骨峰值及骨丢失率对骨质疏松的预测价值

骨峰值和骨丢失率是骨质疏松的主要决定因素。骨峰值与ＶＤＲ基因等遗传因素有关，骨丢失率随年龄、部位不同而异，且受体重、绝经年限等因素影响。骨峰值和骨丢失率对预测骨折有一定价值。     

围生期孕妇骨量及骨代谢影响因素的临床分析

目的:探讨整个孕期影响骨代谢的相关因素.方法:选择在我院产科单胎足月分娩的健康产妇168名为调查对象,取入院待产后空腹血和晨尿,测定尿钙(Ca)、肌酐(Cr)、血碱性磷酸酶(ALP),产后3天内用双能X线骨密度仪测量左股骨颈骨密度.了解孕产史、母系骨质疏松家族史、孕期补钙及喝牛奶情况.结果:①发生骨量减少的产妇82例(48.8%),其中5例达到骨质疏松;②初产年龄及分娩前体重与左侧股骨颈骨密度值呈正相关(r=0.159,P=0.037);③发生骨量减少的孕妇中伴有母系骨质疏松家族史11例(73.3%),较骨量正常的孕妇伴母系骨质疏松家族史4例(26.7%)明显增多,差异有统计学意义(χ2=3.965,P=0.046);④持续补钙组孕妇左侧股骨颈骨密度高于未持续补钙组,骨形成指标血ALP、骨吸收指标尿Ca/Cr低于未持续补钙组,差异均有统计学意义(P<0.05).结论:孕期容易发生骨量减少,尤其对于伴有母系骨质疏松家族史的孕妇.孕期适当增加体重、持续补钙可以防治孕期骨质疏松,降低骨转换率.     

跟骨钢板内固定治疗跟骨骨折27例

目的：研究跟骨钢板内固定治疗跟骨骨折的临床疗效。方法：根据骨折类型选用可塑形跟骨钢板和螺钉内固定治疗跟骨骨折。结果：所有病例均治愈，其中优良率达93．1％。结论：跟骨钢板内固定治疗跟骨骨折具有固定牢靠，治愈率高的特点，是比较理想的方法之一。     

自体骨与同种异体骨治疗兔桡骨骨缺损的实验对比研究

目的:探讨采用同种异体骨治疗兔桡骨骨缺损疗效的实验研究。方法:将12只健康成年新西兰大白兔作为同种异体骨供体,28只作为实验受体。按美国组织库标准制备同种异体骨。将受体实验动物双侧桡骨中段切除10 mm,制成骨缺损模型。受体实验动物右侧桡骨骨缺损内植入自体髂骨骨粒(对照组);左侧取等量同种异体骨粒同法植入(实验组)。于术后2、4、8、12周,对骨缺损修复组织内OPG蛋白的表达检测采用免疫组织化学方法。术后12周,检测两组骨小梁相对体积、骨小梁数量和骨密度。结果:术后两组未见感染现象发生。术后2、4周实验组OPG蛋白表达低于对照组,差异有统计学意义(P<0.05)。术后8、12周两组OPG蛋白表达差异无统计学意义。术后12周两组骨小梁相对体积、骨小梁数量和骨密度比较,差异无统计学意义。结论:同种异体骨具有较好的组织相容性,其骨性愈合过程与自体骨移植相似,并且来源广泛,能够避免因自体骨移植带来的诸多并发症,可以成为治疗骨缺损的重要材料。     

不同妊娠期骨代谢状况的研究

测定不同妊娠期孕妇血清及新生儿脐血游离钙（Ｃａ〕、骨型酸性磷酸酶（ＴＲ－ＡＣＰ）及碱性磷酸酶（ＡＬＰ），并与非妊娠妇女进行对照。结果显示：对照组、妊娠早中期组、妊娠晚期组及新生儿组游离Ｃａ分别为１．１６±０．０７、１．１３±０．０７、１．０９±０．１１、１．２５±０．０６ｍｍｏｌ／Ｌ，并随孕周增加而明显下降。新生儿组游离Ｃａ值显著高于妊娠晚期组（Ｐ＜０．０１）。提示：胎盘逆浓度主动转运游离Ｃａ，同时ＴＲ－ＡＣＰ、ＡＬＰ活性随孕周增加而升高，说明孕妇骨代谢非常活跃。     

