Long-term treatment of Paget''s disease of bone with salmon calcitonin.

Twenty-eight patients with symptomatic Paget's disease of bone were treated with synthetic salmon calcitonin for periods of 9 to 42 months (average, 23 months). Serum alkaline phosphatase concentration and urinary hydroxyproline excretion, which had been elevated before treatment, were decreased by calcitonin treatment in all patients, and some decrease was sustained in 23 in association with variable decreases in pain, heat and stiffness of major joints. Improvement was sustained further in approximately half of these patients; the other half had partial return of symptoms. Calcium absorption was increased in 9 of 10 patients studied; the increase did not correlate with plasma concentrations of parathyroid hormone. The mean endogenous fecal calcium excretion was decreased significantly but there was no significant change in mean urinary calcium excretion. Mean accretion rate of calcium to bone, studied in 10 patients, was decreased by 35% after 6 months of treatment and by a further 23% 1 year later. There was no consistent effect of calcitonin treatment on bone mineral mass. No serious adverse effects of treatment such as allergic reactions were observed. Calcitonin appears to be effective initially in most patients with Paget's disease of bone, but with long-term treatment resistance may be acquired.     

正常妊娠钙代谢和骨吸收指标的变化

目的 :探讨正常妊娠期及产后恢复期钙代谢指标和骨密度的变化。方法 :对 43例正常妊娠期及产后恢复期和 2 1例健康妇女对照组分别测定骨密度、抗酒石酸酸性磷酸酶、血清白蛋白、总钙、离子钙、碳酸氢根、尿Ca/Cr比值。结果 :妊娠期及产后期骨密度无明显变化 ,血清白蛋白自妊娠 30d后逐渐明显降低 ,总钙降低 ,离子钙无变化 ,抗酒石酸酸性磷酸酶增高 ,尿Ca/Cr比值升高 ,妊娠中期后碳酸氢根下降。各项变化指标产后 2个月后逐步恢复正常。正常妊娠期总钙 ,尿Ca/Cr比值 ,抗酒石酸酸性磷酸酶的参考值分别为 :2 17± 0 2 3mmol/L ;0 6 1± 2 4 ;5 9± 1 9u/L。结论 :妊娠期间骨吸收指标无明显改变 ,血清离子钙增高 ,骨代谢明显活跃。     

维持性血液透析患者甲状旁腺体积增大的相关性研究

目的探讨维持性血液透析患者甲状旁腺体积增大的发生率及其相关因素。方法176例维持性血液透析患者,用彩色多普勒测量其甲状旁腺体积,并同时检测患者血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙、血磷、血清碱性磷酸酶(alkaline phosphatase,AKP)等骨代谢指标。结果1)根据血清iPTH结果176例维持性血液透析患者分为高iPTH组(血清iPTH>300ng/L)84例(47.7%),正常iPTH组(血清iPTH150～300ng/L)32例(18.2%),低iPTH组(血清iPTH<150ng/L)60例(34.1%)。2)176例维持性血液透析患者中有60例伴有甲状旁腺体积增大(34.1%),其中高iPTH组有48例(57.1%)、正常iPTH组4例(12.5%)、低iPTH组8例(13.3%)。高iPTH组患者甲状旁腺体积增大的发生率明显高于正常iPTH组和低iPTH组(P<0.05)。高PTH组甲状旁腺体积增大的程度亦明显高于正常PTH组和低PTH组(P<0.05)。3)甲状旁腺体积增大与透析龄≥5年、不规律服用活性维生素D3制剂的比例、血磷和血碱性磷酸酶水平呈正相关,与血液滤过次数<2次/月和血钙水平呈负相关。结论维持性血液透析患者甲状旁腺体积增大的发生率较高,多发生于甲状旁腺激素高分泌组。透析龄、不规律服用活性维生素D3制剂、血iPTH是甲状旁腺体积增大的独立危险因素。     

