男性2型糖尿病患者维生素D营养状况及其对骨代谢指标的影响

目的 了解男性2型糖尿病患者维生素D营养状况及其对骨代谢指标的影响.方法 采用Roche E170全自动电化学发光免疫分析仪检测258例男性2型糖尿病患者血清的25羟维生素D[25(OH)D]、总Ⅰ型前胶原氨基端肽(tPINP)和Ⅰ型胶原羧基端肽(β-CTX).根据血清25 (OH)D水平分为维生素D严重缺乏(＜25nmol/L)、缺乏(≥25nmol/L且＜ 50nmol/L)、不足(≥50nmol/L且＜75 nmol/L)和充足(≥75nmol/L).结果 男性2型糖尿病患者总体25(OH)D浓度为33.80±18.43nmol/L,为维生素D缺乏水平.根据年龄将受试者分为中年组(35 ～49岁)、老年前期组(50 ～ 59岁)、老年1组(60～69岁)、老年2组(＞70岁),发现随着年龄的增长,25(0H)D的浓度呈逐渐降低趋势,老年2组的25(OH)D显著低于中年组(P=0.044),而骨标志物在各年龄组间差异均无统计学意义(P＞0.05).258例男性2型糖尿病患者中维生素D严重缺乏、缺乏、不足、充足的比例分别为36.43％ (94/258)、48.45％(125/258)、11.63％ (30/258)和3.49％ (9/258).维生素D严重缺乏组的β-CTX明显高于其他各营养状况组(均P＜0.05),而tPINP在各营养状况组间差异均无统计学意义(P＞0.05).相关分析表明,血清25(OH)D水平与β-CTX呈负相关(r=-0.197,P=0.001),与tPINP无相关性(r=-0.046,P =0.464).结论 男性2型糖尿病患者存在严重维生素D缺乏和不足状况,维生素D严重缺乏对骨吸收可能有影响.     

老年髋部骨折患者尿脱氧吡啶啉与肌酐比值及Singh指数的相关性

背景：尿脱氧吡啶啉与肌酐比值与Singh指数是临床常用的评估骨强度和骨量丢失情况的指标,但二者之间的相关性分析鲜有报道。 目的：观察脱氧吡啶啉与肌酐比值与Singh指数在老年髋部骨折中的相关性。 方法：对100例60岁以上新鲜股骨颈骨折或股骨转子间骨折患者测定尿脱氧吡啶啉、尿肌酐及股骨近端Singh指数,计算脱氧吡啶啉与肌酐比值与Singh指数的关系。 结果与结论：100例股骨颈骨折或股骨转子间骨折患者尿脱氧吡啶啉与肌酐比值为(6.11±2.09) nmol/mmol;其中97例高于正常值范围,提示这些患者已经有骨量的丢失;Singh指数4级以下91例;5级9例。Spearman相关性分析结果显示,老年髋部骨折患者尿脱氧吡啶啉与肌酐比值与Singh指数呈负相关(r=-0.32,P=0.007)。提示脱氧吡啶啉与肌酐比值与Singh指数存在线性相关性,在评价老年髋部骨折患者骨质方面2种方法结果一致。     

非体外循环下冠状动脉旁路移植围术期血浆脑钠肽释放及其相关性研究

背景：B型脑钠肽已成为心血管疾病诊断重要的血清标志物,作为心血管疾病危险因素分层的重要因子。 目的：分析冠状动脉旁路移植前后B型脑钠肽与各项血流动力学参数的关系。 方法：选择30例冠心病行冠脉旁路移植患者,分为左室射血分数≥ 50%心功能正常患者13例;左室射血分数< 50%心功能不全患者17例。观察患者移植前1 d、移植后7 h、移植后1,3,5,7 d血浆B型脑钠肽水平变化趋势,分析移植前后B型脑钠肽与心功能各项指标的相关关系。 结果与结论：左室射血分数≥ 50%组患者冠脉旁路移植前后血浆B型脑钠肽水平显著低于左室射血分数< 50%组;组内比较移植后血浆B型脑钠肽水平均显著高于移植前(P < 0.05或P < 0.001)。患者冠脉旁路移植前B型脑钠肽水平与纽约心脏病协会心功能分级、左房内径、左室内径呈正相关(r=0.61;r=0．34;r=0．67);与左室射血分数、心排血量呈负相关(r=-0.75;r=-0.70)。患者移植后B型脑钠肽峰值浓度与出院前纽约心脏病协会心功能分级、超声心动图左室舒张末期内径、肺动脉压力呈正相关(r=0.72;r=0.70;r=0.45)。结果说明冠心病患者冠脉旁路移植前血浆B型脑钠肽质量浓度与左心室射血分数及左心室舒张末期内径有很好的相关性,能准确反映冠脉旁路移植前后的心功能状态。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