新生儿及其母亲骨营养状况的研究

目的 通过对产妇及其新生儿在分娩当天进行血25-(OH)D3、血钙和血磷浓度的测定以及在产后3 d内采用骨定量超声仪对母儿进行骨超声波速度(speed of sound,SOS)的测量来评价母儿的骨营养状况和两者的相关性.方法 32例足月分娩产妇在分娩当天测定血清25-(OH)D3、血钙和血磷浓度,对其分娩的新生儿在出生时留取脐血进行血25-(OH)D3、血钙和血磷浓度的测定.产妇在分娩后3 d内进行桡骨定量超声SOS值的测量,同时对新生儿也进行胫骨SOS值的测量.分析母儿骨SOS值之间的相关性.选取与本实验组孕妇同年龄段健康妇女39例作为对照组,进行桡骨SOS值的测量,比较产妇组与正常妇女组骨SOS值之间有无差异.结果 (1)新生儿脐血中25-(OH)D3的浓度(14.7±7.8)nmol/L平均为孕妇血25-(OH)D3浓度(30.3±10.2)nmol/L的37.3%,两者之间呈正相关(r=0.680,P=0.000);(2)新生儿脐血的血钙浓度(2.36±0.28)mmol/L和血磷浓度(1.57±0.76)mmol/L与孕妇的血钙(2.09±0.17)mmol/L和血磷浓度(1.04±0.28)mmol/L之间无相关性(r=0.146,P=0.467;r=0.148,P=0.445),新生儿脐血中的血钙浓度和血磷浓度显著高于其母血中的血钙和血磷浓度(t=4.35,P=0.000;t=10.58,P=0.000);(3)新生儿骨SOS值(3054±76)m/s与其母亲的骨SOS值(4170±241)m/s之间无相关性(r=-0.223,P=0.220);(4)新生儿脐血25-(OH)D3的浓度与其骨SOS值有显著相关(r=0.412,P=0.026);(5)正常妇女的骨SOS值(4258±100)m/s高于产妇组的骨SOS值(4170±241)m/s,两组比较差异有统计学意义(t=2.062,P=0.043).结论 胎儿维生素D的营养状况与母体维生素D的营养状况密切相关,维生素D的营养状况与胎儿的骨骼发育密切相关.上海地区在秋冬季有较多孕妇可能有维生素D缺乏,应加强对孕产妇骨营养状况的监测.     

授乳与骨量减少

妊娠期约有30g钙从母体移至胎儿体内。产褥期授乳每日丢失约220mg钙。本文的资料产后1个月后是否授乳,血中雌激素浓度有显著差异,至少持续到产后6个月。此期间血中雌激素与催乳素(PRL)的浓度,授乳妇女比非授乳妇女呈明显的低雌激素、高催乳素状态,提示前者比后者卵巢功能恢复延迟,此状况影响产后的骨代谢。从钙丢失和卵巢功能恢复延迟考虑,长期授乳妇女必须摄取钙。 产褥期骨代谢减少的原因多数是由于从母乳丢     

雌激素对去卵巢大鼠骨丢失的骨形态计量学及组织 …

目的 了解大鼠卵巢性激素缺乏致骨丢失的组织学改变以及四种不同雌激素制剂对其的影响。方法 将５０只ＳＤ大鼠随机分为６组,去势且（９只）在去势手术后３周处死大鼠;对照组（９只）开腹后关腹;去势＋利维爱组、去势＋盖福润组、去势＋倍美力组、去势＋维尼安组（各８只）在去势手术后３周予相应的药物治疗,术后６周（药物治疗后３周）处死各组大鼠,进行骨形态计量学、骨密度（ＢＭＤ）测定,并行病理及电镜下观察。结果 （     