低钙透析对低甲状旁腺激素血液透析患者矿物质及骨代谢的影响

目的 低钙透析对低甲状旁腺激素血液透析患者甲状旁腺激素及骨代谢的影响。方法 选取70例血清全段甲状旁腺激素(intact parathyroid,iPTH)<100 pg/mL的维持性血液透析患者。应用1.25 mmol/L钙浓度透析液进行血液透析治疗,随访1年。常规检测生化指标——血钙、血磷、血清碱性磷酸酶(alkaline phosphatase,ALP),化学发光法检测iPTH、骨钙素(osteocalcin, OC)、I型前胶原氨基末端前肽(procollagen type I amino-terminal propeptide, PINP)、β胶原蛋白(β-crosslaps, β-CTX),观察患者应用1.25 mmol/L钙浓度透析液前及应用后1、3、6、12个月时血钙、血磷、ALP、iPTH变化以及OC、PINP、β-CTX等骨代谢指标的变化。结果 1)血清iPTH浓度于应用1.25 mmol/L钙浓度透析液3个月后显著升高(P<0.001);2)更换透析液后各时间点与更换前比较,血清OC浓度、PINP浓度及β-CTX浓度于更换1个月后显著升高,差异有统计学意义(P<0.001);3)OC浓度变化与年龄呈负相关(r=-0.816,P<0.001)、与基线iPTH浓度呈正相关(r=0.673,P=0.037);β-CTX浓度变化与年龄呈负相关(r=-0.718,P<0.001)、与基线iPTH浓度吴正相关(r=0.651,P=0.020);4)更换透析液前基线血清iPTH浓度(P<0.001)、糖尿病史(P=0.012)是iPTH改善的独立影响因素。结论 低钙透析可以改善低甲状旁腺激素患者iPTH浓度,升高OC、PINP及β-CTX浓度,增加骨代谢,是治疗低转运骨病的有效方法。     

骨化三醇不同口服方法对 63 例维持性血液透析患者的临床影响探讨

目的 探讨口服骨化三醇对维持性血液透析患者的矿物质和骨代谢异常的影响.方法 将我院行维持性血液透析治疗6个月以上,且血清全段甲状旁腺激素（IPTH）水平300 ～ 600 pg/mL63例患者,随机分为空白对照组、每日口服组、骨化三醇冲击治疗组.观察8周,比较骨化三醇治疗前后IPTH、血清钙、钙磷乘积、碱性磷酸酶（ALP）、颈动脉内膜厚度等相关因素的变化情况.结果 F检验结果显示,3组患者ALP、颈动脉内膜厚度和IPTH指标不完全一致（P＜0.05,拒绝H0假设,接收H1假设）,而血清内钙磷含量差异无统计学意义（P＞0.05）.LSD法两两比较结果显示,ALP含量指标3组患者差异具有统计学意义,并且骨化三醇冲击治疗组＜每日口服组＜空白对照组;颈动脉内膜厚度和IPTH指标也具有类似规律.结论 口服骨化三醇对治疗维持性血液透析患者矿物质和骨代谢异常治疗有效,尤其是口服冲击治疗取得满意临床效果.     

重组人甲状旁腺激素治疗绝经后骨质疏松妇女临床研究

目的观察重组人甲状旁腺激素治疗绝经后骨质疏松妇女的临床疗效。方法选择绝经后妇女骨质疏松患者58例随机分为观察组31例和对照组27例,观察组给予皮下注射重组人甲状旁腺素20ug每天1次;对照组给予肌肉注射降钙素20IU每1次,两组均每日给予钙尔奇D600mg／d,连续治疗6个月。观察两组腰椎（L2～L4）的骨密度及T值,血钙磷及碱性磷酸酶（AKP）等指标的变化情况及不良反应。结果治疗后观察组和对照组腰椎（L2～L4）的骨密度均有明显的增加（P〈0.01）。但两组间比较无明显差异。观察组治疗后的碱性磷酸酶明显增高,而对照组无明显变化。对照组治疗后的血清胆固醇降低显著优于观察组（P〈0.01）。两组均未发生严重不良反应。结论重组人甲状旁腺激素与降钙素都能显著提高骨密度（BMD）和缓解骨质疏松的症状．对于治疗绝经后的骨质疏松安全有效。     