荣成地区3260名儿童血清25-羟维生素D水平调查

目的了解荣成地区儿童的血清25-羟维生素D的水平,为临床应用维生素D制剂提供参考。方法以在荣成市妇幼保健院进行系统化管理的儿童在2008年10月1日～2009年3月31日半年来儿童保健科做保健3月-6岁儿童,取清晨空腹静脉血,用酶联免疫法检测血清25-羟维生素D平均水平。结果荣成地区儿童健康儿童血清25-羟维生素D水平为(89.4±29.3)nmol/L,如以25-羟维生素D50nmol/L作为维生素D缺乏的标准,则其发生率为8.5%,上述指标随年龄增长呈有规律的波动趋势。结论荣成地区健康儿童的维生素D营养状况好;血清25-羟维生素D水平随年龄波动。     

骨质疏松症与维生素D受体基因多态性的相关性

背景：骨质疏松是多基因调控疾病,峰值骨量变化和骨量丢失均受遗传因素影响。 目的：通过观察维生素D受体基因 ApaⅠ多态性在山东半岛汉族人群中的分布规律及与骨质疏松的关系,探讨原发性骨质疏松症的遗传易感因素。 方法：选取367名长期居住在山东半岛地区无亲缘关系的汉族人群。将受试者分为骨密度正常组227例,骨质疏松组63例,骨质疏松性骨折组77例。 结果与结论：实验人群维生素D受体基因的基因型频率分布符合Hardy-Weinberg平衡定律(χ² =1.583, P > 0.05)。基因型频率分布依次为aa型占53.1%,Aa型占10.6%,AA型占36.3%。年龄与不同部位骨密度值之间呈负相关(P< 0.01),体质量指数与骨密度值之间呈正相关(P < 0.01),在将年龄和体质量指数进行校正后发现aa基因型在腰椎(P < 0.05)、wards三角(P < 0.05)骨密度较低。运用χ2检验分析骨密度正常组各基因型与骨质疏松性骨折组之间差异无显著性意义(χ² =4.795,  P > 0.05)。结果证实,山东半岛地区汉族人群中,维生素D受体基因ApaⅠ酶切位点多态性与原发性骨质疏松症存在关联,提示维生素D受体基因ApaⅠ酶切位点多态性在决定个体骨质疏松症遗传易感性方面起重要作用。     

孕晚期维生素D水平对新生儿骨发育的影响

目的研究孕晚期孕产妇维生素D水平对骨发育评价指标及对肺发育成熟的指标的影响,探寻孕晚期维生素D水平对胎儿骨发育的作用及机制。方法随机抽选待分娩的孕产妇182名,据其分娩前一周维生素D水平,将其分为维生素D充足组(≥75nmol/L)、维生素D不足组(74-50nmol/L)和维生素D缺乏组(50nmol/L)。分娩时采取其胎儿脐带血,测量胎儿出生时身长、头围及胸围,用ELISA试剂盒检测维生素D含量。结果在孕妇孕晚期维生素D明显缺乏组,而新生儿维生素D水平与其母亲孕晚期维生素D水平呈正相关(R2=0.642,P0.05),而维生素D含量正常组孕产妇的新生儿身长、头围及胸围较其他两组明显长(P0.05)。结论沈阳地区孕晚期维生素D缺乏将导致新生儿维生素D水平低,骨发育延缓。     

