围绝经期女性肾功能与骨密度的相关性研究

目的观察围绝经期女性肾功能与骨密度的相关性。方法选取2014年3月至2017年12月在我院接受健康检查的710名40～55岁汉族女性作为研究对象。通过双能X线吸收法测量受试者腰椎(L1～4)和左侧股骨颈的骨密度(bone mineral density,BMD),根据测量结果将受试者分为高BMD组和低BMD组。使用肾小球滤过率(estimated glomerular filtration rate,eGFR)和肌酸酐清除率(creatinine clearance rate,CCr)来评估肾功能。运用多变量逻辑回归和一般线性模型评估肾功能和BMD之间的相关性。结果 eGFR与BMD、体重和尿酸呈负相关(P 0. 05); CCr与BMD、体重、高血压、LDL-C、空腹血糖、碱性磷酸酶、尿酸和eGFR呈正相关(P0. 05);低eGFR对低BMD有保护作用(P0. 05);低CCr水平与低BMD显著相关[校正比值(AOR)=1. 42,95%置信区间(CI)=1. 05～1. 95]。在绝经前妇女(AOR=1. 46,95%CI=1. 11～1. 96)中观察到这种关联。结论围绝经期女性肾功能与骨密度密切关联,且绝经状态会影响这种关联。     

肌肉强度和肌肉质量与绝经后女性骨密度的相关性研究

目的探索绝经后女性肌肉强度和肌肉质量与骨密度相关性。方法分析了2014年3月至2017年8月在我院就诊的340名绝经后妇女。使用双能量X射线吸收测定法检测股骨颈和腰椎骨密度(bone mineral density,BMD)、全身骨密度和附肢骨骼肌肌肉量(appendicular skeletal muscle,ASM)。ASM指数(ASMI,kg/m~2)按照ASM(kg)除以高度的平方(m~2)计算。测量握力(kg)作为肌肉力量的指标。结果调整ASMI和年龄后(股骨颈标准化偏回归系数β=0. 105,腰椎=0. 116),握力强度与几个骨骼部位BMD呈显著性正相关(P0. 05)。股骨颈和腰椎骨密度的调整平均值显示出握力强度从最低到最高三分位数的显著增加趋势。本研究结果表明肌肉强度与绝经后妇女肌肉量的几个位点的BMD密切相关。无论肌肉大小如何,肌力强健的绝经后妇女都有健康的骨骼状态。结论绝经后女性骨密度和肌肉强度密切相关,与肌肉质量无明显相关性。     

肌肉含量指标对绝经后女性骨质疏松症发生风险的预测价值分析

目的 评价肌肉含量指标与骨密度(bone mineral density, BMD)的关联性,筛选预测绝经后女性骨质疏松(osteoporosis, OP)发生风险的最佳部位肌肉指标及其截止点。方法 选取2018年1月至2021年10月贵州医科大学附院健康管理中心的1366名绝经后女性,采用DXA和BIA测量BMD和四肢骨骼肌含量(ASM),以ASM算出各肌肉含量指标：ASMI、ASM_BMI及SMI。应用ROC曲线及Logistic回归分析验证肌肉指标对OP风险的预测能力及评估关联强度。结果 OP组的肌肉含量低于非OP组,除腰椎BMD间的SMI和股骨颈、腰椎BMD间的内脏脂肪面积及大粗隆、全髋BMD间的ASM_BMI差异无统计学意义(P>0.05),各部位不同BMD间脂肪、肌肉含量指标差异均有统计学意义(P<0.05)。Pearson分析显示,各部位BMD与SMI呈负相关(r=-0.095、-0.122、-0.195、-0.177);与ASM、ASM、ASM_BMI呈正相关(r=0.369、0.298、0.085...     

