体成分对男性2型糖尿病患者骨密度的影响

目的 应用双能X线骨密度仪（DXA）探讨体成分对男性2型糖尿病患者骨密度的影响。方法 选择年龄50～60岁在我科住院的男性2型糖尿病患者107例，分为正常体重组、超重组和肥胖组，分别测定其身高、体重，计算体重指数（BMI），利用全自动生化分析仪测定血糖、血脂，高压液相色谱法测定糖化血红蛋白（HbA1c），采用双能Ｘ线骨密度仪测定腰椎、左股骨大转子骨密度（BMD）及体成分，并进行统计学分析。结果 3组男性2型糖尿病患者腰椎BMD分别为1.12±0.05，1.21±0.07，1.36±0.09，左股骨大转子BMD分别1.12±0.06，1.22±0.08，1.41±0.08，与骨密度呈正相关；全身各部位肌肉含量与骨密度成正相关，且大腿＞上肢＞躯干；不同部位脂肪含量对骨密度的影响是不同的，其中上肢脂肪和大腿脂肪与骨密度成正相关，而躯干脂肪与骨密度成负相关；年龄、糖化血红蛋白、血脂对男性2型糖尿病患者骨密度无明显影响，而体重指数、肌肉含量及脂肪含量影响明显。结论 体重指数、肌肉含量和脂肪含量对男性2型糖尿病患者骨密度有直接影响。男性2型糖尿病患者加强锻炼，减少腹部脂肪含量，增加四肢肌肉含量，可以预防骨质疏松症的发生。     

老年2型糖尿病患者骨密度及临床相关因素分析

目的 了解老年2型糖尿病患者骨密度的变化，初步探讨临床相关因素对骨密度变化的影响。方法 采用双能X线骨密度仪测定65例老年2型糖尿病患者及80例年龄、性别匹配的正常对照者腰椎及髋部骨密度，同时测定前者空腹血糖（FBG）、餐后2h血糖（PBG）、空腹C肽、餐后2hC肽、果糖胺（FA）、糖化血红蛋白（HBAle）、胆固醇（chol）、甘油三酯（TG）。结果 65例糖尿病患者各部位骨密度值均低于正常对照者，但仅腰椎降低有统计学意义（P〈0．05）；糖尿病组30例（45％）合并骨质疏松（OP）。OP与非0P组病程有显著性差异（P〈0．05）。结论 2型糖尿病会导致骨矿密度减低，并与糖尿病病程密切相关。     

胰岛素样生长因子-I与老年女性糖尿病患者骨密度关系的研究

目的 探讨老年女性糖尿病患者骨密度及血清胰岛素样生长因子-Ⅰ（IGF-Ⅰ）的变化及其相互关系。方法 用双能X线骨密度仪分别测定老年女性糖尿病患者骨密度值；用酶联免疫的方法测定受试者血清IGF-Ⅰ的水平，并与正常对照组比较。结果 老年女性2型糖尿病组骨质疏松（OP）发病率高于对照组（P〈0．05）；血清IGF-Ⅰ水平低于对照组（P〈0．05）；糖尿病伴OP组血清IGF-Ⅰ低于无OP组（P〈0．05）；糖尿病患者骨密度值与血清IGF-Ⅰ水平显著正相关（P〈0，05）。结论 老年女性2型糖尿病组OP发病率增高，与IGF-Ⅰ水平降低导致骨形成减少有关。     

α-骨化醇治疗绝经后骨质疏松患者的疗效观察

目的：观察α-骨化醇治疗对绝经后骨质疏松症患者的临床疗效。方法120例绝经后骨质疏松患者随机分为α-骨化醇治疗组（治疗组）及安慰剂对照组（对照组），治疗1年，分别在治疗前、后检测患者骨密度。结果试验后两组患者骨密度均降低，对照组试验后骨密度显著低于试验前（P＜0．05），但试验组骨密度显著高于对照（P＜0．05）。结论α-骨化醇可有效治疗绝经后骨质疏松。     

