中老年骨质疏松与下肢动脉粥样硬化相关性分析

目的探讨中老年骨质疏松与下肢动脉粥样硬化的相关性。方法 110例中老年患者行骨密度及下肢动脉彩超等检查,根据患者骨密度值分为骨量正常组43例,骨量减少组42例,骨质疏松组25例,比较3组收缩压、舒张压、血清白蛋白、血钙、血肌酐、血脂、血尿酸、空腹血糖及动脉粥样硬化积分(Crouse积分)差异;根据Crouse积分将患者分为无动脉粥样硬化组40例,轻度动脉粥样硬化组48例及中重度动脉粥样硬化组22例,比较各组间腰椎骨密度T值及左髋关节骨密度T值差异;分析骨密度T值与Crouse积分相关性。结果骨质疏松组空腹血糖[(6.52±2.97)mmol/L]高于骨量正常组[(5.56±1.11)mmol/L](P0.05);骨质疏松组Crouse积分[(14.00±9.00)分]高于骨量正常组[(8.00±5.00)分]和骨量减少组[(8.00±7.00)分](P0.05);不同骨密度组间收缩压、舒张压、血清白蛋白、血钙、血肌酐、血脂、血尿酸比较差异均无统计学意义(P0.05);中重度动脉粥样硬化组腰椎骨密度T值(-1.90±0.71)低于轻度动脉粥样硬化组(-0.98±0.57)(P0.05),中重度动脉粥样硬化组左髋关节骨密度T值(-1.28±0.35)低于无动脉粥样硬化组(-0.40±0.17)及轻度动脉粥样硬化组(-0.63±0.22),差异均有统计学意义(P0.05);骨密度T值与Crouse积分呈负相关(r=-0.218,P=0.022)。结论中老年人群Crouse积分越高,提示骨密度越低。     

FRAX评估绝经后女性2型糖尿病患者的骨折概率

目的：评估绝经后女性2型糖尿病（type 2 diabetes mellitus,T2DM）患者未来10年内发生髋部骨折和主要骨质疏松性骨折的概率。方法：选取298例住院的绝经后T2DM女性患者及183例非糖尿病绝经后女性对照者,采用双能X线骨密度仪测其定腰椎2-4（L2-L4）、股骨颈骨密度。采用FRAX中国模式计算其10年内髋部骨折概率和主要骨质疏松性骨折概率。结果：绝经后T2DM女性患者的10年内髋部骨折概率为（0.94±1.03）%,10年内主要骨质疏松性骨折概率为（3.58±1.68）%。与绝经后女性对照组相比,绝经后T2DM女性患者的股骨颈骨密度[（0.83±0.13）g/cm2比（0.80±0.11）g/cm2,P=0.047]和L2-L4骨密度[（1.04±0.17）g/cm2比（0.97±0.14）g/cm2,P〈0.001]均显著增高,差异有统计学意义（P〈0.05）。但使用FRAX评估的10年内髋部骨折概率[（0.94±1.03）%比（0.96±0.80）%,P=0.814]和主要骨质疏松性骨折概率[（3.58±1.68）%比（3.72±1.35）%,P=0.305],在绝经后T2DM组与对照组间无统计学差异。结论：尽管绝经后T2DM女性患者的股骨颈骨密度和L2-L4骨密度均显著高于对照者,但2组间的10年内发生骨折概率无统计学差异。绝经后女性T2DM患者的骨密度增高及未将T2DM作为一个危险因素纳入FRAX誖计算系统中,可能是2组间骨折概率无差异的原因所在。因此,在未来的FRAX测评系统中,需将T2DM作为一个独立的危险因素纳入其中。     