骨胳及肌肉系统疾病

900886 进行性骨化性肌炎1例报道/欧芳兰…∥北京医学。-1989,11(6)。-328 患儿,男,8岁。入院前2个月左侧背部发现—1.5×1.5cm肿物,质较硬,不红,有压痛。之后于颈、腰、腹部出现类似肿物。颈及腰部活动受限。无发热与皮疹。查体:于胸骨左缘第Ⅱ～Ⅲ肋间可触及震颤并可闻及Ⅲ级连续粗糙的机器样双期杂音。双股动脉可闻枪击音。左颈部、左背部肩胛下、左腹直肌有不与皮肤粘连之硬块。右腹直肌硬肿有压痛。腰部脊柱两侧肌肉硬肿,轻压痛。脊柱侧弯。     

四环素-雌酮和雌酮作用去势大鼠的骨形态计量学对照研究

目的比较四环素－雌酮和雌酮对卵巢切除（ＯＶＸ）大鼠股骨远端骨干骨形态参数的影响。方法２０只雌性大鼠随机分成４组,每组５只：四环素－雌酮治疗组、雌酮治疗组、ＯＶＸ组和假手术组,建立ＯＶＸ大鼠骨质疏松动物模型,药物喂养１３周后处死,用骨形态计量学方法研究四环素－雌酮和雌酮对骨形态和动力学参数的影响。结果与假手术组相比,四环素－雌酮组和雌酮组骨小梁的连接性均明显地高于假手术组（Ｐ＜０．０５）。与ＯＶＸ组相比,四环素－雌酮和雌酮组四环素标记表面和类骨质表面均明显增加,四环素－雌酮组的结果又明显高于雌酮组,更明显高于其它两组（Ｐ＜０．０５）。结论四环素－雌酮和雌酮可以明显地加强骨小梁的连接性,四环素－雌酮提高骨激活频率的作用优于雌酮。     

雌激素、三苯氧胺与氟化物配伍预防去势大鼠骨丢失的研究

目的　比较三苯氧胺与雌激素对骨代谢的影响 ,及两者与氟化物配伍后是否产生协同效果。方法　将 142只 6月龄雌性SD大鼠行去势手术或假手术后随机分为 7组 (每组 19～ 2 1只 ) :(1)假手术组 ;(2 )去势组 ;(3)雌激素组 ;(4 )氟化物组 ;(5 )雌激素 +氟化物组 ;(6 )三苯氧胺组 ;(7)三苯氧胺 +氟化物组。治疗 12个月 ,行骨密度、腰椎骨组织形态计量学参数 (不脱钙骨切片 )、右股骨中段三点弯曲试验观察 ,并行子宫病理及血脂检查。结果　 (1)术后 12个月时 ,全身骨密度去势组为2 79mg/cm2 、治疗组为 2 86～ 2 98mg/cm2 ,腰椎骨密度分别为 2 32mg/cm2 、2 5 1～ 2 6 6mg/cm2 (P均<0 0 5 ) ;股骨中段骨密度 ,雌激素组 2 16mg/cm2 ,明显高于三苯氧胺组 195mg/cm2 (P <0 0 5 ) ;配伍治疗组与单药治疗组无明显差异 (P >0 0 5 )。 (2 )术后 4个月 ,两个配伍治疗组最大载荷 (均为 145牛顿 )与去势组 [(118± 2 4)牛顿 ]有显著差异 (P <0 0 5 ) ;术后 12个月各治疗组最大载荷为 132～ 15 5牛顿 ,均明显高于去势组 (10 8± 13)牛顿 (P <0 0 5 ) ,雌激素组最大载荷、弹性载荷均明显高于三苯氧胺组 (P <0 0 5 )。 (3)各组骨组织形态计量学检查未发现骨矿化不良现象。结论　雌激素在维持骨量、骨强度方面优于三苯     

