甲状旁腺激素和降钙素与氟的变化规律及其诊断价值的研究

关于饮水含氟量和人均日摄氟量不同的人群,甲状旁腺激素(PTH)、降钙素(CT)的变化规律及其在氟中毒发病机制中的作用、诊断价值如何,报道较少,且结果不一。为此,笔者测定了不同饮水含氟量人群(包括氟斑牙和氟骨症病例)人均日摄氟量,血清PTH、CT、ALP、F~-、Ca~(2+)、尿F、Ca~(2+)。     

燃煤型软化型大鼠氟骨症骨代谢因子变化的探索

目的以氟病区煤烘玉米为主要饲料,复制燃煤型软化型氟骨症大鼠模型,通过对燃煤型软化型氟骨症大鼠血清骨代谢相关因子的研究,探讨氟骨症的发病机理。方法 210只断乳2周的SD大鼠,适应性喂养一周后,按体重均衡随机数字法将其分为对照组,低氟剂量组,中氟铝组,高氟铝组,高铝组,高氟组,高氟营养不良组,共7组,每组30只,组内雌雄各半。正常对照组食用正常饲料,其它组均食用不同配方饲料,复制燃煤型软化型氟骨症大鼠模型。2.大鼠骨骼病理学检测采用Goldner's Massion trichrome(三色法)染色、荧光观察与HE染色、光镜观察。3.采用放射免疫分析法(RIA)测定燃煤型软化型大鼠血清中BGP、CT、PHT、IGF-1浓度的变化。结果 1.复制燃煤型软化型氟骨症大鼠,经骨骼病理学检测,高氟铝组及高氟营养不良组呈骨软化型。2.染毒90 d时,高氟铝组和高氟营养不良组发生了骨软化,其血清BGP、PTH显著升高;高氟营养不良组血清CT比对照组升高,提示OC活性出现被抑制的倾向,抑制骨吸收作用;高氟铝和高氟营养不良组大鼠血清IGF-1均低于对照组,提示在营养不良和(或)干预铝的情况下,生长情况出现被抑制的现象。染毒165 d,高氟铝组和高氟营养不良组大鼠血清BGP、血清PTH、血清CT、血清OPG含量升高不显著;大鼠的血清IGF-1,继续保持低水平。结论燃煤型软化型氟骨症大鼠,骨代谢相关因子的影响作用并非引起单一因素的变化,而是多种因子的异常波动,它们之间还可能互相影响,尤其是软化型氟骨症大鼠的血清BGP和PTH的变化更明显。     

氟对大鼠骨代谢的影响

目的 观察氟对大鼠骨代谢的影响,探讨氟骨症的发病机制.方法 Wistar雄性大鼠80只,体质量80～100 g.将大鼠按体质量随机分为4组:对照组(饮用自来水),低剂量组(NaF,50 mg/L),中剂量组(NaF,100 mg/L),高剂量组(NaF,150 mg/L),每组20只.饲养12周,乙醚麻醉处死大鼠,观察大鼠氟斑牙发生率;股动脉取血,放射免疫法测定血清骨钙素(BGP)、甲状旁腺激素(PTH)、降钙素(CT);比色法测定血清碱性磷酸酶(ALP)、酸性磷酸酶(ACP).结果大鼠氟斑牙检出率组间比较差异有统计学意义(x2=82.81,P＜0.01);其中低(80%,16/20)、中(100%,20/20)、高剂量组(100%,20/20)与对照组(0,0/20)比较差异有统计学意义(x2值分别为22.67、40.00、40.00,P均＜0.01).大鼠血清BGP、PTH、CT组间比较差异有统计学意义(F值分别为38.614、20.778、3.023,P＜0.01或＜0.05);但ALP、ACP组问比较差异无统计学意义(F值分别0.609、2.895,P均＞0.05).血清BGP:低、中、高剂量组[(19.60±12.79)、(33.41±10.81)、(39.46±9.51)mg/L]高于对照组[(7.35±3.22)mg/L,P均＜0.01],中、高剂量组高于低剂量组(P均＜0.01);血清PTH:低、中、高剂量组[(72.27±25.38)、(67.80±12.01)、(106.52±36.37)pmol/L]高于对照组[(47.08±9.22)pmol/L,P均＜0.01],高剂量组高于低、中剂量组(P均＜0.01);血清CT:中、高剂量组[(13.39±2.07)、(15.05±4.77)pmol/L]低于对照组[(26.06±28.31)pmol/L,P均＜0.05],也低于低剂量组[(24.49±14.10)pmol/L,P＜0.05].结论氟影响大鼠的骨代谢,BGP、PTH、CT在氟骨症发病中起着重要的作用.     