定量超声测定维持性血液透析患者骨密度结果及影响因素分析

目的分析维持性血液透析(maintenance hemodialysis,MHD)患者的骨密度和其他临床指标间的关系,探讨导致MHD患者骨质疏松的危险因素。方法回顾性分析宝鸡市人民医院102例MHD患者的临床资料,用定量超声(quantitative ultrasound system, QUS)检测跟骨骨密度的T值。根据T值将患者分为骨量正常组(T值≥-1.0)、骨量减低组(-2.5T值-1.0)及骨质疏松组(T值≤-2.5)。比较3组患者各项临床指标的差异,分析T值和各临床指标间的相关性。结果 102例MHD患者中41例骨质疏松(40.2%),50例骨量减低(49.0%),11例骨量正常(10.8%)。3组患者的年龄(F=5.054,P=0.032)、25-羟基维生素D(F=18.131,P=0.009)和亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)指数(F=5.714,P=0.043)差异有统计学意义。Pearson相关性分析提示T值与年龄呈负相关(r=-0.412,P=0.033),与25-羟基维生素D(r=0.596,P=0.021)和OSTA指数(r=0.387,P=0.046)呈正相关。多元逐步回归分析结果显示,25-羟基维生素D是影响骨密度T值的主要因素(t=6.214,P0.001)。结论 MHD患者骨质疏松发生率高,25-羟基维生素D缺乏是导致其骨质疏松的主要危险因素。     

2型糖尿病合并骨质疏松影响因素研究

目的探讨2型糖尿病(T2DM)合并骨质疏松的影响因素。方法选取151例T2DM住院患者,采用双能X线骨密度仪测定腰椎1～4椎体及股骨近端的骨密度,根据T值分为骨量正常组40例、骨量减少组68例、骨质疏松组43例。比较3组临床资料及生化指标,采用多因素Logistic回归对T2DM合并骨质疏松的影响因素进行分析。结果骨量正常组、骨量减少组、骨质疏松组T2DM患者的性别、年龄、BMI、糖尿病病程、空腹胰岛素、空腹C肽、ALT、空腹血糖、血清肌酐、TSH、碱性磷酸酶比较差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,BMI、糖尿病病程均为T2DM合并骨质疏松的影响因素(P均<0.05)。结论糖尿病病程、BMI为T2DM合并骨质疏松的影响因素,应关注糖尿病病程较长及BMI较低的T2DM患者,积极防治骨质疏松。     

骨代谢生化指标对中老年人骨质疏松症的评估价值

目的:了解中老年人骨代谢生化指标随年龄变化的特点,分析骨代谢生化指标在骨质疏松症诊断评估中的价值。方法:选择2002-10/2004-03华中科技大学同济医学院附属同济医院综合科门诊和住院的中老年体检患者410例为研究对象。测定410例中老年人腰椎正位骨密度,同时检测所有患者空腹血清骨钙素、血清碱性磷酸酶及晨尿吡啶啉,尿吡啶啉用肌酐校正。按年龄段(40～49,50～59,60～69,70～79,>80岁)和不同骨密度组(骨质疏松、骨量减低、骨密度正常)对男性和女性的骨代谢生化指标值分别进行分析。结果:中老年男性骨钙素随年龄增长下降,尿吡啶啉/肌酐随年龄增长上升,均低于女性(P<0.05),中老年女性骨钙素和尿吡啶啉/肌酐在50～69岁时明显高于其他年龄组(P<0.05)。70岁以后又趋于下降,尿吡啶啉/肌酐值与同年龄的老年男性相近,差异无显著性意义(P>0.05)。各年龄段男性或女性血清碱性磷酸酶基本在正常范围。中老年男性骨质疏松组和骨量减低组的骨钙素低于骨密度正常组,而尿吡啶啉/肌酐明显高于骨密度正常组(t=7.051,7.898,P<0.05);中老年女性骨质疏松组和骨量减低组的骨钙素和尿吡啶啉/肌酐均明显高于骨密度正常组(t=3.633,17.923,P<0.05);同性别骨质疏松组和骨量减低组的骨钙素和尿吡啶啉/肌酐值比较,差异无显著性意义(     

