硫酸脱氢表雄酮与骨质疏松的关系及在临床中的应用

目的探讨血清硫酸脱氢表雄酮(dehyclroepiandrosterone sulfat DHEA-S)与性别差异和增龄性变化所引起的骨质疏松(osteoporosis OP)的关系。方法健康人群300例分为10组,分别为20~30岁、30~40岁、40~50岁、50~60岁、大于60岁男女性各30例;大于60岁糖尿病患者60例,分为两组,分别为男性女性各30例;大于60岁糖尿病合并OP患者60例,分为两组,分别为男性女性各30例,采用化学发光免疫分析法测定血清DHEA-S浓度。结果 (1)观察到健康人群组血清DHEA-S浓度随年龄增长而降低,同年龄组男性较女性浓度高(P0.05);(2)大于60岁糖尿病合并骨质疏松患者DHEA-S较同龄健康人群降低(P0.05);(3)大于60岁糖尿病合并骨质疏松患者较大于60岁糖尿病患者DHEA-S降低(P0.05)。结论DHEA-S浓度与年龄呈负相关,DHEA-S与增龄引起的骨质疏松密切相关,DHEA-S与糖尿病合并骨质疏松疾病有密切关系,以上两种疾病中血清DHEA-S浓度均明显降低。     

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。     

多囊卵巢综合征患者性激素结合球蛋白和硫酸脱氢表雄酮的相关性分析

目的 探讨多囊卵巢综合征（PCOS）患者血清硫酸脱氢表雄酮（DHEAS）与性激素结合球蛋白（SHBG）的关系。方法 检测了45例PCOS患者血清空腹胰岛素、睾酮、DHEAS与SHBG的浓度,20例正常育龄期妇女作为对照。结果 PCOS患者血清空腹胰岛素、睾酮水平明显较对照组高（P〈0.05）,其DHEAS与SHBG的浓度存在负相关关系（P〈0.05）。结论 PCOS患者由于高胰岛素血症导致循环血SHBG的减少,进而使性激素水平发生紊乱,使PCOS患者表现为高雄激素血症、DHEAS与SHBG呈负相关关系。肾上腺激素DHEAS参与了PCOS的发生。     

糖尿病患者血清硫酸脱氢表雄酮含量与大血管病变的关系

目的　探讨男性 2型糖尿病患者血清硫酸脱氢表雄酮 (DHEA- S)含量变化与大血管病变的关系。方法　用化学发光法测定 6 8例男性 2型糖尿病患者血清 DHEA- S含量 ,并与 30例年龄匹配的男性健康人对照。结果　糖尿病组 DHEA- S含量明显低于对照组 (P<0 .0 1) ,且这种下降在糖尿病并发大血管病变时更为显著 (P<0 .0 1)。 DHEA- S含量与甘油三酯 (TG)及低密度脂蛋白 (L DL)呈负相关 ,(P<0 .0 5 )。结论　男性 2型糖尿病患者血清硫酸脱氢表雄酮含量的降低可能与大血管病变的发生有关 ,其确切的发病机理有待研究     

动脉粥样硬化性血栓性脑梗死患者氧化低密度脂蛋白和硫酸脱氢表雄酮的临床研究

目的：研究动脉粥样硬化性血栓性脑梗死（ATCI）患者血清中氧化低密度脂蛋白（OX—LDL）、硫酸脱氢表雄酮（DHEA—S）的改变及其相关。方法：采用病例对照研究，应用ELISA竞争法和双抗体夹心法测定ATCI患者组和对照组血清OX—LDL、DHEA—S水平。结果：ATCI患者组血清OX—LDL水平高于对照组，DHEA—S水平低干对照组（均P〈0．01）；且ATCI组两者呈负相关（r=-0．338，P〈0．01），血清DHEA-S与梗死面积无关，血清OX—LDL水平与梗死面积有关。结论：血清中DHEA—S水平下降和OX—LDL水平升高可能与ATCI的发生发展相关。     

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100 mg、钙尔奇D 600 mg;对照组口服钙尔奇D 600 mg.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.     