核因子与白细胞介素-6在骨质疏松模型中的表达特征

目的 探讨白细胞介素（IL）-6和核因子变化对绝经后骨质疏松的影响，以及其在骨质疏松发病过程中的关系及意义。方法 4月龄成年雌性BALB／C小鼠随机分假手术对照组和去卵巢骨质疏松模型组，术后第12周测量全身骨密度后处死，用免疫组织化学方法测定股骨下端骨组织中核因子及IL-6的蛋白含量及表达水平并进行细胞定位，对照研究骨密度（BMD）和骨微环境中核因子及IL-6水平。结果 去卵巢骨质疏松模型组小鼠与假手术对照组相比，骨密度下降，骨小梁稀疏；免疫组织化学染色结果显示。核因子及IL-6蛋白在模型组蛋白含量明显高于对照组且与骨密度呈显著负相关（P＜0．01或P＜0．05），NF-kB p65与IL-6呈显著正相关（P＜0．01）。结论 绝经后骨质疏松症骨组织及骨髓中核因子的蛋白含量及表达水平升高。可能激活破骨细胞分化因子IL-6的转录，使其表达增加，骨吸收活动增强，造成骨组织形态改变并导致骨质疏松。     

普伐他汀对2型糖尿病糖、脂代谢及血小板活化功能的影响

目的：探讨普伐他汀对2型糖尿病患者血小板活化功能及糖、脂代谢的影响。方法：测定31例伴高脂血症及34例血脂正常的2型糖尿病患者的CD62P,CD63及血糖,血脂,胰岛素水平,并计算胰岛素敏感指数（ISI）;对伴高脂血症患者用普伐他汀降脂治疗8周后重复测定上述指标。结果：伴高脂血症患者的CD629P,CD63及TG,TC,LDL－C,较血脂正常组明显升高（P＜0．05－0．01）,ISI和HDL－C明显降低（P＜0．01）;伴高脂血症患者经普伐他汀降脂治疗8周后TG,TC,LDL－C及CD62P,CD63明显较治疗前降低（P＜0．05－0．01）,HDL－C及ISI较治疗前显著升高（P＜0．05）。结论：普伐他汀对伴高脂血症的2型糖尿病患者在调脂治疗的同时可降低血小板活性,改善胰岛素抵抗。     

绝经后女性股骨近端骨密度与骨质疏松性骨折相关性研究

目的：研究绝经后女性股骨近端骨密度的变化规律与骨质疏松症、骨质疏松性骨折间的关系。方法采用法国Medlink公司Osteocore 3型双能X线骨密度仪,对本地区417例绝经后女性股骨颈、大转子、粗隆间、全髋进行骨密度测定。结果骨折组各年龄段、各部位的BMD均比非骨折组低（ P＜0．05）。随着年龄的增长,股骨近端骨量逐渐丢失,除了45～50组,其余各年龄段骨折组的患病率明显高于非骨折组（ P＜0．05）,骨密度值越低,骨折危险性越大。结论绝经后女性股骨近端骨密度与发生骨质疏松性骨折的风险呈明显负相关性,应该注意预防。     

北京城区10?12岁女孩骨密度的研究

目的 观察10－12岁女孩骨密度（BMD）的变化。方法 对375例健康女孩行全身扫描和左前臂扫描，按首位（10岁）平均体重指数（BMI）分组为超重组（BMMI＞19．6）、正常组（BMI＝14．2－19．6）、偏轻组（BMI＜14．2）。1年和2年后，利用同台双能X线骨密度仪再次扫描，连续3年追踪观察该年龄段女孩每年BMD的变化。结果 全身各部位的BMD值和全身总的骨矿含量（BMC）值第2年明显高于第1年（P＜0．01－0．001）。第3年（12岁）与第2年（11岁）相比：仅前臂远端1／10处BMD值有明显增加（P＜0．001），前臂远端1／3处BMD值和全身总的BMD值无增加，且全身总的BMD值略有下降（P＞0．05）；但全身总的BMC值有明显增加（P＜0．001）。BMD、BMC值均以超重组最高，正常组次之，偏轻组最低。结论 青春期女孩不同部位的BMD值年增长率快慢不一，但全身总的BMC值总是随着年龄增长而增加。     