2型糖尿病并发骨质疏松与NLR、RDW和MPV的关系

目的研究2型糖尿病(T2DM)并发骨质疏松与中性粒细胞/淋巴细胞的比值(NLR)、红细胞分布宽度(RDW),血小板平均体积(MPV)的关系。方法选择从2015年1月到2017年1月在首都医科大学附属北京友谊医院医院进行治疗的T2DM患者314例纳入本次研究。根据双能X线吸收测定法(DEXA)检测的T值进行分组,当腰椎或者股骨T值≥-1.0时记为骨量正常组,-2.5T-1.0记为骨量减少组,T≤-2.5记为骨质疏松组。对比各组一般资料,NLR、RDW及MPV的水平,分析各指标间的相关性。结果骨质疏松组的年龄、女性比例均分别明显高于骨量正常组及骨量减少组,BMI水平明显低于骨量正常组及骨量减少组,差异有统计学意义(P0.05)。骨质疏松组的NLR、RDW及MPV水平均分别明显高于骨量正常组及骨量减少组,且骨量减少组的NLR、RDW及MPV水平均分别明显高于骨量正常组,差异有统计学意义(P0.05)。根据Spearman法分析相关性发现,患者的年龄、性别与NLR、RDW及MPV水平呈正相关,而BMI与NLR、RDW及MPV水平呈负相关。结论 T2DM并发骨质疏松患者NLR、RDW及MPV水平明显上升,且患者的NLR、RDW及MPV与其年龄、性别及BMI之间具有较为紧密的关联。     

磁共振化学位移成像对骨质疏松的诊断价值

目的：探讨磁共振化学位移成像对骨质疏松的诊断价值。方法：将70例患者分别按腰椎和髋部骨密度T分数分为骨量正常组、骨量减少组和骨质疏松组,所有患者均行MRI化学位移成像,通过测量MRI化学位移成像中同反相位图像上腰椎1-4椎体的信号强度,计算椎体信号下降指数,分析3组椎体信号下降指数的差异,并同腰椎和髋部骨密度值分别行相关性分析。结果：按照腰椎骨密度分组,正常组、骨量减少组和骨质疏松组的椎体信号下降指数中位数分别是59.73%（21.84%-72.35%）、59.64%（21.55%-78.42%）、57.04%（34.77%-77.30%）,通过两两比较,骨质疏松组与骨量正常组、骨质疏松组与骨量减少组比较,有显著性差异（P〈0.001）,骨量正常组和骨量减少组比较,无显著性差异（P=0.685）。按照髋部骨密度分组,骨量正常组、骨量减少组和骨质疏松组的椎体信号下降指数中位数分别是62.41%（21.84%-77.63%）、58.39%（40.96%-78.42%）、54.76%（21.55%-77.30%）,通过两两比较,三组间均有显著性差异（P〈0.001）,腰椎信号下降指数和髋部骨密度值呈显著正相关（rp=0.351,P=0.004）,腰椎信号下降指数和腰椎骨密度值无显著相关（P=0.379）。结论：MR化学位移成像通过测量椎体信号下降指数能够反映椎体骨髓脂肪含量变化,在骨质疏松的诊断中可能具有较高的临床价值。     

老年男性2型糖尿病患者甲状旁腺素、维生素D与骨密度的关系

目的 探讨老年男性2型糖尿病患者主要钙调激素甲状旁腺素(PTH)和维生素D的变化对骨密度的影响.方法 应用双能X线骨密度仪测定60例老年男性2型糖尿病患者的腰椎和髋部骨密度,检测血清中骨代谢及血糖相关的指标,并根据骨密度测定结果将60例老年男性2型糖尿病患者分为骨量减少组(32例)、骨质疏松组(12例)、正常组(16例),测定3组的血清PTH和25羟维生素D3,分析其与患者不同部位骨密度的相关性.结果 依据患者腰椎或髋部的骨密度值,骨质疏松的检出率为20.0％(12/60),骨量减少的检出率为53.3％(32/60).3组的血清PTH比较差异有统计学意义(F=3.32,P=0.043),骨量减少组、骨质疏松组与正常组相比,PTH水平明显上升[(44.87±10.62)、(50.24±20.32)μg/L与(36.96±12.36)μg/L,P均＜0.05].但25羟维生素D3浓度3组比较差异无统计学意义(P＞0.05).相关分析显示,PTH水平与髋部骨矿面密度(BMD)呈显著负相关(r=-0.224,P ＜0.05),与腰椎BMD无显著相关性(r=-0.187,P＞0.05).结论 老年男性2型糖尿病患者的髋部BMD与血清PTH浓度负相关.     