老年男性慢性阻塞性肺疾病患者骨密度及骨代谢相关指标的临床研究

目的 通过测定老年男性慢性阻塞性肺疾病(COPD)患者的骨密度、骨代谢生化指标,探讨COPD与骨质疏松的关系.方法 选择203例老年男性COPD患者(COPD组)和40例同龄同性别健康对照者(对照组)为研究对象,采用双能X线骨密度检测仪进行骨密度测定,同时测定血清钙、磷、镁、血清总碱性磷酸酶(T-ALP)、甲状旁腺激素(PTH)、空腹尿钙与肌酐比值(Ca/Cr)、抗酒石酸盐酸性磷酸酶(TRAP)、骨钙素(GBP)等骨代谢生化指标.结果 (1)COPD组股骨颈部(Neck)、股骨大转子(G.T)、股骨粗隆间(InterTro)、第二腰椎(L2)、第三腰椎(L3)及第四腰椎(L4)的骨密度值低于对照组,差异有统计学意义(P＜0.05);吸入激素的COPD患者骨密度测定值仅在股骨Neck及L2两处低于未吸入糖皮质激素的COPD患者,差异有统计学意义(P＜0.05).(2)COPD组与对照组血清钙、磷及T-ALP、GBP水平间差异无统计学意义(P＞0.05),而血清镁、PTH、TRAP及尿钙/肌酐间差异均有统计学意义(P＜0.05);吸入激素的COPD患者较未吸入者血清镁、BGP降低,TRAP、尿钙/肌酐值升高,差异有统计学意义(P＜0.05).(3)吸入糖皮质激素治疗的时间与左侧股骨Neck、G.T及腰椎L3、L4的骨密度测定值呈负相关(r值分别为-0.69、-0.38、-0.46及-0.54,P＜0.05).结论 老年男性COPD患者的骨密度测定水平低于同龄健康人群.COPD患者中,吸入糖皮质激素者与未吸入者骨密度变化无显著差异,但吸入糖皮质激素者较未吸入者骨吸收指标升高,骨形成指标下降.     

继发性甲状旁腺功能亢进的血液透析患者骨代谢及骨密度研究

目的探讨继发性甲状旁腺功能亢进（secondary hyperparathyroidism, SHPT）的维持性血液透析患者骨密度及骨代谢特点。方法156例患者纳入本研究,常规检测透析前血钙、血磷、碱性磷酸酶、C反应蛋白,化学发光法检测血清全段甲状旁腺素（iPTH）、骨钙素（OC）、I型前胶原氨基末端前肽（PINP）、β胶原蛋白水平（β-CTX）,双能X线法测定患者骨密度。结果维持性血液透析患者诊断SHPT 66例,非SHPT 90例。 SHPT患者较非SHPT患者OC[（197.36±177;44.19）ng/ml vs.（527.89±177;85.53）ng/ml,P＆lt;0.001],PINP[（327.15±177;40.40）ng/ml vs.（616.99±177;125.82）ng/ml, P＆lt;0.001]、β-CTX[（1.99±177;0.16）ng/ml vs.（2.47±177;0.15）ng/ml,P=0.049]水平增高。 SHPT患者较非SHPT患者骨密度结果全身平均BMD值[（1.01±177;0.12） vs.（0.93±177;0.14）,P=0.017],Z值[（-0.78±177;0.50） vs.（-1.00±177;0.79）,P=0.043]减低;lo-gistic回归分析,透析前血磷（P=0.000）、OC（P=0.007）、透析龄（P=0.002）是SHPT的独立影响因素。结论全面评估SHPT患者骨代谢指标及骨密度情况,对于患者SHPT骨病的诊断及治疗有着重要意义。     

EFFECTS OF LEVOTHYROXINE ON BONE METABOLISM IN PATIENTS WITH DIFFERENTIATED THYROID CANCER AFTER OPERATION AND ^131I ABLATION