他莫西芬对去卵巢骨质疏松大鼠影响的实验研究

目的 探讨选择性雌激素受体调节剂他莫西芬对去卵巢造成的骨质疏松大鼠性激素及骨密度的影响。方法 通过切除大鼠卵巢造成骨质疏松模型,观察他莫西芬对骨质疏松大鼠血清雌二醇（E2）、卵泡刺激素（FSH）、黄体生成素（LH）、泌乳素（PRL）、乳酮（PROG）、皮质醇（COR）、睾酮（T）及骨密度 （BMD）的影响,并与尼尔雌醇（nilestrial）做阳性对照。结果 他莫西芬治疗的去卵巢骨质疏松大鼠血清E2水平高于病理对照组（P＜0．05）,LH水平低于病理对照组（P＜0．05）,左侧后腿股骨胫骨及平均骨密度均高于模型组（P＜0．01,P＜0．1,P＜0．05）。结论 他莫西芬能提高去卵巢骨质疏松大鼠骨密度,其作用机制可能与其拟雌激素样作用有关。     

河北地区不同年龄健康男性不同部位骨密度与体成分分析

目的探讨河北地区不同年龄健康男性不同部位骨密度（BMD）与体成分的关系。方法 225名受试对象年龄20～79岁,每10岁为1个年龄组,其中20～29岁28名,30～39岁35名,40～49岁40名,50～59岁42名,60～69岁39名,70～79岁41名,均检测正位腰椎（L2～4）、股骨（股骨颈、Ward三角、大转子、转子间）BMD,同时测定全身各部位肌肉和脂肪含量。结果各年龄组体质量指数（BMI）无明显差别,具有可比性。男性在40～49岁组骨质疏松发生率为5.00%,50～59岁组为13.04%,60～69岁组24.39%,70～79岁组41.86%。30～39岁组各部位BMD均为最高值,且在股骨颈、Ward三角明显高于其他年龄组（P〈0.05）,20～29岁、40～49岁、50～59岁间各部位BMD比较均无明显差异（P〉0.05）,60～69岁组L2～4、股骨颈、转子间BMD均明显高于70～79岁组（P〈0.05）;30～39岁组躯干、腿部、总肌肉含量均高于其他年龄组,但与40～49岁组比较均无明显差异（P〉0.05）,50～59岁与70～79岁组比较,躯干、总肌肉含量差异有统计学意义（P〈0.05）;各部位脂肪含量随增龄虽有增加趋势,但仅70～79岁组躯干、腿部、总脂肪含量较20～29岁、30～39岁组明显增加（P〈0.05）,其他年龄组各部位脂肪含量两两比较差异均无统计学意义（P〉0.05）;多元线性回归分析显示男性L2～4、股骨均值BMD均与BMI、所对应的肌肉含量、年龄关系密切,与所对应的脂肪含量无相关性。结论河北地区健康男性各部位骨密度均随增龄逐渐降低,无快速骨量丢失期,各部位骨峰值出现在30～39岁之间,各部位肌肉含量均与BMD有明显相关性,与脂肪含量无关。     