去卵巢山羊腰椎骨计量学指标的变化

目的　探讨用山羊制作绝经后骨质疏松动物模型的可行性。方法　切除山羊的双侧卵巢 (OVX) ,制备腰椎不脱钙骨切片 ,应用骨组织形态计量学方法 ,观察正常对照组 (3只 ,无手术处理 )、假手术组 (3只 ,开腹后缝合切口 )、OVX术后 6个月组 (4只 )、术后 18个月组 (5只 )腰椎骨计量学指标的变化。结果　OVX术后 6、18个月组的骨小梁体积占全部骨组织体积的百分比 [(7 9± 1 7)与 (5 8± 0 7) % ]、骨小梁体积占海绵骨体积的百分比 [(12 7± 1 8)与 (9 9± 0 6 ) % ]、平均骨小梁板密度 [(1 0± 0 2 )与 (1 1± 1 1)个 /mm]显著减少 (P <0 0 1) ;平均骨小梁板厚度 [(12 9± 4 5 )与 (95± 15 ) μm]也显著减少 (P <0 0 5 ) ;骨小梁表面和体积之比 [(16 6± 4 6 )与 (2 1 4± 3 1)mm2 /mm3 ]与平均骨小梁板间隙 [(10 0 4± 2 33)与 (95 3± 10 3) μm]则显著增加 (P <0 0 1) ;四环素单标记、双标记、1/ 2单标记与双标记表面之和占全部骨小梁表面的百分比 [(19 5± 3 8)与 (17 5± 1 0 ) %、(16 4± 3 3)与 (13 9± 2 5 ) %、(2 6 2± 5 1)与 (2 2 7± 2 9) % ],平均类骨质宽度 [(11 6± 1 1)与(12 0± 1 0 ) μm]、骨矿化延迟时间 [(2 3 6± 8 2 )与 (2 3 0± 6 1)d]、组织水平的骨形成速率     

淫羊藿对去卵巢大鼠骨组织白细胞介素6 mRNA表达的影响

】     

雷洛昔芬对去卵巢大鼠骨密度及血E2、IL-6水平影响的研究

目的观察雷洛昔芬对去势大鼠骨密度、血清E2、IL-6及子宫内膜的影响，探讨雷洛昔芬抗骨质疏松的作用机制。方法48只3个月龄雌性SD大鼠，随机分为SHAM组（假手术），0VX组（单纯去势），0VX＋E2组（去势＋雌激素），0VX＋R组（去势＋雷洛昔芬），每组12只。3个月后处死采集血，用放射免疫分析法检测并比较各组E2及IL-6的表达，取子宫内膜用HE染色法观察各组子宫内膜的形态变化并对子宫内膜腺体数目进行统计学分析。结果雷洛昔芬组大鼠骨密度显著高于去卵巢组（P＜0．05），血清IL-6浓度值显著降低，雌激素浓度的改变差异无统计学意义（与去卵巢组比较P＞0．05），对子宫内膜无明显影响（P＞0．05）。结论雷洛昔芬治疗骨质疏松的作用与血清中IL-6水平降低相关，与雌激素无显著相关，对子宫内膜无显著影响。     

Effects of strontium ranelate,raloxifene and misoprostol on bone mineral density in ovariectomized rats

Objectives

To investigate the effects of strontium ranelate, raloxifene and misoprostol on bone mineral density (BMD) in ovariectomized rats to contribute to the individualization of the treatment of postmenopausal osteoporosis.