慢性阻塞性肺疾病患者血清MMP-9、TNF-α与骨转换生化指标及骨密度的关系

目的探讨慢性阻塞性肺疾病(COPD)并发骨质疏松患者血清基质金属蛋白酶(MMP-9)、肿瘤坏死因子-α(TNF-α)与骨转换标志物、骨密度的相关性。方法选取该院接诊稳定期COPD患者84例,根据患者骨密度(BMD)测试结果将其分为骨质疏松组(28例)、低骨量组(26例)与正常骨量组(30例),采用ELISA法检测各组MMP-9、TNF-α水平,以及骨转化生化标志物血清骨特异性碱性磷酸酶(sBAP)、血清骨钙素(sOC)、血清I型胶原羧基末端肽(sCTX)。结果骨质疏松组、低骨量组血清MMP-9、TNF-α水平高于正常骨量组,骨质疏松组血清MMP-9、TNF-α水平高于低骨量组,差异均有统计学意义(P0.05)。骨质疏松组sBAP、sOC低于正常骨量组,sCTX高于正常骨量组,低骨量组sBAP、sOC低于正常骨量组,骨质疏松组sBAP低于低骨量组,sCTX高于低骨量组,差异均有统计学意义(P0.05)。骨质疏松组、低骨量组腰椎骨密度、腰椎骨密度T值、股骨颈股密度与股骨骨密度T值均低于正常骨量组(P0.05),骨质疏松组腰椎骨密度、腰椎骨密度T值、股骨颈股密度与股骨骨密度T值低于低骨量组(P0.05)。血清MMP-9与骨转换生化指标、骨密度水平均呈负相关(P0.05);TNF-α与骨转换生化指标呈负相关(P0.05)。结论 COPD并发骨质疏松患者MMP-9、TNF-α呈现为高表达,与骨转换生化指标存在负相关性,同时与骨密度也存在一定关系。     

中老年男性2型糖尿病患者下肢动脉粥样硬化斑块与骨密度的关系

目的探讨中老年(年龄≥45岁)男性2型糖尿病(type 2diabetes mellitus,T2DM)患者下肢动脉粥样硬化斑块与骨密度(bone mineral density,BMD)的关系,分析其发生低骨量的危险因素。方法中老年男性T2DM患者237例,均进行下肢动脉彩超检查,并根据有无下肢动脉粥样硬化斑块分为斑块组171例和无斑块组66例;测量患者腰椎、股骨颈和髋关节BMD,并分为骨量正常组160例和低骨量组77例;采用Pearson相关分析下肢动脉粥样硬化斑块与BMD的相关性;采用多因素logistic回归分析中老年男性T2DM患者发生低骨量的危险因素。结果斑块组患者股骨颈、髋关节BMD值[(0.924±0.142)、(1.027±0.157)g/cm~2]均低于无斑块组[(0.970±0.137)、(1.071±0.133)g/cm~2)](P0.05);低骨量组患者下肢动脉粥样硬化斑块发生率(81.8%)高于骨量正常组(67.5%)(P0.05);下肢动脉粥样硬化斑块的发生与股骨颈、髋关节BMD值呈负相关(r=-0.144,P=0.028;r=-0.130,P=0.047);高龄(OR=1.064,95%CI:1.022～1.109,P=0.003)、空腹血糖升高(OR=1.226,95%CI:1.050～1.431,P=0.010)及下肢动脉斑块形成(OR=2.445,95%CI:1.090～5.483,P=0.030)是中老年男性T2DM患者发生低骨量的危险因素(P0.05),体质量指数增高(OR=0.822,95%CI:0.731～0.925,P=0.001)是中老年男性T2DM患者发生低骨量的保护因素。结论下肢动脉粥样硬化斑块是中老年男性T2DM患者发生低骨量的危险因素。     