老年骨质疏松症患者血清铝及其内生肌酐清除率BMD、PTH、CT等关系初探

作者对162例老年骨质疏松症病人进行了血清铝(Al)、钙(Ca)、磷(P)、内生肌酐清除率(Ccr)、桡骨中段骨密度(BMD)、甲状旁腺激素(PTH)、降钙素(CT)、碱性磷酸酶(AKP)的测定。并选82例年龄、性别相似构成的健康老人为对照,对其相互关系进行了初步分析,报告如下。     

正常人和原发性甲状旁腺功能亢进患者血清PTH、CT及其他骨矿物质代谢指标昼夜节律的变化

血清甲状旁腺激素(PTH)、降钙素(CT)与骨代谢指标昼夜节律变化的关系尚有争议。本文旨在探讨正常人和原发性甲状旁腺功能亢进症(甲旁亢)患者血清PTH和CT含量昼夜节律变化及其与骨代谢指标的关系。     

原发性甲状旁腺机能亢进患者血清rT_3水平下降

作者测定了原发性甲状旁腺机能亢进(1°HP-T)和恶性疾病引起的高钙血症(HCM)患者的血清甲状旁腺激素(PTH)和甲状腺激素(TH)浓度,以研究PTH与TH水平之间的关系。 病人和方法 经手术证实的1°HPT16例,男4     

正常人与氟骨症病人血清和头发8种微量元素测定分析

本文对60名正常人和41名氟骨症病人测定了血清和头发的8种微量元素,包括Cu、P、Zn、Mg、Fe、Ca、Mn和Ba。结果表明:氟骨症病人血清Cu明显高于对照,Zn和Fe低于对照;而发Cu和Mg均明显升高。头发容易收集,更便于临床测定,但不能代替血。最后讨论了8种元素变化的意义,但对其病理机制尚不完全清楚。     

血清PTH与NT-proBNP水平在老年心力衰竭病人心功能分级的意义

目的探讨血清甲状旁腺激素(PTH)与N末端脑钠肽前体(NT-proBNP)水平在老年心力衰竭(心衰)病人心功能分级上的意义。方法选择2014年5月—2015年5月收治我院心内科的老年心力衰竭病人306例作为心衰组,老年健康体检者300名作为正常对照组,采用酶联蛋白吸附试验(ELISA)进行血清PTH和NT-proBNP检测。结果心衰组血清PTH和NT-proBNP水平与正常对照组比较,差异有统计学意义(P0.01);心功能Ⅰ级和Ⅱ级血清PTH水平比较,差异有统计学意义(P0.05)。心功能Ⅰ级和Ⅱ级两组血清NT-proBNP比较,差异无统计学意义(P0.05);心功能Ⅱ级,Ⅲ级血清PTA和NT-proBNP比较,差异有统计学意义(P0.01)。结论血清PTH和NT-proBNP检测用于评价老年病人心功能状态,而PTH可评价早期心功能状态,为临床诊断与疗效观察提供依据。     

女性围绝经期骨密度和E2、PTH、CT相关性分析

目的 本文分析了女性在围绝经期血清雌二醇(E2)、甲状旁腺素(PTH)、降钙素(CT)水平的变化对骨密度(BMD)的影响. 方法 测定绝经前期正常体检(A)组、绝经期(B)组和绝经时间＞1年(C)组的腰椎L2～L4、股骨颈、大转子、华氏三角区正侧位的BMD及血清中E2、PTH、CT的浓度,对BMD与多个变量之间的关系进行相关性分析. 结果 与A组比较,B组及C组BMD、E2及CT 水平显著降低,而 PTH水平显著升高.C组BMD、E2水平显著低于B组,而CT及PTH在2组间差异无统计学意义.相关性分析显示在绝经期妇女中E2、CT与BMD呈正相关;PTH与BMD呈负相关. 结论 女性E2、PTH、CT水平影响骨形成、骨吸收和BMD,使骨代谢趋向于负平衡,是女性易发骨质疏松的重要原因.     