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。     

中老年女性骨转换指标与骨密度和骨质疏松风险的关系

目的了解中老年女性骨转换指标变化对骨密度(BMD)和骨质疏松患病风险的影响。方法 632名健康中老年女性(年龄40~89岁),测定空腹血清骨特异性碱性磷酸酶(BAP)、骨钙素(OC)、骨I型胶原C-末端肽(s CTX)和N-末端肽(s NTX),以及腰椎和近端股骨骨密度(BMD),并分析这些骨转换指标与BMD和骨质疏松患病风险的关系。结果本研究检测的各种骨转换指标与腰椎、股骨颈和髋部BMD呈显著负相关(r=-0.238~-0.528,P均=0.000)。调整年龄、身高、体重和体重指数后,血清BAP、OC和s CTX与腰椎和股骨颈BMD的偏相关系数仍然有显著性意义。多元线性回归分析显示,这些骨转换指标对腰椎BMD是一个有意义的负性决定因素,大约可以解释腰椎BMD 7.6%~27.9%的变异性。各种骨转换指标水平最高的四分位组(Q4)与最低的组(Q1)比较,腰椎、股骨颈和髋部的骨质疏松患病风险,分别显著增加4.6~15倍(OR=4.6~15,95%CI:2.6~30),3.2~13倍(OR=3.2~13,95%CI:1.5~36)和3.0~13倍(OR=3.0~13,95%CI:1.3~44)。结论本研究揭示了中老年女性骨转换指标与BMD和骨质疏松患病风险的关系,提示骨转换指标水平变化是中老年女性BMD的重要决定因素,骨形成指标和/或骨吸收指标水平增加者骨质疏松患病率和患病风险大大增加。     

中老年女性乳腺癌患者骨丢失的临床研究

目的观察中老年女性乳腺癌患者骨密度(bone mineral density,BMD)变化及影响因素。方法选取40岁以上乳腺癌患者339例为乳腺癌组,同时选择1 356名健康女性为对照组。通过美国GE LUNAR公司生产的Prodigy advance双能X线骨密度仪测量受试者腰椎(L_(1～4))、左股骨BMD。对比乳腺癌组、对照组BMD及骨质疏松(osteoporosis,OP)患病率。结果①随着增龄,乳腺癌与对照组腰椎、股骨BMD逐渐降低。乳腺癌组腰椎、左侧股骨干、全髋BMD 40～49岁年龄段低于对照组,50～80岁年龄段高于对照组。乳腺癌组左侧股骨颈、大转子BMD 40～59岁年龄段低于对照组,60～80岁年龄段高于对照组;②体质量指数(body mass index,BMI)与腰椎、股骨BMD呈正相关(r=0. 101～0. 283,P0. 01)。亚洲骨质疏松自我评价工具(osteoporosis self-assessment tool for asians,OSTA)与BMD呈正相关(r=0. 382～0. 592,P0. 01);③随着增龄,乳腺癌与对照组OP检出率逐渐增加。对照组腰椎OP检出率高于乳腺癌组。50～80岁年龄段股骨OP检出率高于乳腺癌组。结论中老年女性乳腺癌患者与健康人群均有较高骨丢失率。50岁以后健康人群OP患病率高于乳腺癌患者。OSTA对乳腺癌OP风险有较好预测价值。     

老年人血清炎症因子与骨密度变化及骨吸收相关性研究

目的探讨老年人血清炎症标志物与骨密度(bone mineral density,BMD)变化和尿吡啶啉(PYR)及肌酐(Cr)比值变化之间的关系。方法共纳入168名随机选择的受试者(年龄52～78岁,平均63岁,女性占48%)。BMD通过双能X线吸收测定法在基线时和平均2. 9年后测量(平均T值:-0. 18～-0. 61)。测定受试者血清高敏感性(hs) C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,并测量尿PYR/Cr比率。结果受试者全身、腰椎和髋部BMD平均年损失分别为0. 15%、0. 15%和0. 34%。全身BMD的变化与基线hs-CRP、IL-6、TNF-α(β:-0. 41%/U,95%置信区间:-0. 68%,-0. 15%)以及hs-CRP与IL-6(β:-0. 62%/U,95%置信区间:-1. 01%,-0. 23%)的变化密切相关。如果将这些标记置于相同的预测模型中,则只有IL-6基本保持不变。IL-6(髋部和腰椎)和TNF-α(仅腰椎)可显著预测其他部位BMD的变化。最后,PYR/Cr比值的变化与女性基线的IL-6、hs-CRP及其变化呈正相关(P均0. 05),而与男性无关。结论本研究中观察到的IL-6的改变和骨密度降低及骨吸收有关。     