Relationship between bone mineral density and biochemical markers of bone turnover in hemodialysis patients

End-stage renal disease is closely associated with changes in bone and mineral metabolism. In recent times, osteoporosis has become important among hemodialysis (HD) patients. In this study, the investigators sought to evaluate the relationship between bone mineral density (BMD) and biochemical markers of bone turnover among HD patients. A total of 70 uremic patients on a maintenance HD program for at least 1 y were enrolled in the study. All patients were treated with conventional bicarbonated HD for 5 h through the use of low-flux hollow-fiber dialyzers. Bone densitometry was measured by dual energy x-ray absorptiometry in the lumbar spine (LS) and the femoral neck (FN). BMD was classified according to World Health Organization criteria on the basis of BMD T scores. Biochemical bone turnover markers such as calcium, phosphorus, ionized calcium, intact parathyroid hormone, alkaline phosphatase, plasma bicarbonate, blood pH, serum albumin, and hematocrit levels were measured before the HD session in the morning. Male patients (n=37; 52.9%; mean age, 46.2+/-17.0 y) were assigned to a single study group, and female patients (n=33; 47.1%; mean age, 44.0+/-13.1 y) to another. Mean duration of HD treatment was 33.7+/-28.5 mo in females and 33.0+/-26.0 mo in males. Among all patients, BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58 patients (82.8%) and at the FN in 45 patients (64.3%). According to BMD measurements in FN T score, 10% of patients (n=7) were osteoporotic, 54.3% (n=38), osteopenic, and 35.7% (n=25), normal. On the other hand, in LS T score, the results were 47.1% (n=33) osteoporotic, 35.7% (n=25), osteopenic, and 17.1% (n=12), normal. No statistically significant association was found in osteopenia/osteoporosis between sexes according to FN and LS T score (P=.542, P=.267, respectively). No significant relationship was noted between BMD and biochemical markers of bone turnover. A positive correlation was found between FN T scores of BMD and age (r=.413, P=.000). BMD T scores within the range of scores for osteopenia/osteoporosis were observed in 78.5% of patients at the LS and in 58.5% of patients at the FN. The investigators concluded that no correlation could be found between markers of bone turnover and bone mass measurements in both skeletal regions. LS T score results were worse than FN T score results. Elevated alkaline phosphastase levels combined with high intact parathyroid hormone levels are predictive of renal osteodystrophy but not of adynamic bone disease/osteoporosis.     

雌激素受体基因多态性与2型糖尿病患者骨密度的关系

目的探讨雌激素受体(ER)基因多态性与2型糖尿病患者骨密度(BMD)的相关性。方法运用双能量X线吸收法(DEXA)测定61例2型糖尿病患者的BMD,PCR-RFLP检测ER基因多态性。结果2型糖尿病组PP型的BMD与Pp型相比,在L2,L3,L4及L2～4有显著的统计学差异(P值分别为0.045,0.021,0.019和0.019);与pp型相比,在L4有显著的统计学差异(P=0.037)。Pp型与pp型相比,各部位BMD均无显著的统计学差异。ER基因型分布频率为PP型0.128,pp型0.333,Pp型0.539,PP型腰椎BMD明显低于Pp型与pp型。结论2型糖尿病易合并骨量减少和骨质疏松,ER基因PP型与2型糖尿病患者腰椎低BMD密切相关。     