Objective To investigate the effects of substitutive and suppressive doses of levothyroxine on bone metabolism in patients with differentiated thyroid carcinoma after surgery and 131I ablation. Methods The patients, who had received levothyroxine（L-T4） for at least 3 years for treating their differentiated thyroid carcinoma after surgery and 131I therapy, were classified into substitutive group and suppressive group according to the levels of serum free triiodothyronine （FT3）, free thyroxine （FT4）, thyroid-stimulating hormone （TSH）. We compared the levels of FT3, FT4, TSH, serum parathyroid hormone （PTH）, serum calcium （Ca）, serum phosphate （P）, serum alkaline phosphates （ALP） and Bone mineral density （BMD） to those of healthy volunteers well matched for sex, age, menopausal status, and body mass index （BMI）. Results No significant differences were found in the bone density and biochemical parameters of bone metabolism of the subjects treated with substitutive or suppressive doses of L-T4 compared with the control subgroup. No significant differences were observed among the subgroups according to accumulative doses of 131I. No bone fracture was found in all the patients. Conclusion The substitutive and suppressive doses of L-T4 are safe and necessary for patients with differentiated thyroid carcinoma after surgery and 131I therapy. Such treatment for 3 years is not associated with increased risk of osteoporosis. Much longer term of follow up is still needed in patients receiving substitutive and suppressive doses of L-T4.     

血透及腹透患者骨代谢指标比较与相关性分析

目的探讨血液透析（HD）及腹膜透析（PD）患者骨代谢血清生物化学指标的差异及其相关性。方法将患者按所采用的透析方式分为HD组及PD组,分别监测其血清中钙、磷、全段甲状旁腺激素（iPTH）、骨碱性磷酸酶（BALP）和抗酒石酸酸性磷酸酶5b（TRAP5b）的变化。结果两组间的血钙、血磷、iPTH及BALP水平无显著差异;HD组血清TRAP5b水平高于PD组（P〈0．05）;iPTH水平与BALP活性、TRAP5b活性呈正相关关系（r=0．466,r=0．745,P〈0．叭）。结论PD对血清TRAP5b活性的作用优于HD。将iPTH与BALP、TRAP5b结合起来综合分析能更全面了解骨组织的代谢情况,有益于肾性骨病的诊断和治疗。     

甲状腺功能亢进患者治疗前后骨矿代谢的变化与机制

目的 了解甲状腺功能亢地（甲亢）患者治疗前后骨矿物质代的变化与机制。方法 选择４５例甲亢治疗前和治疗后患者。采用酶联免疫法测定了血清有特异性碱性磷酸酶（ＢＡＰ）、尿脱氧吡啶啉（ＤＰＤ）、用放射免疫法测定了血清降钙素（ＣＴ）、甲状旁素（ＴＨ－Ｍ）、骨钙素（ＢＧＰ）及相关生化指标,双能Ｘ线吸收法测定腰椎（Ｉ２－４）和股骨颈（Ｎｅｃｋ）、大转子（Ｔｒｏｃｈ）、Ｗａｎｄ‘ｓ三角（Ｗａｎｄ’ｓ）骨密度（ＭＢ     

Relation of serum growth hormone and estradiol levels and osteoporosis in postmenopausal women