慢性自发性荨麻疹患者血清维生素D、脱氢表雄酮硫酸酯水平与Th1/Th2细胞因子及免疫球蛋白的关系分析

目的探讨不同程度慢性自发性荨麻疹(CSU)患者血清维生素D、脱氢表雄酮硫酸酯(DHEA-S)水平与辅助性T(Th)1/Th2细胞因子、免疫球蛋白的关系及临床意义。方法选取北京京城皮肤医院2016年1月至2017年12月收治的137例CSU患者作为观察组,依据CSU病情分级将观察组分为轻度组(59例)、中度组(41例)、重度组(37例),选取同期该院体检健康者70例作为对照组。比较观察组与对照组、不同CSU病情分级患者血清25-羟基维生素D[25(OH)D]、DHEA-S、Th1/Th2细胞因子、免疫球蛋白水平。结果与对照组比较,观察组血清25(OH)D、DHEA-S、白细胞介素(IL)-2、干扰素(IFN)-γ水平较低,血清IL-4、免疫球蛋白(Ig)E、IgG水平较高(P<0.05)。轻、中、重度组血清25(OH)D、IL-2、IL-4、IFN-γ水平整体比较,差异无统计学意义(P>0.05);病情越重,血清DHEA-S水平越低,IgE、IgG水平越高(P<0.05)。CSU患者血清25(OH)D与IL-2水平呈正相关,与IL-4、IFN-γ水平呈负相关(P<0.05);CSU患者血清DHEA-S与IL-2、IFN-γ水平呈正相关,与IL-4、IgE水平呈负相关(P<0.05)。结论CSU患者血清维生素D水平的降低可能与Th1/Th2细胞失衡相关,血清DHEA-S水平的降低则可能与Th1/Th2细胞失衡及病情的进展相关,也可能与IgE介导的Ⅰ型变态反应相关。     

老年男性脱氢表雄酮水平与老年性疾病

目的:研究血清脱氢表雄酮(DHEA)水平与老年性疾病的关系。方法:565例老年男性,平均年龄79.99±7.73岁,检测其血清脱氢表雄酮水平,分析血清DHEA水平与一些老年性疾病的关系。结果:血清DHEA水平与年龄呈负相关(r=-0.37,P<0.01)。60～70岁年龄组老年人DHEA的平均浓度为9.78±3.85μmol/L,70～8()岁年龄组为3.12±2.32μmol/L,80岁及以上组为1.84±1.22μmol/L。糖代谢异常者血清DHEA浓度降低,在糖尿病或糖耐量无异常组血清DHEA浓度为1.62±1.20μmol/L,非糖尿病或糖耐量异常组血清DHEA浓度为2.63±2.22μmol/L,两组有显著差异。高血压病及高脂血症对DHEA的影响并不显著,高血压病组血清DHEA浓度为2.55±2.09μmol/L,非高血压病组血清DHEA浓度为2.17±1.86μmol/L;高脂血症组血清DHEA浓度为2.69±1.77μmol/L,非高脂血症组血清DHEA浓度为2.34±2.08μmol/L,两组之间均无显著差异。结论:DHEA与年龄密切相关,随着年龄的增加,血清DHEA浓度下降。糖尿病或糖耐量异常者DHEA水平较低,高血压病对DHEA水平影响不显著可能与药物因素有关。     

脱氢表雄酮在绝经后妇女中的作用

脱氢表雄酮（dehydroepiandrosterone,DHEA）是肾上腺及卵巢合成雌二醇及睾酮过程中的中间产物,在肾上腺硫酸化酶的作用下可生成硫酸脱氢表雄酮（dehydroepiandrosterone sulfate,DHEAS）,两者是人体内含量最多的类固醇激素。近年来其在绝经后妇女内分泌及维持健康状态中所起的作用受到关注,本文将对DHEA在绝经后妇女中作用的有关研究进展作一综述。     

Diurnal rhythm and effects of oral contraceptives on serum dehydroepiandrosterone sulfate (DHEAS) are related to alterations in serum albumin rather than to changes in adrenocortical steroid secretion

Dehydroepiandrosterone sulfate (DHEAS), which is of almost exclusive adrenal origin, is important for the androgen status in women and prepubertal children, and DHEAS assays are used in the investigation of hyperandrogenism. There are conflicting reports concerning a diurnal variation in serum DHEAS. Although of adrenocortical origin, serum DHEAS levels are decreased by oral contraceptives (OCs). DHEAS is strongly bound to serum albumin and has a very low metabolic clearance rate. The present study was performed in order to investigate whether a diurnal variation in serum DHEAS exists and, if so, whether this diurnal variation and the decreased DHEAS levels following OC use are related to alterations in adrenocortical steroids or to changes in serum albumin. Serum concentrations of DHEAS, dehydroepiandrosterone (DHEA), cortisol and albumin were determined in blood samples taken every half hour over a 24-h period in 10 healthy women before and during use of combined OCs. Significant and frequently synchronous diurnal variations in serum DHEAS and albumin were found before as well as during OC use. These variations were not synchronous with the diurnal variation in DHEA. OCs significantly decreased serum DHEAS and albumin levels. A multiple regression analysis showed changes in albumin to be the most decisive factor for the diurnal variation as and for OC-induced changes in DHEAS. Changes in serum DHEAS during the day and following OC use are related to alterations in its main binding protein, serum albumin, rather than to changes in adrenocortical steroid secretion.     