血脂与骨密度：新疆男性高血压患者相关性

背景：有研究表明绝经后女性血脂与骨密度有一定相关性,但针对男性对象的研究较少,且结论不一。 目的：通过分析新疆乌鲁木齐市地区维吾尔族与汉族男性高血压患者血脂与骨密度的关系,探讨血脂水平与骨质疏松及骨量减少的相关性,以及民族间的差异。 方法：将193例男性高血压患者,按照民族分为2组,维吾尔族73例,汉族120例,再根据是否合并骨质疏松和骨量减少,将上述2组患者再分别分为2个亚组,分析各组骨密度与血脂的相关性,并用二元Logistic逐步回归方法分析血脂和其他相关因素与骨质疏松之间的相关性。 结果与结论：高血压维吾尔族骨质疏松及骨量减少患者中,胆固醇与股骨颈(r= 0.43,P=0.01)、Ward三角区(r=0.42,P=0.01)均为正相关,而在汉族高血压患者中未见明显相关性。应用二元Logistic回归方法进行分析,在控制体质量指数、年龄和民族因素后,仅胆固醇与骨质疏松及骨量减少的发生有关(OR=1.48,P=0.03)。结果证实,新疆男性维吾尔族与汉族高血压患者中,血脂与骨密度存在一定相关性,可能为骨质疏松发生的影响因素。     

仙珍骨宝胶囊对去卵巢大鼠股骨颈骨代谢的影响

背景：用骨组织形态计量学方法探讨中药对去卵巢大鼠股骨颈骨质疏松的影响,可为采用中药防治绝经后妇女骨质疏松性股骨颈骨折提供实验依据。 目的：观察仙珍骨宝胶囊对去卵巢大鼠股骨颈松质骨的影响。 方法：3月龄SD雌鼠随机分为4组：基础对照组于实验开始时处死取材,去卵巢组和仙珍骨宝组去卵巢造模,仙珍骨宝组在去卵巢后灌胃仙珍骨宝,去卵巢组和年龄对照组灌胃生理盐水,90 d后处死,取股骨颈经不脱钙骨制片进行骨组织形态计量学参数测量。 结果与结论：与年龄对照组比较,去卵巢大鼠静态参数的骨小梁面积百分数和骨小梁数量明显减少(P < 0.01),骨小梁间隙明显增大(P < 0.01);动态参数的每毫米破骨细胞数和破骨细胞贴壁表面长度明显增加(P < 0.01),骨矿化沉积率明显减少(P < 0.01)。说明去卵巢能导致大鼠股骨颈骨量显著减少。给予仙珍骨宝治疗后,大鼠的骨小梁厚度及骨小梁面积明显增加(P < 0.05),每毫米破骨细胞数和破骨细胞贴壁表面长度有所减少,标记周长百分数则有所增加。说明仙珍骨宝能阻止去卵巢所致的大鼠股骨颈骨量丢失。     

妊娠期糖尿病孕妇血清中25-羟维生素D_3缺乏现状及影响因素分析

目的了解深圳地区妊娠期糖尿病病(gestational diabetesmellitus,GDM)孕妇血中25-羟维生素D_3[25-hydroxyvitaminD3,25-(OH)VitD_3]缺乏现状,并探讨其影响因素,为GDM孕妇是否需要补充维生素D提供理论依据。方法收集2016年2月～2018年11月来医院产前检查并确诊为GDM孕妇185例为GDM组,选择同期来院产检的正常孕妇421例为对照组,分别采用c8000全自动化学发光免疫分析系统检测血清中25-(OH)VitD_3的含量,并对检测结果进行统计分析。结果 GDM组孕妇25-(OH)-vitD_3缺乏率为55.68%(103/185),明显高于对照组孕妇的34.68%(146/421),差异有统计学意义(χ~2=3.9105,P0.05);GDM组孕妇血清中25-(OH)-vitD_3水平为39.28±9.06nmol/L,明显低于对照组的58.24±16.52nmol/L,差异有统计学意义(t=2.9250,P0.05);GDM组不同孕期血清中25-(OH)-vitD_3水平均明显低于对照组孕妇,差异有统计学意义(t=2.5069～3.8403,P0.05),且各组中晚期孕妇血清中25-(OH)-vitD_3水平高于孕早期,差异有统计学意义(t=2.0541～2.3085)。结论深圳地区GDM孕妇血清中25-羟维生素D3缺乏现象比较严重,且GDM孕妇血清中25-羟维生素D3水平明显低于正常妊娠孕妇。因此,加强GDM孕妇血清中25-羟维生素D3水平监测,对GDM孕妇能及时、准确、足量补充维生素D提供科学依据。     