Study design

Sixty sexually mature female Sprague–Dawley rats weighing 250 g were used. The 60 rats were divided into six groups of 10 rats each: SR, MISO, RAL, SHAM, DW and OVX. All except the SHAM rats were subjected to bilateral ovariectomy. Three days after surgery, rats were administered strontium ranelate (Protelos^®, 2 g, Servier, Istanbul), 1800 mg/kg/day; misoprostol (Cytotec^®, 200 mcg, Ali Raif, Istanbul), 200 mcg/kg/day; raloxifene (Evista^®, 60 mg, Lily and Company, Istanbul), 3 mg/kg/day and 1 cc of distilled water by gavage for 8 weeks. Bone mineral density measurements were then performed.

Results

The strontium ranelate (SR) group had significantly higher vertebral BMD than all other groups. Femoral density in the SR group was also significantly higher than in other groups and there was no difference between femoral density in the strontium ranelate and sham groups.

Conclusions

Strontium ranelate, raloxifene and misoprostol can prevent bone loss in the vertebrae, whereas strontium ranelate can also prevent bone loss in the femur of ovariectomized rats. Strontium ranelate increases greater than raloxifene and misoprostol BMD in the vertebrae.

Condensation

Strontium ranelate may increase both vertebral and femur BMD in ovariectomized rats while raloxifene and misoprostol may only increase lumbar spine BMD.     

雷洛昔芬和依普黄酮对去卵巢大鼠骨干力学的影响

目的:研究雷洛昔芬和依普黄酮对切除成熟卵巢大鼠骨干生物力学性能的影响,探讨此两种药物治疗绝经后骨质疏松症的疗效。方法:选用6月龄未交配健康雌性Sprague-Dawley大鼠50只,随机分为5组,每组10只:(1)假手术组(sham);(2)骨质疏松组(OVX);(3)OVX加戊酸雌二醇组(Valerate Estriol,E_2;0．8mg·kg~(-1)·d~(-1));(4)OVX加雷洛昔芬组(Raloxifene,RLX;5mg·kg~(-1)·d~(-1));(5)OVX加依普黄酮组(Ipriflavone,IPR; 100mg·kg~(-1)·d~(-1));于去势手术3周后开始按分组设计喂药(灌胃),治疗3个月后处死。取大鼠右股骨及第三腰椎测定骨密度;然后对右股骨中段进行三点弯曲试验,测定多个股骨干生物力学指标。结果:(1)骨密度:OVX组椎骨及股骨干骺端密度明显下降,使用E_2和RLX能够显著提升骨密度;但股骨干密度各组间差异无统计学意义;(2)骨干生物力学性能:三点弯曲实验结果显示,OVX组股骨干生物力学指标较sham组明显下降,用RLX和IPR治疗与E_2一样可阻止这种变化(P＜0．05)。结论:雷洛昔芬和依普黄酮能阻止卵巢切除所致的成熟雌性大鼠股骨干(皮质骨)生物力学性能受损。     

Bilateral Ovariectomy in Young Rats: What Happens in Their Livers during Cecal Ligation and Puncture Induced Sepsis?

Study ObjectivePediatric ovarian masses comprise a heterogeneous group of benign and malignant lesions. Surgical methods consist of emergency or programmed surgery with tumoral resection and uni/bilateral oophorectomy or salpingo-oophorectomy. We examined whether bilateral ovariectomy (OVX) worsens liver injury during the onset of cecal ligation and puncture (CLP)-induced sepsis in rats.DesignThe rat groups were: sham, bilateral-OVX, sepsis, and OVX-sepsis.SettingsAfter OVX operation, rats were allowed to recover for 12 weeks. At the end of recovery, CLP was applied 16 hours after sepsis induction.Main OutcomeThere was a significant difference in the numerical density of hepatocytes only between the sepsis and the OVX-sepsis groups. Serum ALT and AST were increased significantly in the OVX-sepsis group. NF-κB activation after OVX increased after induction of sepsis. OVX-sepsis group showed marked thrombosis in portal vein branches and the central vein, degeneration in the bile ducts, and widespread ischemic areas in liver sections. Intra-inflammatory cell invasion was observed in both the portal and intrasinusoidal areas.DiscussionThis study indicates that increases in liver NF-κB activity in ovariectomized rats following CLP-induced sepsis correlates with elevated levels of serum ALT and AST and with histopathologic changes in rat liver. Bilateral OVX therefore appears to play a role in the activation of NF-κB or in production of cytokines in liver cells. Thus, we provided novel insight into the effects of OVX on liver injury following CLP-induced sepsis.     