甲状旁腺激素分析

回顾从1982.1.21——1984.11.6的100例已确诊的原发性甲旁亢手术病人,88例术前测定甲状旁腺激素(PTH)水平,有41％的病人PTH水平正常。放射免疫分析测定PTH水平不受年令、性别,药物和饮食的影响,目前已列为常规检查项目。由于PTH在血清中是以完整分子和片段两种分子形式存在,各实验室制备抗血清专一性、配制试剂和标准较困难、同时很难获得抗人PTH抗血清。因此     

氟中毒对雄鼠垂体—性腺轴功能的影响

分别用腹腔注射氟化钠和喂饲含氟水的方法制造了雄鼠亚急性和慢性氟中毒模型,观察了对大鼠垂体—性腺轴功能的影响。得到如下结果:亚急性氟中毒大鼠前列腺、睾丸和垂体的相对重量均无显著变化,血清睾酮水平降低,LH 水平显著升高,但垂体 LH 含量无显著变化;慢性氟中毒大鼠睾丸和垂体的相对重量均无显著变化,但前列腺的相对重量有随饮水氟浓度的升高而降低的趋势,血清睾酮水平降低,且与饮水氟浓度呈剂量—效应关系,血清 LH 无明显变化,但垂体 LH 含量有所降低。     

氟砷联合中毒患者无机元素和胶原代谢状况观察

目的观察改水后地方性氟中毒、氟砷联合中毒患者无机元素和胶原代谢的改变.方法用氯胺T法测定尿羟脯氨酸含量;用氟离子选择电极法测定尿氟含量;用二乙氨基二硫代甲酸银法测定尿砷含量;用Baird PS-4型等离子体光谱仪测定尿中钾、钠、钙、磷、镁、锌含量;用美国BECKMAN公司LX 20型全自动生化分析仪检测血清中钙、磷、镁、锌、铁含量.结果各组之间尿氟、砷、HOP/Cr、钠、钾和血清钙、镁含量的差别均有统计学意义(P<0.05).结论单纯氟中毒和氟砷联合中毒所致人体的无机元素和胶原代谢紊乱在脱离高氟高砷暴露20年后不能完全纠正,氟砷联合中毒患者体内无机元素和胶原代谢紊乱的恢复比单纯氟中毒患者更缓慢.     

少儿地方性氟骨症骨损害的X线表现及改水降氟后变化

目的了解少儿氟骨症骨损害X线表现、特点,与成人氟骨症X线改变的异同以及脱离高氟影响后的X线变化,为地方性氟骨症的诊断、防治效果评价及发病和转归机理研究提供参考。方法在水氟含量较高(4.3～16.0 mg/L)的地方性氟中毒病区,借助X线检查方法筛选出30例儿童氟骨症病例,对其出现的各种X线征象、特点进行观察和分析,追踪观察并统计了8例儿童氟骨症病例改水前、后X线表现及诊断结果的变化。结果 30名患者中,轻度22例,中度4例,重度4例。硬化型改变26例,软化型2例,混合型2例。所有患者都有骨纹X线征象异常,表现为骨小梁增多、增密(密集),粗大、模糊、紊乱、融合。严重紊乱和融合的骨纹使骨密度增高,骨质硬化。前臂、小腿、骨盆骨软化变形。与成人氟骨症不同,骨周软组织和关节无异常所见。结论少儿地方性氟骨症主要发生在氟含量更高的氟中毒病区,X线表现为骨质方面的损害,骨周软组织和关节不受波及。在改换水源降低饮水氟含量5年后,原有异常骨X线征象即可出现相当明显的逆转或恢复正常影像。部分改水前骨硬化患者在改水后出现了骨质疏松征象,机制有待研究。     

地方性氟骨症硼砂制剂治疗前后骨矿密度和血尿氟变化

１３２例地方性氟骨症病人分别给予硼砂片、复方硼砂片和安慰剂，共６个月。实验前后用单光子吸收法（ＳＰＡ）测定前臂骨矿密度（ＢＭＤ），同时测定血、尿赢（Ｆ－）。与天津市正常人比较，前臂ＢＭＤ女性降低。全部病人血、尿Ｆ－增高。治疗后实验两组前臂ＢＭＤ减低者ＢＭＤ明显增加，血Ｆ－下降，尿Ｆ－无变化。结果表明，氟骨症病人用硼砂制剂治疗后骨代谢异常有所好转。     