老年男性代谢综合征患者血睾酮水平与骨密度及骨转换指标的相关性研究

目的分析老年男性代谢综合征(MS)患者血睾酮(T)水平与骨密度(BMD)及骨转换指标之间的相互关系。方法收集60～90岁老年男性111例,分为MS组(61例)和非MS组(50例)。测定T、N-MID骨钙素(N-MID-OC)、总I型胶原氨基端延长肽(PINP)、血清β-胶原特殊系列(β-CTX)水平,同时使用双能X线骨密度测量仪测量左前臂、左髋部及腰椎的BMD,分析血清T水平与BMD及骨转换指标的相关性。结果 MS组的T、N-MID-OC、PINP、腰椎、髋骨及桡骨BMD水平均低于非MS组(P<0.05),β-CTX高于非MS组(P<0.05),且随着MS组分的增加,血T、N-MID-OC、PINP水平及腰椎、髋部、桡骨BMD平逐渐下降,β-CTX逐渐增高,差异有统计学意义(P<0.05)。相关性分析表明:血清T与N-MID-OC、PINP及腰椎、髋部、桡骨BMD呈正相关,与β-CTX水平呈负相关(P<0.05)。结论老年男性MS患者中血T水平与BMD及骨转换指标密切相关,低T水平可作为老年男性骨质疏松(OP)的预测因子。     

Bone mineral density: serum markers of bone turnover and their relationships in peritoneal dialysis.

BACKGROUND: The usefulness of bone mass measurements and bone turnover markers to estimate the risk of fracture and the type of underlying renal osteodystrophy are not well established in patients on peritoneal dialysis (PD). OBJECTIVE: To assess bone mass using total and regional bone densitometry in a group of patients on PD and to determine if serum markers of bone turnover identify patients with low bone mass. METHODS: Bone densitometry was studied by dual-energy x-ray absorptiometry (DEXA), and bone turnover using several serum markers, in 65 patients on PD. Bone mass was classified as normal, osteopenic, or osteoporotic according to World Health Organization criteria based on bone mineral density (BMD) T scores. RESULTS: T scores in the osteopenia range were present at the lumbar spine (LS) in 44.6% (45% of men and 44.4% of women) of patients and at the femoral neck (FN) in 56.9% (55% of men and 58% of women). T scores in the osteoporosis range were present at the LS in 13.8% of patients (10% of men and 15.5% of women) and at the FN in 21.5% (30% of men and 17.7% of women). Patients with BMD T scores in the osteoporosis range at both regions had increased serum intact parathyroid hormone (iPTH) levels compared to patients in the osteopenic/normal range. Bone mineral content in the whole skeleton (TBMC) correlated negatively with iPTH (r = -0.34) and with total time on dialysis (r = -0.26); in multivariate analysis, only iPTH correlated negatively with TBMC (B = -0.26, p = 0.03). No correlations were found between the other bone markers and BMD T scores at the FN or LS. There were no significant differences in absolute BMD or BMD T scores at the LS or FN between patients with and patients without fractures. CONCLUSIONS: BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58.4% of these patients on PD and at the FN in 78.4%. TBMC correlated negatively with iPTH. There were no correlations between markers of bone turnover and bone mass measurements at the two skeletal regions, although patients with BMD T scores in the osteoporosis range had increased serum iPTH levels. Bone mass measurements were not different between patients with and patients without fractures.     

2型糖尿病合并非酒精性脂肪性肝病肝纤维化与骨密度的相关性

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)肝纤维化与骨密度的关系。方法:筛选T2DM患者539例,依据腹部超声分为T2DM组(n=234)、T2DM+NAFLD组(n=305),再依据非酒精性脂肪肝肝纤维化评分(non-alcoholic fatty liver disease fibrosis score,NAFLDFS)分为<-1.455排除纤维化亚组、-1.455~0.676可疑纤维化亚组、>0.676诊断纤维化亚组,行骨密度检查并测定空腹血糖(fasting blood glucose,FBG)、空腹C肽(fasting C-peptide,F-CP)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(HbA1c)、肝功能及血脂等血清学指标。结果:与T2DM组相比,T2DM+NAFLD组股骨颈、Ward’s三角、大粗隆、股骨干及全部股骨的骨密度及T值下降(P<0.05)。与-1.455~0.676亚组及<-1.455亚组相比,>0.676亚组股骨颈、Ward’s三角的骨密度及T值下降(P<0.05)。T2DM组和T2DM+NAFLD组骨量异常(骨量减少和骨质疏松)发生率存在差异(48.29%vs 65.90%,P<0.01);<-1.455亚组,-1.455~0.676亚组,>0.676亚组骨量异常发生率存在差异(48.39%vs 67.98%vs 82.5%,两两比较均P<0.01)。相关性分析示:NAFLDFS与股骨颈、Ward’s三角的骨密度及T值呈负相关(P<0.05)。Logistic回归分析示:在控制年龄、性别、BMI、病程、FBG、ALT、HDLC、HbA1C及载脂蛋白B(APOB)后,NAFLDFS评分是骨量减少的独立危险因素。-1.455~0.676亚组相对于<-1.455亚组骨量减少的风险增加(OR=2.235,95%CI 1.040~4.803,P<0.05);>0.676亚组相对于<-1.455亚组骨量减少的风险增加(OR=4.463,95%CI 1.221~16.308,P<0.05)。结论:T2DM合并NAFLD肝纤维化患者骨密度减低,两者具有相关性,进展性肝纤维化是骨量减少的危险因素。     

