bone

The effect of dietary depletion of calcium on collagenous bone matrix-induced ectopic bone was studied, following thirty days of deficiency. While the molar ratio of phosphorus and calcium did not exhibit any significant differences between the control and experimental groups, individual concentrations of these minerals showed significant reduction in the ossicles derived from experimental rats. A concomitant decrease and increase in urinary excretion of calcium and phosphate was noted in the calcium deficient group; the serum levels of these parameters, however, were not affected. Both hexosamine and hydroxyproline levels appeared higher in calcium deficient ossicles. A significant elevation of alkaline and acid phosphatase as well as aryl sulfatase was observed in calcium deficient ossicles. There appeared to be no difference between control and experimental rats in the rate of calcification as measured by ⁴⁵Ca uptake. These results suggest that dietary deficiency induces significant resorption of ectopic bone without altering mineralization capacity. It is suggested that matrix-induced ectopic bone may be used as a suitable experimental model to study pathophysiology of bone loss under various experimental conditions.     

老年骨质疏松患者服用钙加维生素D后骨密度及生化指标的改变

目的了解补充钙和维生素D对骨丢失和骨转换的影响。方法对31例门诊原发性骨质疏松症和骨量减少患每日服用1片碳酸钙和维生素D复合剂(每片含元素钙600mg和维生素D125IU),连服6个月。治疗前后检测腰椎骨密度(BMD)、骨矿含量(BMC)及骨转换生化指标。结果碳酸钙和维生素D复合剂每日1片能明显改善骨质疏松引起的腰背疼和腿痛性痉挛,有明显疗效。可以维持腰椎骨密度,明显增加男性腰椎骨矿含量( 2．7％),与治疗前比较,明显提高血清250HD( 13．8％)和BGP(％29．5％),减少尿HOP／Cr比值(-17．5％)。结论老年人每天1片碳酸钙和维生素D复合剂对防止骨丢失,改善维生素D的营养状态,促进骨形成和抑制骨吸收有一定作用。