氟骨症患者的血清骨钙素测定

氟骨症患者的血清骨钙素测定梁君慧，陈丽佳，张勋堂，梅玉芝，郭平，李东喜，张世和，游友臣，常树军，郑文保选择经Ｘ线摄片确诊氟骨症患者３１名，正常对照４１名．观察血清骨钙素（ＢＧＰ）水平，并对其发生机制作初步探讨。资料和方法１．对象选择：新疆石河于地区１...     

老年男性骨质疏松症患者骨密度和生化指标的变化

目的：了解老年男性骨质疏松症患者骨密度和骨代谢生化指标变化的特点。方法：对30例老年男性骨质疏松症患者进行腰椎（L2－4）骨密度（BMD）、骨矿含量（BMC）、血和尿骨代谢生化指标的测定,并与对照组进行比较。结果：骨质疏松（OP）组的BMD和BMC均显著小于对照组,分别比对照组下降21．6％和25％;OP组骨形成指标血清碱性磷酸酸（ALP）和C端骨钙素（BGP）明显高于对照组,分别上升25．4％和222％;骨吸收指标尿羟脯氨酸与肌酐的比值（HOP／Cr)和Ⅰ型胶原N－末端肽与肌酐的比值（INTX／Cr)明显高于对照组,分别上升22．6％和223％。OP组血清T水平明显低于对照组,两组血清25－羟维生素D3（25－OH－D3）均在正常低限或低于正常水平。结论：腰椎（L2－4）BMD和BMC是诊断男性骨质疏松症的主要依据;老年男性骨质疏松症患者一部分人属于骨代谢高转换型;雄激素对老年男性骨量的维持起重要作用;老年男性维生素D缺乏质疏松症发生的重要基础。     

血清骨钙素和骨保护素在燃煤型氟骨症患者中的表达

目的 观察血清骨钙素(BGP)、骨保护素(OPG)在燃煤型地方性氟中毒(简称地氟病)人群中的表达,为深入认识氟骨症发病机制以及评价和监测除氟效果提供基础依据.方法 选择贵州省6个燃煤型地氟病病区村居民作为观察对象,进行临床氟骨症检查,按病情分度分为正常、轻度、中度、重度4种,按不同分型分为正常、硬化型、疏松型、混合型4种,并根据氟骨症病情分度情况,将观察病区村分为轻、中、重病区村.分别用放射免疫法和酶联免疫法检测观察对象血清BGP、OPG.结果 重度氟骨症患者血清BGP[(6.78±4.43)μg/L]与正常[(3.58±1.53)μg/L],轻、中度患者[(3.44±2.66)、(3.41±2.20)μg/L]比较均明显增高(P<0.05);轻、中、重度患者血清OPG[(1251.55±998.31)、(1265.94±931.77)、(1560.55±858.07)ng/L]与正常[(520.81±385.05)ng/L]比较明显增高(P<0.05).混合型氟骨症患者血清BGP[(6.09±2.62)μg/L]与正常,硬化、疏松型患者[(3.97±1.53)、(3.20±2.12)μg/L]比较均明显增高(P<0.05);硬化、疏松、混合型氟骨症患者血清OPG[(1321.63±1017.00)、(1205.42±852.22)、(1529.01±402.83)ng/L]与正常比较明显增高(P<0.05).轻病区村人群血清OPG[(452.06±338.10)ng/L]与中、重病区村[(1266.30±899.14)、(1851.80±956.08)ng/L]比较明显降低(P<0.05),重病区村与中病区村比较则明显增高(P<0.05).结论 血清OPG可作为燃煤型氟中毒骨病变的一个早期生物学指标.重度氟骨症患者的骨代谢(骨再建)处于活跃状态,并随着氟中毒的严重程度加重而加重.     