广州地区骨量峰值的调查研究

目的　研究广州城乡居民骨量峰值及其特点和影响中青年妇女骨量的因素 ,为原发骨质疏松症的诊断和预防提供有用的数据。方法　随机抽取广州地区 2 0～ 4 9岁城乡正常男女性居民 4 80人 ,先行问卷调查再进行腰椎 (L2～ 4 )正位和髋部的双能X线骨密度 (BMD)的测量。结果　男性腰椎和髋部骨量峰值 (PBM)出现在 2 0～ 2 9岁 ,L2～ 4 的PBM值为 1 14 0± 0 0 12 9(g cm2 ) ,BMD随年龄增长而下降。女性腰椎和髋部PBM出现在 30～ 39岁 (髋部的Ward’s区出现在 2 0～ 2 9岁 ) ,L2～ 4 的PBM为 1 138± 0 0 99(g cm2 ) ,男女性无显著差异。髋部PBM男性高于女性差异有显著性。 4 0～ 4 9岁不论L2～ 4 和髋部BMD女性都高于男性差异有显著性。妊娠、分娩、哺乳、避孕药、输卵管结扎术对骨量影响无显著性。结论　广州地区女性的PBM近似北京及上海地区高于成都地区。 4 0～ 4 9岁女性腰椎及髋部BMD都高于男性 ,可能与广州地区女性从事较重农业劳动有关。男性则低于沈阳、北京、上海而高于成都     

Lean mass as a significant determinant of regional and total body bone mineral density in premenopausal women

We investigated the relations of body composition to regional and total body bone mineral density (BMD) in 275 healthy Japanese premenopausal women (mean age, 37.1 ± 9.2 years; range, 16–55 years). In all subjects, the right side was dominant. BMD of the head, bilateral arms, lumbar spine (L2–L4), bilateral legs, and total body were measured using whole-body scanning by dual-energy X-ray absorptiometry (DXA). Total fat mass, total lean mass, regional lean mass, and regional fat mass were measured by DXA. Baseline characteristics including age, height, body weight, and body mass index were recorded for each subject. Possible correlations between regional or total body BMD with variables were determined on univariate and stepwise multiple regression analysis. BMD, lean mass, and fat mass were compared between the bilateral extremities. Total lean mass for the right arm, regional lean mass for the left arm, total lean mass for the lumbar spine, body weight for the bilateral legs, and total lean mass for the whole body were the most significant determinants of BMD on stepwise multiple regression analysis. Right-arm BMD was significantly higher than left-arm BMD. However, no significant difference was observed between BMD in the right and left legs. We concluded that lean mass is a more significant determinant of regional and total body BMD than fat mass in premenopausal women. Received: June 12, 1997 / Accepted: Oct. 23, 1997     

绝经后妇女血清调钙激素水平与骨代谢关系探讨

目的 探讨绝经后妇女血清调钙激素水平对骨形成、骨吸收及骨密度的影响。方法 142名健康绝经后妇女测定血雌二醇（E2）、睾酮（T）、总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4)、甲状旁腺激素全段（PTH－SP）、降钙素（CT）、骨钙素（BGP）、尿脱氧吡啶啉（DPD）、尿肌酐（Cr）。双能X线骨密度仪测定腰椎、髋部、前臂骨密度（BMD）,对检测结果进行分析。结果 本组骨质疏松患病率为60．48％,低骨量32．39％,正常骨量7．13％。血清6种调钙激素中T、E2、TT3、TT4、CT与BMD、BGP呈正相关,与年龄负相关;PTH－SP与BMD呈负相关,与年龄、DPD／Cr呈正相关。结论 绝经后妇女血调钙激素水平影响骨形成、骨吸收和骨密度,使骨代谢趋向于负平衡,是绝经后妇女易发生骨质疏松症的重要原因。     

Body composition and muscle strength as predictors of bone mineral density in Crohn’s disease