Reduced expression of CRHR2 and Sp-1 in myocardium of ovariectomized rats is improved by exercise training

Abstract

Exercise training has been looked on as a non-pharmacologic approach to treating ovariectomy (OVX)-induced dysfunctions. In this study, we investigated whether chronic exercise impacts on expression of urocortins (UCNs) and corticotropin-releasing hormone receptor type 2 (CRHR2) in myocardium of OVX rats. Bilateral OVX or sham-operation was performed under anesthesia. Both groups were then divided into two subgroups, with or without treadmill training for 8 weeks. It was found that OVX as well as exercise did not affect the mRNA levels of UCN, UCN2 and UCN3 in myocardium. OVX caused down-regulation of CRHR2 in myocardium. Exercise training reversed the OVX-induced reduction of CRHR2, but had no influence on CRHR2 level in sham rats. OVX resulted in a decrease in estrogen receptor α (ERα) expression in myocardium, which was restored by exercise. Moreover, exercise training also reversed OVX-induced down-regulation of specific protein-1 (Sp-1) expression in myocardium. CRHR2 expression level correlated with Sp-1 and ERα level in myocardium. These results indicate that exercise training can restore the CRHR2 level in myocardium of OVX rats, which is associated with ERα and Sp-1 expression.     

戊酸雌二醇对去卵巢大鼠骨质疏松的治疗作用

目的评价国产戊酸雌二醇对去卵巢大鼠骨质疏松的治疗作用.方法雌性健康未交配Wistar大鼠42只,于6月龄时分别行去卵巢和假手术,分组并行如下处理(1)治疗前对照组(8只)于去卵巢后6周处死;(2)治疗末对照组(8只);(3)假手术组(8只);(4)去卵巢17β雌二醇治疗(O+E)组(9只)去卵巢后6周予17β雌二醇20μg@kg-1@d-1皮下注射;(5)去卵巢戊酸雌二醇治疗(O+EV)组(9只)去卵巢后6周予戊酸雌二醇800μg/kg@d-1经胃肠道给药,后4组于去卵巢后14周处死,留取右侧胫骨、股骨及血标本,处死前收集24h尿标本,分别进行骨组织计量学、外周骨定量CT检查、股骨远端凹入实验,以及骨吸收指标脱氧吡啶啉等测定.结果去卵巢后,骨矿盐含量(骨量)减少,骨小梁结构稀疏,骨吸收和骨形成指标均增加.股骨远端松质骨骨量和骨矿盐密度(骨密度)显著降低,松质骨最大载荷和刚度均明显下降.与治疗末对照组相比,O+E和O+EV组骨吸收指标尿脱氧吡啶啉分别下降54.6%和77.4%(P均＜0.01),骨转换受抑制,胫骨近端次级骨小梁的体积比率分别增加122.3%和119.7%[(12.9±0.8)%和(12.8±0.9)%与(5.8±1.3)%比较,P＜0.01],骨小梁的结构得到改善.O+E和O+EV组股骨远端松质骨骨矿盐密度较治疗末对照组分别增加99.5%和128.4%,分别为(258.9±16.9)和(269.2土24.3)mg/cm2比(117.8±30.4)mg/cm3(P＜0.01).O+E组的股骨远端松质骨最大载荷和刚度均较治疗末对照组有显著增加(P均＜0.05),以上各指标在0+E和0+EV组之间差异无显著性.结论戊酸雌二醇能有效地抑制去卵巢大鼠过高的骨转换,使小梁骨骨量增加,结构改善,松质骨的力学特征得到改善.