Endemic fluorosis in Turkish patients: relationship with knee osteoarthritis

Fluoride excess primarily effects dental and skeletal tissues. leading to a condition known as endemic fluorosis. The radiological and clinical features of endemic fluorosis vary in different parts of the world. The aim of this study was to investigate the clinical and radiological features of endemic fluorosis in Turkish patients. Physical examination and radiological investigations were performed in 56 patients with endemic fluorosis and 40 age- and sex-matched controls. Knee osteoarthritis (OA) was the main abnormality in both groups, both clinically and radiologically. The radiological severity of knee OA was greater in the endemic fluorosis group than in controls (P=0.01). Osteophytes at the tibial condyles and superior margin of the patellar articular surface of the femur, polyp-like osteophytes on the non-weight-bearing medial side of the femoral condyle, and popliteal loose bodies were detected more frequently in the endemic fluorosis group than in controls (P=0.0001). We suggest that the presence of atypically located osteophytes in the knees may be a feature of endemic fluorosis in Turkish patients and that endemic fluorosis may increase the severity of OA in the knees.     

山西省临猗县饮水型地方性氟中毒与尿氟关系的研究

目的 了解山西省临猗县饮水型地方性氟中毒的患病情况,探讨氟中毒与尿氟之间的关系,为当地饮水型地方性氟中毒的防治提供依据.方法 2006年在临猗县饮水型地方性氟中毒重、中病区和非病区各选取1个村作为调查点,采用Dean法和离子选择电极法对当地居民进行氟斑牙和尿氟检查,对病区30岁及以上成年人进行前臂正位X线(包括肘与腕)拍片,进行氟骨症患病情况调查.结果 3个地区人群氟斑牙检出率明显不同(X~2=410.945,P<0.01),其中,中病区、重病区氟斑牙检出率分别为92.34%(253/274)、90.09%(291/323),明显高于非病区[23.27%(64/275),X~2值分别为274.927、268.287,P均<0.01].重病区氟骨症检出率[59.75%(141/236)]明显高于中病区[24.76%(52/210),X~2=183.578,P<0.01].3个地区人群尿氟水平差异有统计学意义(H=411.197,P<0.01),其中重病区为(4.69±0.17)mg/L、中病区为(4.86±0.13)ms/L、非病区为(1.75±0.04)mg/L;而氟骨症患病程度与人群尿氟之间呈直线相关关系(r=0.508,P<0.01).结论 山西省临猗县饮水型地方性氟中毒病区氟斑牙、氟骨症患病情况严重,氟骨症患病程度与尿氟水平相关.     

临床与X线方法诊断氟骨症结果比较

目的 比较临床与X线诊断氟骨症结果,为制订诊断标准提供参考依据.方法 采用资料回顾方法,在占林省乾安、农安县选末改水的15个病区屯,按各电饮水平均含氟量分为0.5、1.0、1.5、2.0、2.2、2.4、3.0、3.5、4.0、6.0、7.0 mg/L共11个等级.抽取居住10年以上的16～60岁居民共675例作为观察对象,对两种诊断方法的氟骨症检出情况进行分析和比较.结果 水氟为2.0、2.2、2.4、3.0、4.0 mg/L时,临床检出率(21.43%、22.45%、21.28%、19.05%、38.89%)明显高于X线(0、2.04%、0、4.76%、12.96%,X2值分别为7.96、9.49、11.19、4.08、9.45,P<0.05);水氟为2.0、2.4 mg/L时,X线检出率为0;水氟为3.0、4.0 mg/L时,X线检出率仍较低;水氟为0.5、1.0、1.5、3.5、6.0、7.0 mg/L时,临床检出率(1.00%、4.44%、7.23%、18.00%、54.39%、49.18%)和X线检出率(0、2.22%、3.61%、8.00%、36.84%、52.46%)的差别不明显X2值分别为1.00、0.17、0.47、2.21、3.54、0.13,P>0.05).结论 氟骨症临床和X线检出率随水氟增高析增高,临床方法检出氟骨症随水氟增高的规律性好于X线方法.     