人体25羟维生素D的竞争蛋白结合测定及冬夏季正常值

本文采用二氯甲烷/乙醇粗提血浆,高压液相色谱精分,竞争蛋白结合测定法求得25羟维生素D值,夏季北京居民正常值为13.2±5.9ng/ml(33.0±14.8nmol/L)(n=68),其中男性为13.0±5.7ng/ml(32.5±14.3nmol/L)(n=39),女性为13.5±6.2ng/ml(33.8±15.5nmol/L)(n=29);冬季正常值为10.4±3.8ng/ml(26.1±9.6nmol/L)(n=45),其中男性为10.2±4.2ng/ml(25.4±10.4nmol/L)(n=22),女性为10.7±3.6ng/ml(26.6±8.9nmol/L)(n=23),性别间无显著性差异,夏冬季P值均大于0.5;夏季值之间差异显著(P<0.01)。 文中还对响影测定的有关问题作了讨论。     

Vitamin D status and hyperparathyroisism in postmenopausal osteoporotic patients in Cipto Mangunkusumo hospital Jakarta

Aim: to determine the profile of vitamin D and parathyroid hormone (PTH) and the proportion of vitamin D inadequacy in a population of postmenopausal osteoporotic patients from a rheumatologic outpatient clinic. Methods: a cross sectional study was conducted between October and December 2006 in the Rheumatology Clinic, Cipto Mangunkusumo Hospital with osteoporosis confirmed by bone mineral densitometry (T score less than -2.5 at the lumbar spine or hip). Patients were excluded if there was a history of oral glucocorticoid treatment within 30 days, vitamin D supplementation, and have renal and/or liver function impairments. Forty-two postmenopausal osteoporotic patients aged 51-77 years old who had been postmenopausal for 5-28 years were included in this study. Vitamin D inadequacy was defined as the plasma levels of 25(OH)D less than 50 nmol/L whereas hyperparathyroidism was defined as the PTH level more than 69 pg/dL. Results: vitamin D inadequacy was found in 61.9% of patients and 34.6% of them or 23.8% of total patients were also having high PTH level. There was an inverse correlation between 25(OH)D with PTH levels and positive correlation between duration of menopause and PTH level. Vitamin D inadequacy is common (61.9%) in postmenopausal osteoporotic patients who visited Rheumatology outpatient clinic of Cipto Mangunkusumo Hospital Jakarta. Conclusion: the low concentration of 25(OH)D was correlated with PTH level and duration of menopause. This finding should be confirmed in a larger epidemiological study, either hospital-or community-based to assess vitamin D status among postmenopausal women in Indonesia.     

血浆血栓素A2/前列腺素I2值与骨骼肌无复流现象

背景：在骨骼肌无复流现象中血栓素A2及前列腺素I2是重要参与因子。 目的：观察下肢动脉栓塞患者血浆血栓素A2/前列腺素I2值与骨骼肌发生无复流现象的关系。 方法：选择经影像学及临床表现确诊为下肢动脉栓塞患者36例,行下肢动脉取栓,根据患者取栓后缺血肢体是否发生无复流现象分为无复流组(n=10)和对照组(n=26)。 结果与结论：与对照组比较,无复流组取栓后0 h无复流组前列腺素I2明显减少(P < 0.01);取栓后24 h,无复流组血栓素A2明显升高、前列腺素I2明显下降(P < 0.01)。与对照组相比,无复流组术后血栓素A2/前列腺素I2值升高(P < 0.05)。与术前相比,对照组术后血栓素A2/前列腺素I2值升高后然后下降,无复流组取栓后均维持较高的水平。而取栓前后两组血小板数量及血浆纤维蛋白原的水平差异均无显著性意义。同时术后24 h点无复流组血栓素A2/前列腺素I2值与纤维蛋白原呈正相关(r=0.613, P=0.049);而与血小板数量无相关性(r=0.199,P=0.543)。提示血栓素A2/前列腺素I2值可以作为判断动脉栓塞患者缺血再灌注后骨骼肌发生无复流现象的指标之一。     