Serum GH, E2, FSH, LH levels, bone mass, serum alkaline phosphatase (AKP), calcium levels and urinary calcium/creatine ratio in 42 postmenopausal women were compared with those in 30 women of fertile age. In thirteen out of the postmenopausal women we also observed these parameters before and after treatment with diethylstilbestrol (DES). The postmenopausal women had significantly reduced serum GH (P less than 0.01) and E2 levels (P less than 0.001) and increased serum FSH(P less than 0.001), LH levels (P less than 0.001), and had lower bone mass (P less than 0.01). They also had increased serum AKP levels (P less than 0.05) and urinary calcium/creatine ratio(P less than 0.01). There were positive correlations between serum E2 and GH levels, between postmenopausal bone loss and serum E2, GH decline. The postmenopausal bone loss began early as menopause commenced. After treatment with DES in 13 postmenopausal women, we observed that GH significantly increased (P less than 0.01) and FSH, LH decreased (P less than 0.001), AKP decreased by 27.58% and urinary calcium/creatine ratio decreased by 43.94% (compared with that before treatment). Our results indicate that bone turnover increased after menopause and resorption exceeded formation. There is bone loss in early postmenopause. The postmenopausal bone loss is related to serum GH, E2 levels. Estrogen replacement therapy is necessary in postmenopausal women and it should be given as early as possible. After treatment with DES, increased serum GH levels, decreased AKP values (27.58%) and urinary calcium/creatine ratio (43.94%) suggest that estrogen may play a definite role in bone metabolism through increased GH.     

维持性血液透析患者发生骨质疏松的危险因素及其与血清钙、磷、甲状旁腺素的关系

目的 观察维持性血液透析患者发生骨质疏松的危险因素及骨质疏松与血清钙、磷、甲状旁腺素的关系。 方法 选择绍兴市中医院肾内科2012年1月—2015年12月进行维持性血液透析患者200例进行研究,将其分为骨质疏松组93例,非骨质疏松组107例。收集患者的临床资料,测定患者的跟骨骨密度及血清钙、磷、甲状旁腺素水平。 结果 骨质疏松组患者男性比例(33.3%)低于非骨质疏松组(62.6%)(P<0.05),骨质疏松组≥60岁患者比例(63.4%)高于非骨质疏松组(29.9%)(P<0.05),骨质疏松组患者体重、身高、体重指数[(59.34±10.27) kg、(1.62±0.08) m、(20.89±1.34) kg/m2]均低于非骨质疏松组[(67.35±12.63) kg、(1.67±0.06) m、(22.14±2.54) kg/m2](P<0.05)。骨质疏松组血磷和甲状旁腺素水平(1.91±0.57) mmol/L、(381.34±77.36) ng/L均高于非骨质疏松组(1.64±0.52) mmol/L、(243.64±64.35) ng/L (P<0.05),2组血钙比较差异无统计学意义(P>0.05)。Logistic回归分析显示:性别、年龄、血磷是维持性血液透析患者骨质疏松的独立影响因素(P<0.05)。女性、高龄、血磷升高是维持性血液透析患者骨质疏松的独立危险因素。维持性血液透析患者骨密度值与血清钙、磷、甲状旁腺素水平差异均无统计学意义(均P>0.05)。 结论 女性、高龄、高磷血症是维持性血液透析患者骨质疏松的独立危险因素,维持性血液透析患者的骨密度与血清钙、磷、甲状旁腺素水平无显著相关性。      

西那卡塞联合小剂量骨化三醇治疗重度继发性甲状旁腺功能亢进的 效果及其对骨代谢的影响

目的：探讨西那卡塞联合小剂量骨化三醇治疗维持性血液透析重度继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者的临床疗效及其对骨代谢的影响。方法：选择中南大学湘雅二医院肾内科血液透析 中心维持性血液透析>6个月的重度SHPT患者30例,所有患者全段甲状旁腺激素(intact parathyroid hormone,iPTH)> 600 pg/mL;B超示甲状旁腺有1个以上结节增生;既往药物治疗无效。给予口服西那卡塞25~75 mg/d,同时服用骨化三 醇0.5 μg/d。比较治疗前和治疗后血钙、血磷、iPTH以及骨代谢指标和骨密度的变化,观察患者治疗前有关的临床症状及 治疗后改善情况。结果：入组30例患者,基线iPTH(1 787.3±1 321.0) pg/mL,血钙(2.54±0.19) mmol/L,血磷(2.06±0.15) mmol/L。 治疗2周后患者血磷下降20%;iPTH治疗1个月后较服药前降低35%,3个月后降低70%;治疗1个月后血钙和血磷分别 降至(2.39±0.17)和(1.56±0.50) mmol/L(P<0.05),患者症状明显缓解,12个月后上述指标保持稳定;治疗6个月后骨代谢 指标显示碱性磷酸酶、骨钙素、β胶原特殊序列水平分别较治疗前下降50%,37%和49%;患者的骨密度年下降幅度受 到抑制。无严重不良反应发生。结论：西那卡塞联合小剂量骨化三醇可以改善维持性血液透析患者重度SHPT高钙、 高磷及高iPTH状态,缓解临床症状,改善骨质代谢,可以作为治疗重度SHPT的选择。     