血清骨钙素水平与绝经后女性2型糖尿病患者骨密度的关系

目的:探讨血清骨钙素水平与绝经后女性2型糖尿病(type 2 diabetes,T2DM)患者骨密度(bone minaral density,BMD)间的关系。方法:本研究为回顾性分析,共纳入505例绝经后女性,其中T2DM住院患者305例,非糖尿病对照者200例,采用双能X线骨密度仪(DXA)检测腰椎(第2至第4腰椎)、股骨颈和全髋的BMD,同时检测血清骨钙素(osteocalcin,OC)水平。结果:与正常对照组相比,T2DM组患者的血清OC水平显著降低(P<0.05),腰椎、股骨颈、全髋的BMD及体质量指数显著增高(P<0.01)均呈显著负相关;校正年龄、体质量指数和糖尿病病程后,血清OC水平与腰椎及全髋的BMD间仍存在明显的负相关。结论:血清OC水平与绝经后女性T2DM患者腰椎及全髋的BMD密切相关,随着OC水平的升高,BMD呈下降趋势,提示血清OC水平可作为早期筛查绝经后女性T2DM患者骨质疏松的生化指标,结合血清OC水平和BMD能更好地预测绝经后女性T2DM患者的骨质疏松和骨折的风险。     

绝经后妇女血清基质金属蛋白酶与骨转换生化指标及骨密度的关系

目的探讨绝经后妇女血清基质金属蛋白酶(MMP)-1和MMP-2与骨密度及骨转换生化指标之间的关系。方法采用酶联免疫吸附法测定297名48~80岁女性志愿者的血清MMP-1、MMP-2和血清骨碱性磷酸酶(BAP)、血清骨钙素(OC)及血清Ⅰ型胶原氨基末端肽(NTX),用双能X线吸收法测定腰椎正位1~4总体、股骨颈、华氏区、髋部总体的骨密度。结果MMP-1与骨密度及骨转换生化指标无明显相关性;MMP-2与骨密度呈较弱的负相关,校正年龄与体重指数后,MMP-2与股骨颈、髋部骨密度的相关性消失;MMP-2与BAP、OC、NTX正相关(P<0.01);绝经后骨质疏松症患者血清MMP-2水平高于年龄匹配的正常对照组和骨量减少组(P<0.01)。结论绝经后妇女血清MMP-2与骨转换生化指标相关联,血清MMP-2水平升高可能为高骨代谢转换过程(如绝经后骨质疏松症)中的一种伴随表现。     

老年2型糖尿病合并髋部骨折患者骨代谢的变化

目的探讨老年2型糖尿病合并髋部骨折患者骨代谢的改变和机制,以了解2型糖尿病与老年人髋部骨折的关系。方法测定80例老年2型糖尿病合并髋部骨折患者、90例老年2型糖尿病患者及70例年龄、体重指数相匹配的健康对照者的骨密度(BMD),血清骨钙素(BGP)、甲状旁腺素(PTH)、降钙素(CT)等,组间进行比较。结果老年2型糖尿病合并髋部骨折患者与糖尿病组比较,骨密度及各项骨代谢生化指标差异无统计学意义。老年2型糖尿病合并髋部骨折患者、老年2型糖尿病患者分别与健康对照组比较,BMD、BGP、CT显著低于对照组(P<0.01),PTH显著高于对照组(P<0.01)。结论老年2型糖尿病患者较易患骨质疏松,其骨改变特点是骨吸收增加,骨形成下降。骨质量的改变不是老年2型糖尿病患者发生髋部骨折的直接原因。     