Assessment of vitamin D status in healthy children and adolescents living in Tehran and its relation to iPTH,gender, weight and height

Abstract

This study was conducted to determine the frequency of vitamin D deficiency and its correlation with different factors. Three hundred and thirteen healthy children and adolescents (192 females and 121 males aged 8–18 years, mean ± SD, 12.7 ± 2.3 years) were enrolled, and measurements of serum 25-hydroxyvitamin D [25(OH)D] (using EIA) and intact parathyroid hormone (iPTH) (using immunoradiometric assay (IRMA)) were conducted. The grades of vitamin D status were defined according to blood level of 25(OH)D as follows: severely deficient < 12.5; deficient, ≥ 12.5 and < 25; insufficient, ≥ 25 and < 50; normal ≥ 50 and < 250 nmol/L. Severe deficiency was detected in 25% of subjects (males 8%; females 92%), deficiency in 27% (males 34%; females 66%) and insufficiency in 26% (males 58%; females 42%). The mean 25(OH)D level in males was significantly greater than that in females (p < 0.001), and this level was significantly higher in prepubertal compared to pubertal subjects (p < 0.001). 25(OH)D had a negative correlation with iPTH (p < 0.001). The curve of iPTH began to rise when 25(OH)D reached 75 nmol/L. The level of 25(OH)D had a negative correlation with BMI-SDS and height-SDS in females (p-value, 0.01 and 0.039, respectively). The subjects did not have any signs or symptoms of rickets. Frequency of vitamin D deficiency did not have any significant seasonal variation. Furthermore, vitamin D deficiency was not found to be related to the type or location of the subjects' homes. In this study, subclinical vitamin D deficiency was significantly more prevalent in females, particularly those undergoing puberty. Children who were obese and taller than average, had lower levels of 25(OH)D, and level of 25(OH)D should be maintained > 75 nmol/L in order to prevent PTH rising.     

股骨头骨骺缺血性坏死模型兔构建及组织病理学变化和p53与bcl-2的表达

背景：研究表明儿童股骨头骨骺缺血性坏死(Perthes病)的发病与儿童股骨头血液供应、髋关节周围病变、外伤、内分泌因素、遗传等多种原因有关。 目的：建立可靠的Perthes病的动物模型,并观察其股骨头组织学变化、细胞凋亡情况及p53和bcl-2基因的表达,并探讨凋亡基因p53和bcl-2与Perthes病的的相关性。 方法：采用C型臂透视下经右侧股骨颈注射TH胶致骺板缺血,建立幼兔Perthes病模型,并以同样方法用经右侧股骨颈给予注射生理盐水的兔作对照,于建模后4,6,8,10,12周分别取模型组和对照组两组右侧股骨头做病理切片,观察两组髋关节骺板细胞凋亡情况,并观察两组右侧股骨头p53和bcl-2等凋亡基因表达阳性率的变化。 结果与结论：建模后4周开始出现模型组右侧髋关节关节间隙增宽,出现点状出血变性区并逐步扩大,随后关节软骨与骨骺的黏附强度下降,骨质松脆,干骺端疏松变软。模型组右侧股骨头骺板细胞凋亡率与p53基因表达阳性率呈明显正相关性(r =0.68, P < 0.05),与bcl-2基因表达阳性率之间呈明显负相关性(r =-0.75, P < 0.01)。实验建立的perthes病动物模型稳定,简单,无反复现象。结果证实了Perthes病的发生与p53和bcl-2凋亡基因相关。     

Correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength in Indonesian elderly women living in three nursing homes