The prevalence of triggers in paediatric migraine: a questionnaire study in 102 children and adolescents

The prevalence and characterization of migraine triggers have not been rigorously studied in children and adolescents. Using a questionnaire, we retrospectively studied the prevalence of 15 predefined trigger factors in a clinic-based population. In 102 children and adolescents fulfilling the Second Edition of The International Headache Classification criteria for paediatric migraine, at least one migraine trigger was reported by the patient and/or was the parents’ interpretation in 100% of patients. The mean number of migraine triggers reported per subject was 7. Mean time elapsed between exposure to a trigger factor and attack onset was comprised between 0 and 3 h in 88 patients (86%). The most common individual trigger was stress (75.5% of patients), followed by lack of sleep (69.6%), warm climate (68.6%) and video games (64.7%). Stress was also the most frequently reported migraine trigger always associated with attacks (24.5%). In conclusion, trigger factors were frequently reported by children and adolescents with migraine and stress was the most frequent.     

Diurnal rhythm and effects of oral contraceptives on serum dehydroepiandrosterone sulfate (DHEAS) are related to alterations in serum albumin rather than to changes in adrenocortical steroid secretion

Dehydroepiandrosterone sulfate (DHEAS), which is of almost exclusive adrenal origin, is important for the androgen status in women and prepubertal children, and DHEAS assays are used in the investigation of hyperandrogenism. There are conflicting reports concerning a diurnal variation in serum DHEAS. Although of adrenocortical origin, serum DHEAS levels are decreased by oral contraceptives (OCs). DHEAS is strongly bound to serum albumin and has a very low metabolic clearance rate. The present study was performed in order to investigate whether a diurnal variation in serum DHEAS exists and, if so, whether this diurnal variation and the decreased DHEAS levels following OC use are related to alterations in adrenocortical steroids or to changes in serum albumin. Serum concentrations of DHEAS, dehydroepiandrosterone (DHEA), cortisol and albumin were determined in blood samples taken every half hour over a 24-h period in 10 healthy women before and during use of combined OCs. Significant and frequently synchronous diurnal variations in serum DHEAS and albumin were found before as well as during OC use. These variations were not synchronous with the diurnal variation in DHEA. OCs significantly decreased serum DHEAS and albumin levels. A multiple regression analysis showed changes in albumin to be the most decisive factor for the diurnal variation as and for OC-induced changes in DHEAS. Changes in serum DHEAS during the day and following OC use are related to alterations in its main binding protein, serum albumin, rather than to changes in adrenocortical steroid secretion.     

儿童及青少年失眠的临床特征及治疗研究概况

儿童及青少年是生命历程的关键阶段,许多有助于确定当前和未来健康结果的行为模式在此间得以确立,儿童及青少年精神卫生保健至关重要。儿童及青少年失眠受青春期生理发育、学校及家庭等社会环境、心理行为等多种因素影响,囊括了入睡困难、睡眠时间不足、睡眠质量差和日间困倦等一系列症状,明显影响其精神状态和生活学习质量。儿童及青少年失眠的治疗方法以睡眠卫生教育、认知行为治疗和正念冥想等综合治疗为主。笔者从失眠的相关成因、症状和治疗方法3个方面对儿童及青少年失眠作一综述,为其临床诊疗提供参考。     