定量CT测量分析髋部骨折人群腰椎与股骨近段骨密度的相关性

目的 在髋部脆性骨折人群中采用定量CT分析腰椎与股骨近段骨密度的相关性。方法 纳入行髋部和低剂量肺CT的髋部脆性骨折患者201例，使用QCT Pro测量，获得全髋、股骨颈、大转子、转子间整体与松质骨的体积骨密度和面积骨密度(aBMD)以及腰椎(L_1、2)松质骨体积骨密度(vBMD)。分析腰椎与髋部各感兴趣区骨密度相关性。结果 男女性腰椎松质骨vBMD与髋部各感兴趣区BMD均线性相关(P<0.05)。女性腰椎松质骨vBMD与全髋松质骨vBMD标准化回归系数最高(β=0.465,P<0.05)。男性腰椎松质骨vBMD与转子间松质骨vBMD标准化回归系数最高(β=0.532,P<0.05)。结论 在髋部脆性骨折人群中，相对于髋部整体骨密度，腰椎松质骨vBMD与髋部松质骨骨密度的相关性更高；女性腰椎松质骨vBMD与全髋松质骨体积骨密度相关性最高；男性腰椎松质骨vBMD与转子间松质骨vBMD相关性最高。     

老年女性2型糖尿病患者骨密度与握力的相关性研究

目的探索老年女性2型糖尿病患者骨密度与握力的相关性。方法选取首都医科大学宣武医院内分泌科住院的≥60岁的女性2型糖尿病患者共112名,计算体重指数(BMI),测定糖化血红蛋白(HBA1c),C反应蛋白(CRP),白细胞介素6(IL-6)水平及握力;采用双能X线吸收仪测定四肢骨骼肌肌肉含量(ASM)及骨密度(BMD)。分析骨密度与握力,四肢骨骼肌肌肉含量及炎症因子的相关性。结果老年女性糖尿病患者骨质疏松组BMI、四肢骨骼肌肌肉含量,握力显著低于非骨质疏松组(P0.001)。两组CRP,IL-6无显著差异。相关分析显示年龄与左、右股骨颈的骨密度显著负相关(分别为r=-0.248,P=0.008;r=-0.232,P=0.014)。四肢骨骼肌含量与腰椎的骨密度显著正相关(r=0.280,P=0.003)。BMI、握力与双侧股骨颈骨密度及腰椎骨密度均显著正相关(r=0.207~0.372,P0.05~P0.001)。多元Logistic回归分析显示,BMI、握力是影响骨质疏松的独立危险因素(分别为OR=1.24,P=0.002;OR=1.14,P=0.005)。结论握力而不是肌肉含量是影响老年女性2型糖尿病患者骨质疏松的独立危险因素。     

青年男性血清25羟维生素D、PTH水平与区域骨密度的关系

目的 调查广州地区青年男性维生素D、PTH状态及其与区域骨密度之间的关系.方法 随机选取2011年5月-2012年8月在广州军区广州总医院门诊部体检的60名广州青年男性志愿受试者,年龄18～44岁.评估血清25(OH)D、PTH水平,并分析血清25(OH)D、PTH与骨转换指标和区域骨密度(BMD)的相关性.结果 46.7％的青年男性血清25(OH)D水平＞30 ng/mL,53.3％低于30 ng/mL,5％低于20 ng/mL.血清25(OH)D水平与年龄分布无统计学差异(P＞0.05).双变量分析显示血清25(OH)D水平与PTH负相关(r=-0.264,P=0.042),与β-Crosslaps负相关(r=-0.257,P=0.047).血清25(OH)D水平、PTH与L1-4以及单个腰椎L1、L2、L3、L4的BMD无相关性.股骨大转子BMD与血清25(OH)D正相关(r=0.271,P=0.040),校正年龄、BMI和骨生化指标后,正相关性更加明显(r =0.319,P=0.020).多元线性回归分析显示BMI、ALP与全腰、L1、L3、L4椎BMD相关,BMI、PINP与L2椎BMD相关,BMI、25(OH)D与全髋、大转子BMD相关.结论 青年男性广泛存在血清25(OH)D不足状态,血清25(OH)D水平与股骨大转子BMD明显正相关,适当补充维生素D和钙剂,对维持大转子区域的骨量至关重要.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。