砷对氟中毒影响的流行病学研究

为探讨砷与氟在对机体骨等矿化组织的损害作用中的相互影响,按国家统一方法,选择居民经济状况,饮食结构,生活习惯,民族、燃煤时间、总摄氟量等相近的单纯氟中毒病区和砷氟合并中毒病区进行调查对比。结果显示,２调查点日人均总摄氟量无显差异,儿童氟斑牙检出率及分布无显性差异,但砷氟病区人群尿氟含量及氟中毒临床症体征检出率分离显单纯氟病芡。结果表明砷可能通过减少氟的吸收及氟在组织蓄积而减轻氟对机体骨等矿化     

2006-2010年吉林省地方性氟中毒监测结果分析

目的 掌握吉林省地方性氟中毒病情变化,为调整防治策略提供科学依据.方法 2006-2010年,采用分层整群抽样方法,每年在全省14个病区县的轻、中、重病区中抽取5个屯作为监测点.水氟、尿氟测定采用离子选择电极法(GB/T 8538-1995);8～12岁儿童氟斑牙诊断采用Dean法;氟骨症诊断2006-2008年采用<地方性氟骨症临床分度标准>(GB 16396-1996),2009、2010年采用<地方性氟骨症临床诊断标准>(WS192-2008).结果 共监测25个病区屯,其中改水屯14个,常住人口8005人,受益人口7154人,占常住人口的89.37%;未改水屯11个.按照<国家生活饮用水卫生标准>要求,14个改水屯居民饮用水含氟量均合格(≤1.20 mg/L),14个改水屯学校中有3个饮水含氟量超标;检测11个未改水屯饮用水含氟量,有7个超标.共检查改水屯8-12岁儿童363人,氟斑牙检出率为39.12%(142/363);未改水屯303人,氟斑牙检出率为43.89%(133/303).共检查改水屯16岁以上成人6424人,氟骨症检出率为6.27%(403/6424);未改水屯3572人,氟骨症检出率为13.89%(496/3572).已改水的中、轻病区16岁以上成人氟骨症患者和8-12岁儿童的尿氟几何均值均在正常参考值(WS/T 256-2005,1.40 mg/L)以下.结论 吉林省改水病区氟中毒病情已得到一定程度的控制,未改水病区氟中毒病情仍然较重,氟中毒防治任务仍很艰巨.

Abstract：

Objective To identify changes in the occurrence of endemic fluorosis in order to provide scientific basis for making countermeasures. Methods Five villages from 14 counties of mild, moderate and severe fluorosis affected areas were selected by stratified cluster sampling every year in the whole province during 2006 - 2010. Water and urinary fluorine were determined by ion selective electrode method(GB/T 8538-1995); dental fluorosis of children 8-12 years old was diagnosed with Dean method; skeletal fluorosis was diagnosed according to "clinical indexing standards of endemic skeletal fluorosis "(GB 16396-1996), between 2006 and 2008, and "clinical diagnosis standard of endemic skeletal fluorosis"(WS 192-2008) between 2009 and 2010. Results A total of 25 diseased villages were surveyed, 14 with water sources changed, covered a resident population of 8005 people, beneficiary population 7154, and accounting for 89.37% of the resident population; not changed villages 11. In accordance with the "State drinking water health standards", in the 14 changed villages the fluoride in drinking water was qualified (≤ 1.20 mg/L), there were 3 schools whose water fluorine content exceeded the standard; among the 11 villages that did not change water sources 7 drinking water samples fluorine content exceeded the standard. Of the 8 to 12 years old children in villages with changed water sources, 363 of them were checked and 142 dental fluorosis were found, the detection rate of dental fluorosis was 39.12% (142/363); in villages with water sources not changed, 303 children were checked, the detection rate of dental fluorosis was 43.89%(133/303). Of sixteen and elder adults in water source changed villages, 6424 people were checked and 403 skeletal fluorosis were found, skeletal fluorosis detection rate was 6.27% (403/6424); 3572 people were checked in not changed villages, the detection rate of skeletal fluorosis was 13.89%(496/3572). In water sources changed areas, geometric mean of urinary fluoride was in the normal reference value(WS/T 256-2005, 1.40 mg/L)or less. Conclusions Endemic fluorosis is decreased in water improved areas, but in unimproved areas the disease is still severe, and control of endemic fluorosis is still an arduous task.     