Relationships between serum osteoprotegerin, matrix metalloproteinase-2 levels and bone metabolism in postmenopausal women

Background Serum osteoprotegerin (OPG) and matrix metalloproteinase-2 (MMP-2) have been shown to play a role in bone metabolism by degrading the bone matrix. The present study was undertaken to compare OPG and MMP-2 with bone mineral density and three markers (alkaline phosphatase (AKP), calcium and phosphorus) in postmenopausal women in Wuhan.Methods Serum OPG, MMP-2, and AKP of 78 Chinese postmenopausal women aged 48 to 65 were measured using enzyme-linked immunosorbent assay (ELISA). Bone mineral density was measured with dual energy X-ray absorptiometry (DEXA), and serum calcium and phosphorus were measured by auto biochemical analysis .Results Serum OPG and MMP-2 concentrations were significantly higher in postmenopausal women with osteoporosis ((127.6±6.3) ng/L; (1388±121) μg/L)) than those in age-matched normal controls ((72.3±2.4) ng/L; (1126±141) μg/L, P&lt;0.01). Negative relationships were found between serum OPG, MMP-2 levels and bone mineral density in osteoporotic women. Adjusted by age and body mass index (BMI), the correlation of MMP-2 with bone mineral density of the neck of the femur disappeared. In osteoporotic women, negative correlations between OPG, MMP-2 levels and serum calcium were found (r=–0.216; r=–0.269, P&lt;0.05), but positive correlations between OPG and serum AKP, serum phosphorus (r=0.235; r=0.124, P&lt;0.05).Conclusions Significant correlations exist between serum OPG, MMP-2 levels and bone metabolism in high bone turnover of postmenopausal osteoporotic women. The concentrations of serum OPG and MMP-2 increase possibly as a concomitant event in the high bone turnover state, such as postmenopausal osteoporosis. Therefore serum OPG and MMP-2 could be used as indicators for the bone metabolism in postmenopausal osteoporotic women.     

骨化三醇联合摄精消白胶囊对早期糖尿病肾病患者尿蛋白及骨密度的影响

目的 观察骨化三醇联合摄精消白胶囊对早期糖尿病肾病(diabetic nephropathy,DN)患者尿蛋白及骨密度的影响.方法 选取2018年7月—2019年12月就诊于本院的早期DN患者94例,按照随机数字表法随机分为3组.对照组29例予以降糖、降压治疗;西药组33例在对照组治疗基础上,予以骨化三醇口服治疗;联合...     

肝硬化患者骨密度及骨代谢变化分析

目的:探讨肝硬化child分级与骨密度(BMD)及骨代谢的关系,为防治肝硬化患者出现骨质疏松(OP)提供科学依据。方法:采用QCT骨密度测量仪对47例肝硬化患者和36例健康男性的BMD进行检测,同时测定血清甲状旁腺素(PTH)、骨钙素(BGP)、血清Ca和P水平。结果:随肝硬化肝功损害程度的加重,BMD、BGP、Ga、P均降低,PTH升高。结论:BMD降低是长期慢性肝病缓慢作用所致,故提倡在治疗肝硬化同时,也要进行预防OP的治疗。     