中老年妇女骨转换生化指标和骨密度的变化

目的 探讨中老年妇女骨转换生化指标与骨密度随绝经的变化.方法 408名符合条件40 ～80岁的女性志愿者,同一时间段留取血清和晨尿,统一用酶免方法 测定血清骨碱性磷酸酶(BAP)、骨钙素和尿I型胶原氨基末端肽(uNTX);用舣能X线骨密度仪测定前后位腰椎1-4(L1-4)、左侧股骨颈的骨密度.结果 (1)BAP、骨钙素和uNTX与年龄、孕次、生育次数和绝经年限呈正相关(均P相似文献   

正常女性与年龄相关的骨转换生化指标和骨密度的关系

目的　探讨女性人群骨转换生化指标 :血清骨特异性碱性磷酸酶 (sBAP)、血清骨钙素(sOC)和尿Ⅰ型胶原氨基末端肽 (uNTX)随年龄变化及其与骨密度 (BMD)之间的关系。方法　用ELISA测定sBAP、sOC和uNTX ,用DXA仪测定腰椎 1～ 4前后位 (AP)、股骨颈 (FN)的BMD。结果( 1)sBAP、sOC和uNTX与年龄呈正相关 ,3个骨生化指标随年龄的变化均以三次回归模型的拟合程度最好 ,拟合曲线的决定系数 (R2 )为 0 181～ 0 381(P <0 0 0 1)。 ( 2 )按每 10岁年龄段分组发现 :这3个生化指标在 30～ 39岁年龄段最低 ,随后随年龄的增长而升高 ;5 0～ 5 9岁段达最高值。 ( 3)按是否绝经分组结果表明 :绝经后妇女sBAP、sOC和uNTX水平均较绝经前妇女高 (P <0 0 0 1) ,而绝经后妇女的AP、FN部位的BMD都低于绝经前妇女 (P <0 0 0 1)。( 4 )sBAP、sOC与uNTX呈正相关 (P<0 0 0 1) ,sBAP、sOC和uNTX与AP、FN部位的BMD呈负相关 (P <0 0 0 1)。结论　sBAP、sOC和uNTX是反映女性随年龄及绝经变化的骨转换的敏感和较特异的指标 ,能较好地预测BMD ,妇女BMD降低与骨的代谢转换率升高有关。     

骨密度与骨代谢生化指标在原发性骨质疏松症诊断上的意义

骨密度与骨代谢生化指标在原发性骨质疏松症诊断上的意义薛延董洁英郭春英张海文贾维维何玉香孙华毅王军骨质疏松症是以骨量减少为特征，骨组织显微结构改变和骨折危险度增加的疾病，而原发性骨质疏松症是指老年性和绝经后的骨质疏松症。本组对２８例原发性骨质疏松症（Ｐ...     

燃煤污染型氟骨症患者骨密度的初步研究

本文对燃煤污染型氟骨症患者62人进行了骨密度检查,并选择非病区健康人76名作为对照。研究发现,氟骨症组40—49岁年龄段女性的桡、尺骨骨密度明显低于相应的对照组,差异显著(P<0.05)。氟骨症组50—59岁年龄段男性桡骨骨宽度明显大于相应对照组,差异显著(P<0.05)。本文对其意义进行了初步探讨。     

肝性骨病骨密度与血清骨钙素放免测定水平的变化

本文对24例肝硬变患者进行了血清骨钙素放免测定和双能X线骨密度及骨矿含量测定。结果17例（70．8％）腰椎2，3，4骨质密度和骨矿物含量均降低，提示骨质疏松，而X线摄片只提示3例有骨质疏松，故骨密度测定可作为肝性骨病的有效检测手段之一。24例患者中血清骨钙素异常者5例，其中升高者3例，降低者2例。骨钙素能否作为肝性骨病的敏感生化指标，尚待进一步研究。     

糖尿病微血管病对骨密度及骨钙素的影响

为探讨糖尿病微血管病对骨密度及骨钙素的影响，选择2型糖尿病患者60例，按其是否合并糖尿病微血管病（眼病、肾病、神经病变）分为两组，合并微血管病（1组）33例，不合并微血管病（2组）27例。用生化法测定两组的空腹血糖（FBG）、果糖胺（GSP）、血清总碱性磷酶（TALP）及血钙（Ca^2 ），RIA法测定骨钙素（BGP），DEXA法测定腰椎和髋部骨密度（BMD）；按其身同、体重计算体重指数（BMI）。结果：两组BMI、GSP、FBG、TALP及Ca^2 均未见明显差异；1组血清BGP水平明显低于2组，有显著性差异；1组第2－4腰椎（L2－4）、股骨颈、Ward′s三角区及股骨大转子的BMD均低于2组，差异有显著性。认为糖尿病微血管变可能降低骨形成，加重骨质疏松，使腰椎和髋部BMD明显降低。     