福州市儿童青少年体质指数与血压的相关性分析

目的分析福州市7¹8岁儿童青少年体质指数与血压的相关性,为开展相关的健康教育、健康促进提供基线资料。方法随机抽取福州市2个城区中等水平的小学和中学各一所,从各年级每个年龄段随机抽取至少20人,男女各半,共调查718岁儿童青少年体质指数与血压的相关性,为开展相关的健康教育、健康促进提供基线资料。方法随机抽取福州市2个城区中等水平的小学和中学各一所,从各年级每个年龄段随机抽取至少20人,男女各半,共调查7¹8岁儿童青少年590人并进行身高、体重和血压的测量。依据《中国学龄儿童青少年超重肥胖筛查体重指数值分类标准》,将学生分为正常、超重和肥胖3类,比较3类学生的收缩压及舒张压。结果 718岁儿童青少年590人并进行身高、体重和血压的测量。依据《中国学龄儿童青少年超重肥胖筛查体重指数值分类标准》,将学生分为正常、超重和肥胖3类,比较3类学生的收缩压及舒张压。结果 7¹2岁男生的超重率和肥胖率均高于1312岁男生的超重率和肥胖率均高于13¹8岁的男生,差异有统计学意义(P<0.05);与正常体重组比较,718岁的男生,差异有统计学意义(P<0.05);与正常体重组比较,7¹2岁、1312岁、13¹8岁和718岁和7¹8岁男生超重肥胖组的SBP和DBP均值以及1318岁男生超重肥胖组的SBP和DBP均值以及13¹8岁和718岁和7¹8岁女生超重肥胖组SBP均值均明显升高,差异有统计学意义(P<0.05);718岁女生超重肥胖组SBP均值均明显升高,差异有统计学意义(P<0.05);7¹2岁男生的BMI与SBP、DBP均呈显著正相关(P<0.05),1312岁男生的BMI与SBP、DBP均呈显著正相关(P<0.05),13¹8岁男生和女生的BMI与SBP、DBP均呈显著正相关(P<0.05);在控制了年龄、性别因素后,718岁男生和女生的BMI与SBP、DBP均呈显著正相关(P<0.05);在控制了年龄、性别因素后,7¹2岁男生及1312岁男生及13¹8岁男生、女生BMI与SBP仍呈独立正相关(P<0.05),1318岁男生、女生BMI与SBP仍呈独立正相关(P<0.05),13¹8岁男生BMI与DBP也呈独立正相关(P<0.05)。结论福州市718岁男生BMI与DBP也呈独立正相关(P<0.05)。结论福州市7¹8岁儿童青少年超重肥胖检出率男生比女生高、低年龄组比高年龄组高;BMI与血压呈独立正相关,BMI与SBP的相关性比BMI与DBP相关性强,年龄越大BMI与SBP的相关性也越强,男生的BMI与SBP、DBP的相关性较女生更为显著。     

Serum concentrations of dehydroepiandrosterone and dehydroepiandrosterone sulfate and their relation to cytokine production during and after normal pregnancy

Background: Since dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) have been suggested to have immunoregulatory effects, changes in the levels of these substances during and after pregnancy might affect the maternal immune system. We examined serum concentrations of DHEA and DHEAS, and cytokine production during pregnancy and after delivery. Methods: The subjects were 73 normal pregnant, 76 normal postpartum and 30 normal non-pregnant women. Whole-blood was stimulated with phorbol 12-myristate 13-acetate (PMA) and ionomycin and the levels of cytokines in the supernatant were measured using enzyme-linked immunosorbent assay (ELISA). DHEA and DHEAS were measured using ELISA and gas chromatography–mass spectrometry (GC-MS), respectively. Results: The serum DHEA levels increased in the first and in the second trimesters and decreased after delivery until 11 months postpartum. DHEAS levels were decreased in the second and in the third trimesters and returned to non-pregnant levels after pregnancy. All measured cytokines (IFN-γ, IL-2, IL-4 and IL-10) were decreased during pregnancy and subsequently increased postpartum. We found significant negative correlations between DHEA and cytokine levels. Conclusions: Increase of serum DHEA in the first and the second trimesters may suppress immune reaction during pregnancy, while a decrease of DHEA after delivery may induce postpartum enhancement of the maternal immune system. DHEA may be involved in modifying the maternal immune responses during and after pregnancy.     

性早熟女童血清ghrelin水平研究

目的 探讨性早熟女童血清ghrelin水平变化.方法 将87例5～9 岁性早熟女童根据第二性征发育情况、骨龄、子宫、卵巢容积及促性腺激素释放激素(GnRH)激发试验的结果分为特发性中枢性早熟(ICPP)组和单纯乳房早发育(PT)组,选择34例年龄相当的健康女童作为对照组,采用夹心法酶联免疫吸附试验测定空腹血清ghrelin水平.结果 ICPP组血清ghrelin水平为Log(2.728±0.304)ng/L,明显高于对照组[Log(2.567±0.304)ng/L],差异有统计学意义(P<0.05);PT组血清ghrelin水平为Log(2.613±0.300)ng/L,与ICPP组和对照组比较,差异均无统计学意义(P>0.05).结论 ICPP组血清ghrelin水平明显高于对照组,推测ICPP女童血清ghrelin变化可能与性激素升高有关.     

Developmental diversity in symptom research involving children and adolescents with cancer

The purpose of this literature review was to evaluate developmental diversity in studies describing physical symptoms in children and adolescents receiving cancer treatment. Developmental diversity was conceptualized as individual differences based on normal stages of human development, including cognitive, psychosocial, and physiologic aspects. Searches of Medline and the Cumulative Index of Nursing and Allied Health Literature identified 53 articles published between January 1986 and November 2006. Most studies addressed symptoms in school-aged children and adolescents; few compared symptoms across age groups. Additional measures are needed to describe younger children's symptoms. Alternate research methodologies may be appropriate to describe their symptom experiences.