Compromised skeletal status is a frequent finding in patients with Crohn’s disease (CD), leading to increased fracture risk. Low body weight is associated with bone mineral density (BMD) in CD, although the relative importance of its components, lean and fat mass, is unclear. Muscle strength is also a predictor of BMD in nondiseased populations; however, its association with bone in CD is unknown. We examined the independent effects of body composition and muscle strength on regional and whole-body BMD in a cohort of CD patients. Sixty men and women, aged 22–72 years, with disease duration of 13 ± 7 years, underwent scanning of the spine, hip, forearm, and whole-body BMD by dual-energy X-ray absorptiometry (DXA). Lean tissue, appendicular muscle mass (AMM), and fat mass were derived by DXA and grip strength by dynamometry. Medical history, medication usage, clinical variables, and nutritional intake were obtained by questionnaire. Prevalence of osteopenia and osteoporosis was 32 and 17%, respectively, with osteopenia more common at the hip and osteoporosis more common at the spine. In multiple regression analyses, AMM was an independent predictor of whole-body and regional BMD whereas lean mass was an independent predictor at the hip. Neither grip strength nor fat mass was independently associated with BMD. Of the components of body composition, muscle mass was strongly associated with regional and whole-body BMD. Preserving or augmenting muscle mass in this population may be a useful strategy to preserve BMD and thereby reduce fracture risk.     

武汉地区1359例骨密度测定及骨质疏松患病率分析

目的 分析武汉地区人群骨密度（BMD）变化规律及骨质疏松（OP）患病率。方法 使用美国Hologic公司双能X线骨密度仪对武汉地区2－91岁的居民1359人进行L1－4和髋部BMD测定,然后进行比较和统计分析。结果 男性腰椎骨峰值在30－34岁年龄段,女性在35－39岁;男、女性髋部骨峰值均在30－34岁。峰值后随年龄增长BMD逐渐下降,女性在50岁后可见明显的骨质丢失加速,而男性丢失是逐渐和缓慢的。武汉地区50－79岁人群骨质疏松症发病率男性为37．8％,女性为67．3％。结论 骨质疏松研究的重点在中老年妇女,但对于男性也不可忽视;骨质疏松的预防应从青少年开始。     

Relationship of upper body fat distribution to higher regional lean mass and bone mineral density

 We investigated the relationship of upper body fat distribution to regional bone mineral density (BMD). Subjects were 361 regularly menstruating premenopausal women with right-side dominance. Age, height, and weight were recorded. Regional (arms, L2–L4 of the lumbar spine, and legs) BMD, regional (arms, trunk, and legs) lean mass, and the ratio of trunk fat mass to leg fat mass amount (trunk–leg fat ratio) were measured by dual-energy X-ray absorptiometry. Body fat distribution was assessed by trunk–leg fat ratio. Trunk–leg fat ratio was positively correlated with regional BMD (r = 0.120–0.216; P < 0.05–P < 0.001) and regional lean mass (r = 0.162–0.229; P < 0.01–P < 0.001). Regional lean mass was more positively correlated with regional BMD (r = 0.319–0.475; P < 0.001). These relationships remained significant after adjusting for age and height. However, correlation of trunk–leg fat ratio with regional BMD disappeared after additionally adjusting for regional lean mass. In premenopausal women, upper body fat distribution is associated with higher regional BMD via greater regional lean mass irrespective of age and height. Received: July 15, 2002 / Accepted: October 29, 2002 Offprint requests to: T. Douchi     