骨代谢生化标志物在氟骨症研究中的应用

氟骨症骨转换加速，骨代谢异常。用成骨细胞分泌的酶如骨碱性磷酸酶、骨钙素等骨代谢生化标志物评估骨形成，用破骨细胞分泌的酶如抗酒石酸酸性磷酸酶及骨吸收中形成的代谢产物如尿羟脯氨酸等生化标志物评估骨吸收。目的是为氟骨症的研究提供新的参考。     

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。     

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人的一生不断进行着骨的新陈代谢。这是通过旧骨吸收和新骨形成来完成。在正常人两者紧密偶联,假如两者失偶联会引起骨量、骨结构和骨强度的改变。但体内骨结构和骨强度很难被检测。近代通过测定骨转换生化标志物了解是否存在骨代谢的失衡。文章介绍骨形成和骨吸收的生化标志物及其临床应用,由于无创伤,价较廉,正被推广应用。     

雌激素加间断孕激素对去卵巢大鼠模型骨转换生化指标的影响

目的观察雌激素(E)加间断孕激素(P)对双侧卵巢切除(OVX)大鼠模型骨转换生化指标的影响。方法35只雌性大鼠随机分成5组,每组7只。①假手术(Sham)组、②卵巢切除(OVX)组、③卵巢切除 雌激素(OVX E)组、④卵巢切除 孕激素(OVX P)组、⑤卵巢切除 雌激素 孕激素(OVX E P)组。实验10w后处死大鼠,测定股骨重量、骨密度(BMD),检测血清骨钙素(BGP)、碱性磷酸酶(ALP)、钙、磷,同时检测尿钙、羟脯氨酸(HOP)及肌酐(Cr)等指标。结果与Sham组相比:OVX组和OVX P组体重增加、股骨重量和BMD减少(P<0.05),血清BGP、ALP及尿钙、HOP及Cr升高,而OVX E组、OVX E P组股骨重量和BMD、血清BGP、ALP及尿钙、HOP及Cr均无明显差异(P>0.05)。结论单用孕激素不能阻止OVX导致的骨吸收及骨量丢失;雌激素 间断孕激素能阻止OVX导致的骨吸收及骨量丢失;孕激素的间断加入没有影响雌激素对OVX大鼠骨代谢的有利作用。     

骨密度测量在职业性氟中毒诊断中的应用

目的　观察骨密度测量在职业性氟中毒诊断中的应用价值。方法　运用 SD- 10 0 0型单光子吸收法定量测定某铝厂接触氟工人 113人 ,并与该厂非接触氟职工 80人的骨密度及 X线平片的资料进行比较。结果　氟作业者骨密度增高、骨皮质增厚及骨髓腔增大的异常率都显著高于正常人群 (P <0 .0 1) ;曾经 X线平片诊断为氟骨症者 ,骨密度检查的异常率基本上是符合的 ,而 X线平片没有诊断骨密度异常者 ,用骨密度测定能发现其中大部分骨密度异常。结论　骨密度测量对早期氟中毒检查的灵敏度高 ,在氟中毒的诊断中有一定的应用价值。     

Quantitative ultrasound is better correlated with bone mineral density and biochemical bone markers in elderly women

The association between quantitative ultrasound (QUS) and bone turnover in postmenopausal women of different ages is an area of continuous investigation. The aim of this study was to investigate the relationship of ultrasound parameters [broadband ultrasound attenuation (BUA) and speed of sound (SOS)] to bone mineral density (BMD) and biochemical markers of bone turnover in three age groups of postmenopausal women. One hundred and twenty-three postmenopausal Caucasian women were divided into three groups according to their age: group A, range 44–54 years, mean age (±SD) 48.3 ± 2.3; group B, range 55–65 years, mean age 59.4 ± 2.1; and group C, range 66–77 years, mean age 68.2 ± 3.1. Ultrasound parameters were measured by the DTU-one imaging ultrasonometer in the calcaneus. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, and trochanter. Bone turnover was assessed by serum bone-specific alkaline phosphatase (BAP), urinary excretion of free deoxypyridinoline, N-telopeptides (NTX), and C-telopeptide breakdown products of type I collagen (CTX). QUS and BMD were significantly correlated in all sites, except hip BMD in group A. The most significant correlation was observed between BUA and femoral neck BMD in group C (r = 0.626, p < 0.01). BUA correlated significantly with BAP, NTX, and CTX (r = −0.434, −0.511, −0.478, respectively; p < 0.01), and SOS with BAP and NTX (r = −0.351 and −0.356, respectively; p < 0.05) only in group C. In groups A and B, ultrasound parameters did not correlate significantly to biochemical markers. Ultrasound parameters were better correlated to hip BMD and to biochemical markers of bone turnover in elderly postmenopausal women. These ultrasound measurements could be used as a screening test for bone status, either in nonambulatory third aged women or in those living in rural areas where attending medical centers with DEXA equipment and biochemical laboratories is difficult.     