Pamidronate increases bone mineral density in women with postmenopausal or steroid-induced osteoporosis

INTRODUCTION: We aimed to determine the efficacy and safety of a cyclic intravenous therapy with pamidronate in patients with postmenopausal or glucocorticoid-induced osteoporosis. METHODS: We enrolled 86 Austrian female patients with postmenopausal (n = 69, mean age 68.13 +/- 1.14) or glucocorticoid-induced (n = 17, mean age 66.89 +/- 2.03) osteoporosis defined as a T-score of < -2.5 for bone mineral density (BMD) of the lumbar spine L1-L4. Patients received a single intravenous dose of 30 mg pamidronate at 3 months intervals. The per cent change in BMD was primary, whereas the safety and the biological response were secondary endpoints. RESULTS: Seventy-six female patients (88%) completed study. Sixty patients received pamidronate therapy for the treatment of late postmenopausal osteoporosis and 16 patients received the same treatment for glucocorticoid-induced osteoporosis. At the end of the trial, lumbar spine (L1-L4) BMD increased significantly in patients with postmenopausal osteoporosis (P = 0.000067), whereas in patients with glucocorticoid-induced osteoporosis no significant change was observed (P = 0.724). The increase in the Ward's triangle BMD did not reach significance level in postmenopausal women receiving pamidronate (P = 0.0740). However, pamidronate treatment for glucocorticoid-induced osteoporosis resulted in a significant increase in Ward's triangle BMD (P = 0.0029). The efficacy of pamidronate treatment for postmenopausal osteoporosis was also reflected in a decrease in circulating biochemical markers for bone formation, including alkaline phosphatase and osteocalcin. In addition, pamidronate was well tolerated with no incidence of severe gastrointestinal events. CONCLUSION: Cyclic intravenous administration of pamidronate is well-tolerated therapy in postmenopausal osteoporosis, and increases spinal BMD. Randomized controlled studies with adequate number of patients are needed to test the efficacy of the compound in the treatment of glucocorticoid-induced osteoporosis.     

老年男性代谢综合征患者骨密度与骨量、骨代谢物的关系

目的：观察老年男性代谢综合征患者骨密度与骨代谢指标含量表达的变化规律。 方法：选择200605／06济南地区部队干休所离休老干部查体人员。代谢综合征及其相关组分诊断标准采用1999年WHO代谢综合征的工作定义。应用Setriscam^TM数字化成像技术及放射免疫分析法，对代谢综合征组90例（其中骨质疏松22例和骨量减少30例），单纯高血压组38例，单纯糖尿病组30例，单纯高血脂组32例患者进行骨密度、骨钙素等骨代谢指标和生化指标的测定，与相同年龄对照组进行比较，并对骨密度与各项骨代谢指标进行相关性分析。 结果：①代谢综合征骨质疏松组、代谢综合征骨量减少组、单纯糖尿病组的骨密度和峰值百分比明显低于正常对照组（P〈0．05—0．01）。②代谢综合征组、代谢综合征骨质疏松和骨量减少组骨钙素、Ⅰ型胶原C端肽低于正常对照组（P〈0．05-0．01），甲状旁腺素高于正常对照组（P〈0．05）。三组患者均存在不同程度高血糖、高血压和血脂紊乱。③代谢综合征骨质疏松组骨密度与骨钙素呈正相关关系（r=0．262），与甲状旁腺素呈负相关（r=0．233），与血压呈明显负相关（r=-0．285），与生化指标之间无相关性。 结论：代谢综合征骨质疏松患者骨密度与骨钙素、甲状旁腺素、Ⅰ型胶原C端肽、血压之间密切相关。