AIM: to investigate the correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength. METHODS: this was a cross-sectional correlative study, conducted at three nursing homes in Jakarta and one nursing home in Bekasi in January 2005. The subjects were women aged 60 years or above. Those selected study subjects underwent quadriceps femoris muscle strength examination with Cybex dynamometer with 150 degrees/second speed, twice (three repetitions with 30 second rest time). The 25 (OH)D concentration was measured by ELISA. RESULTS: out of 67 subjects who met the required criteria for this study, five subjects withdrew from the study during muscle strength examination. The mean age was 71.1 (SD 7.2) years old while the mean serum vitamin D concentration was 68.2 (SD 21.6) nmol/l. Vitamin D deficiency (相似文献   

Relationships between myocardial injury, all-cause mortality, vitamin D, PTH, and biochemical bone turnover markers in older patients with hip fractures

This study examined the relationships between myocardial injury as indicated by serum cardiac troponin I (cTnI) elevation, 25 hydroxyvitamin D [25(OH)D], and PTH status and biochemical markers of bone metabolism in older patients with hip fracture (HF). In 238 consecutive patients (mean age 81.9 +/- 7.8 yr; 72% women) with low trauma HF, serum concentrations of cTnI, 25(OH)D, PTH, calcium, phosphorus, magnesium, osteocalcin, bone-specific alkaline phosphatase (BAP), and urine excretion of free deoxypyridinoline (DPD) and N-terminal cross-linked teleopeptide of type I collagen (NTx) were measured and clinical data were collected prospectively. Myocardial injury (cTnI >0.06 microg/L) presented in 29%, 25(OH)D deficiency (<50 nmol/L) in 81.6%, elevated PTH (>6.5 pmol/L) in 53%, and excessive bone resorption (increased DPD and/or NTx excretion) in 93.7%. Multivariate logistic regression showed that elevated serum PTH level is a major predictor of peri-operative myocardial injury (OR = 2.13; 95% CI 1.01-4.51; p = 0.049) and in-hospital all-cause mortality (OR = 18.5; 95% CI 2.0-72.3; p = 0.010), independent of age, sex, 25(OH)D status, and comorbidities. The degree of hyperparathyroidism was associated with the risk of cTnI elevation and the mortality rate. In cTnI positive patients, PTH levels correlated with cTnI concentrations (r = 0.28; p = 0.026) and urine DPD exretion (r = 0.37; p = 0.004). These results suggest for the first time that in older patients with HF, elevated PTH level is associated with peri-operative myocardial injury and in-hospital all-cause mortality, and that elevated PTH level contributes to both disturbed bone metabolism and poor outcomes.     

Association between promoter region genetic variants of PTH SNPs and serum 25(OH)-vitamin D level

Parathyroid hormone (PTH) plays a crucial role in calcium metabolism and skeletal development via altering vitamin D level. Besides, hypersecretion of PTH is implicated in the etiology of osteoporosis. In this study, we analyzed association between promoter region sequence variants of PTH gene and circulating 25-hydroxy-vitamin D (25(OH)D) level. Genotypes of PTH SNPs rs1459015, rs10500783 and rs10500784 and circulating serum 25(OH)D level of healthy adults (N=386) of different nationalities living in Riyadh were determined and relation between the different PTH allelic variants and corresponding mean 25(OH)D values were obtained using Analysis of Variance (ANOVA) and Bonferroni post-hoc test for multiple comparisons. We observed a high prevalence of vitamin D deficiency (<50 nmol/l) among all nationals which ranged from 59% among Indians to 82% among Yemeni. Comparison of the means of 25(OH)D levels corresponding to different genotypes of PTH SNPs indicated that the T allele of SNP rs1459015 was associated with higher 25(OH)D level in the Sudanese (P=0.03), while the T allele of SNP rs10500783 was associated with higher 25(OH)D level in Saudis (P=0.03). Analysis of results also indicated that the Sudanese carriers of the CC genotype of SNP rs1459015 had a higher risk of suffering from vitamin D deficiency (P=0.02). In conclusion, our study indicated significant association between specific PTH gene promoter region variants and altered levels of 25(OH)D and vitamin D deficiency among specific nationals.