三七总黄酮抗糖皮质激素诱发骨质疏松的效应

  目的  研究三七总黄酮拮抗糖皮质激素诱发骨质疏松的效应及可能的机制。  方法  将50只体重约170 g的SPF级雌性SD大鼠随机分为五组（10只/组），即正常对照组、模型组（激素组）和三七总黄酮高、中、低剂量治疗组（激素 + 用药组）。模型组和三七总黄酮治疗组采用地塞米松（2.5 mg/kg）肌肉注射，每周2次；同时三个治疗组分别给予三七总黄酮275 mg/（kg·d）、137.5 mg/（kg·d）、68.75 mg/（kg·d）灌胃治疗，每天1次。实验期9周。9周后测定各组大鼠股骨骨密度、反映骨生物力学性能的指标及血清生化指标。  结果  与正常组比较，模型组大鼠股骨骨密度（BMD）、骨生物力学性能、血清钙水平明显降低，血清磷水平及血清碱性磷酸酶活性明显升高（P < 0.05）；与模型组比较，三七总黄酮高、中剂量治疗组大鼠股骨BMD、骨生物力学性能、血清钙水平明显增高，血清磷水平及血清碱性磷酸酶活性明显降低（P < 0.05）。  结论  三七总黄酮可提高糖皮质激素性骨质疏松大鼠骨密度，改善其骨生物力学性能，对糖皮质激素诱发的骨质疏松具有拮抗作用，作用机制与其抑制骨吸收及糖皮质激素诱导的钙磷代谢失衡有关。     

西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的临床研究

目的:研究和分析西那卡塞(盖平)治疗血液透析患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的疗效及安全性。方法:选取118例行血液透析合并SHPT患者,应用随机数字表法分为观察组和对照组,每组纳入59例。对照组患者接受骨化三醇冲击治疗,观察组患者在骨化三醇冲击治疗的同时加用口服盐酸西那卡塞进行治疗。比较两组患者的疗效和治疗期间的不良反应发生率。对两组患者治疗前、后的血清全段甲状旁腺素(i PTH)、血清钙、血清磷、钙磷乘积、成纤维细胞生长因子23(FGF23)、骨特异性碱性磷酸酶(BSAP)水平及甲状旁腺体积进行检测和比较。结果:治疗后,观察组患者的血钙、钙磷乘积水平高于对照组,血磷、血清i PTH、FGF23、BSAP水平及甲状旁腺体积均低于对照组,差异有统计学意义(P<0.05)。观察组和对照组患者的总有效率为96.6%和83.1%,差异均有统计学意义(P<0.05)。观察组和对照组患者的不良反应发生率为20.3%和11.9%,差异均无统计学意义(P>0.05)。结论:SHPT的治疗中,在骨化三醇治疗基础上加用西那卡塞治疗,能够有效缓解患者的钙磷代谢异常,改善临床症状,降低血清FGF23、BSAP水平,具有较好的治疗效果,且不会增加不良反应。     

甲亢患者治疗前后骨生化指标和骨密度变化的临床研究

目的了解甲亢病人治疗1年前、后骨生化指标和骨密度的变化,提高对甲亢性骨代谢异常的认识。方法对136例甲亢病人经抗甲状腺药物治疗或加用维生素D（或活性维生素D）和钙剂治疗1年前、后的骨生化代谢指标血钙、磷、碱性磷酸酶、24h尿钙、尿磷以及骨密度进行测定和分析。结果与正常对照组比较,甲亢患者FT3、FT4、ALP和24h尿钙均明显升高,而TSH和骨密度均明显降低;其骨量减少和骨质疏松发生率亦明显增高。治疗1年后,随着甲亢的控制,甲亢患者的血ALP和24h尿钙水平恢复正常;骨密度明显升高,但仍低于正常对照组;其骨量减少与骨质疏松发生率也有不同程度降低;进一步分析发现,加用维生素D（或活性维生素D）和钙剂治疗的患者上述指标改善较单纯抗甲状腺药物治疗者明显。结论甲亢性骨代谢异常是一种高骨转换状态,可以引起骨量减少和骨质疏松。及早并有效地控制甲亢,尤其加用维生素D（或活性维生素D）和钙剂治疗可以纠正这一异常,并有助于改善骨质量。