2009年河北省饮水型地方性氟中毒病情调查

目的 了解饮水型地方性氟中毒的病情动态和评价防治措施的落实效果,为及时调整防治策略提供科学依据.方法 2009年,采用单纯随机抽样的方法,在河北省饮水型氟中毒病区县中抽取38个县(市、区),采用系统抽样方法,将各病区县所有病区村分成轻、中、重3类,从每类病区村中各抽取1个病区村,对全部病区村进行水氟监测;调查病区村全部8～12岁儿童氟斑牙患病情况,从每个年龄段选择6人,检测尿氟;对各病区村全部16岁以上常住人口开展临床氟骨症检查,并检测20人份(男、女各半)尿氟.结果 共调查112个病区村,其中改水村66个,未改水村46个.采集改水工程水样236份,水氟范围为0.1～4.3 mg/L,有20个工程水氟＞1.2 mg/L,占总数的33.3%(20/60);采集未改水村水样230份,水氟范围为0.2～4.6 mg/L,水氟＞1.2 mg/L的水源数占总数的76.1%(35/46).共对5169名8～12岁儿童进行了氟斑牙患病情况调查,氟斑牙检出率为36.43%(1883/5169),氟斑牙指数为0.81.调查16岁以上成人71 497人,临床氟骨症检出率为4.81%(3438/71 497),中度以上临床氟骨症检出率为1.56%(1114/71 497).分别测定了2876和2021份儿童和成人尿氟,几何均数分别为2.30、3.32 mg/L.结论 水氟＜1.2 mg/L的已改水村儿童氟斑牙检出率均在30%以下,儿童氟斑牙检出率和成人临床氟骨症检出率随着改水时间的延长呈现逐渐下降的趋势.未改水病区,儿童氟斑牙检出率和成人临床氟骨症病情随水氟升高而上升.河北省饮水型氟中毒流行仍然较为严重,应该加快改水降氟进度并提高改水工程合格率.

Abstract：

Objective To understand the status of drinking-water-borne endemic fluorosis and the effect of preventive measure in Hebei province, so as to provide a basis to prevent and cure the disease. Methods Thirtyeight affected counties(cities, districts) with drinking-water-borne endemic fluorosis were sampled by random sampling in Hebei in 2009. All affected villages in every county were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. Dental fluorosis of children aged 8 - 12 were examined and 6 copies of urine samples were randomly collected in each age group in the above-mentioned villages. Clinical skeletal fluorosis was diagnosed among adults aged 16 and over and 20 copies of urine samples were tested for fluorosis in every village.Results A total of 112 affected villages were investigated, among which the drinking water quality of 66 villages were improved and 46 villages were not improved. A total of 236 copies of water samples from the 66 villages were measured and the fluoride content ranged from 0.1 to 4.3 mg/L, among which 20 copies of water samples exceeded the fluorine standard of 1.2 mg/L, accounting for 33.3%. A total of 230 copies of water samples were collected in the 46 villages and the fluoride content ranged from 0.2 to 4.6 mg/L, among which 76.1% (35/46) of the water samples exceeded the fluorine standard of 1.2 mg/L. A total of 5169 children aged 8 - 12 were examined of dental fluorosis, the dental fluorosis rate was 36.43%(1883/5169) and the dental fluorosis index was 0.81. A sum of 71 497 adults aged over 16 years were examined, and the rate of skeletal fluorosis was 4.81%(3438/71 497), moderate or severe clinical detection rate of skeletal fluorosis was 1.56%( 1114/71 497). A total of 2876 copies of children urine samples and 2021 copies of adult urine samples were tested and the geometric mean of fluoride content was 2.30,3.32 mg/L, respectively. Conclusions The prevalence of dental fluorosis of children in the areas with improved water is less than 30% and the rate of dental fluorosis and skeletal fluorosis decline gradually with time.The rate of dental fluorosis and skeletal fluorosis increases with the increase of water fluoride in the water quality not improved areas. The endemic fluorosis is still comparatively serious in Hebei. The progress of improving water quality in the areas with endemic fluorosis should be accelerated and the acceptability of improved water should be enhanced.