跌倒和髋部骨密度对绝经后妇女骨折风险的影响

目的探讨跌倒和骨密度对绝经后妇女骨折发生率的影响。方法对2008年9月至2010年12月在南京市鼓楼医院骨质疏松症专病门诊体检、年龄为45～85岁的500名绝经后妇女的临床资料进行回顾性分析。收集受试者年龄、身高、体重、既往病史、跌倒史和骨折史,并进行跌倒指数和骨密度评估。结果500名绝经后妇女的平均年龄为（65．9±8．2）岁,全髋和股骨颈骨密度T值均值分别为-1．58±1．16和-1．78±1．06。其中159例（31．8％）有跌倒史,222例（44．4％）有骨折史（非暴力性骨折）。Logistic回归分析结果显示,跌倒史对骨折发生率的影响最为显著（OR=5．070）,年龄与骨折发生率呈正相关（OR=1．038）,身高与骨折发生率呈负相关（OR=0．956）。体重、全髋及股骨颈骨密度T值对骨折发生率无明显影响。结论预防骨质疏松性骨折不能仅单纯提高骨密度和增加骨量,预防跌倒和全面提高骨质量需引起临床医师的注意。     

The clinical utility of bone turnover markers in the evaluation of bone disease in patients with haemophilia A and B

Haemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, the utility of bone turnover markers (BTM) remains unknown. The aim of this study was to evaluate bone metabolism in men with haemophilia and to investigate associations between BTM and bone disease. Serum N‐ (NTX‐I), C‐terminal telopeptide of type I collagen (CTX‐I) and tartrate‐resistant acid phosphatase band‐5b (TRAP‐5b), as bone resorption markers, and osteocalcin (OC) and bone‐specific alkaline phosphatase (b‐ALP), as bone formation markers, were assessed. Seventy men with haemophilia A (n = 59) or B (n = 11) were studied. Patients with low BMD had significantly higher b‐ALP concentrations compared with those with normal BMD (12.8 ± 1.60 vs. 9.72 ± 0.58 μg/L, P = 0.009), without any differences in the other BTM. NTX‐I and CTX‐I concentrations were negatively associated with oestradiol levels and hip BMD and positively with human immunodeficiency virus infection, number of affected joints and arthropathy scores. B‐ALP and OC concentrations were negatively associated with hip BMD, severity of haemophilia and fracture history, and positively with the number of affected joints and testosterone concentrations. After multivariate analysis, NTX‐I levels remained negatively associated with oestradiol levels, whereas b‐ALP concentrations negatively correlated with the level of physical activity and positively with the number of affected joints. Increased bone metabolism exists in men with haemophilia and low BMD. Increased b‐ALP levels may identify patients at high risk for fracture. Increased number of target joints, low physical activity and low oestradiol concentrations are independently associated with increased bone metabolism.     

Determinants of skeletal fragility

Strategies to reduce fracture risk must be based on a sound understanding of the mechanisms that underline the increased incidence of fractures with age and with certain diseases. There is evidence that in addition to bone minerals density, other factors influence bone strength. The chapter reviews the biomechanical aspects of age-related fractures, including the interacting roles of traumatic loading and bone strength, and the factors that determine a bones resistances to fracture. Also discussed are the mechanisms by which anti-catabolic and anabolic therapies for osteoporosis may affect bone strength. Finally, several current and future methodologies for improving assessment of bone strength in patients are evaluated.