孕激素对去势雌性大鼠骨密度及骨形态计量作用的初步研究

目的　了解孕激素对去势雌性大鼠骨密度及骨形态计量作用。方法　 5 0只 6月龄Wistar雌性大鼠随机分为 5组 :假手术组和卵巢切除组、卵巢切除后分别加安宫黄体酮 2mg组、安宫黄体酮 2 0mg组和倍美力组。手术后 7d喂药 ,用药后 3个月处死。测定各组大鼠子宫湿重、全身及股骨骨密度并取大鼠椎骨、胫骨组织切片进行形态计量分析。结果　两组孕激素组子宫湿重与卵巢切除组相同 ,均显著低于假手术组与倍美力组 (P <0 0 0 1)。假手术、雌、孕激素组全身骨密度测定均大于卵巢切除组 (P <0 0 5 )。各组股骨骨密度无显著差异。组织切片观察显示 ,假手术与倍美力组骨小梁粗壮、饱满、结构完整 ;卵巢切除组则纤细、断裂、完整性差。孕激素组骨小梁结构优于卵巢切除组但不及假手术及倍美力组。计量分析显示孕激素组椎骨骨小梁面积明显大于卵巢切除组(P <0 0 5 ) ,但低于倍美力组 (P <0 0 5 )。胫骨骨小梁面积与卵巢切除组相仿 ,均明显低于假手术和倍美力组 (P <0 0 5 )。孕激素 2mg与 2 0mg组间无明显差异。结论　两种剂量的安宫黄体酮对卵巢切除大鼠骨质疏松均有一定防治作用 ,但从骨组织形态计量分析 ,其作用较弱 ,与结合雌激素相比 ,尚不足以维持骨量     

Characteristics of regional bone mineral density and soft tissue composition in patients with atraumatic vertebral fractures

To clarify the characteristics of total body and regional bone mineral density (BMD) and soft tissue composition in patients with atraumatic vertebral fractures (AVF), we measured total body and regional BMD, lean mass, and fat mass using dual-energy X-ray absorptiometry. Sixty-four women, aged 55–75 years, were divided into two groups: women with AVF (fracture group, n = 30) and women without AVF (nonfracture group, n = 34). Mean BMD of the second to fourth lumbar vertebrae (L2–4BMD), regional BMD, and soft tissue mass were measured. Regional BMD was measured in the head, arms, legs, ribs, thoracic vertebrae, lumbar vertebrae, and pelvis. Lean mass and fat mass of head, arms, legs, and trunk were measured. L2–4BMD, total body BMD, and BMD of the lumbar spine, thoracic spine, and pelvis of the fracture group were significantly lower than those of the nonfracture group (P < 0.001). Total lean and fat mass of the fracture group tended to be lower than that of the nonfracture group. The results suggest that BMD of weight-bearing bones, except for that of the bones of the legs of the fracture group, is significantly lower than that of the nonfracture group, and that total body lean and fat mass may be a predictor for AVF. Received: September 27, 1999 / Accepted: January 7, 2000     

肠炎性病变患者骨密度测量的临床意义

目的　研究肠炎性病变时骨密度的变化及其临床意义。方法　对３０ 例肠炎性疾病者及３０例健康者,用双能Ｘ 线吸收法（ＤＸＡ）做了全身、腰椎２～４、股骨颈的骨密度测量和肌肉组织以及体脂肪量测量。并作了比较性研究。结果　肠炎性疾病易并发骨质疏松。骨质疏松似有选择性。股骨颈骨量减少较腰椎者明显,故前者宜作为首选受检部位。全身肌肉组织量与全身骨密度正相关。肌肉量测量可反映骨量增减。结论　肠炎性疾病可并发骨质疏松。为预测、预防骨质疏松,密切观察股骨颈骨密度和肌肉量的变化是必要的。     

Association between bone mineral density,lean mass,and fat mass among healthy middle-aged premenopausal women: a cross-sectional study in southern Sri Lanka

Associations between lean mass, fat mass, and bone mass have been reported earlier; however, most of those studies have been done in Caucasian populations, and data from Asian countries, especially those in South Asia, are limited. We examined the associations between lean mass, fat mass, bone mineral density (BMD), and bone mineral content (BMC), determined by dual-energy X-ray absorptiometry technology, in a group of healthy, middle-aged, premenopausal female volunteers. The mean (SD) age of the women (n = 106) was 42.1 (6.1) years and the mean (SD) body mass index was 24.3 (3.6) kg/m². Total body BMD, total body BMC, and BMD in total spine, total hip, and femoral neck showed statistically significant partial correlations (adjusted for age) with total fat mass (r = 0.19–0.43, P < 0.05) and lean body mass (r = 0.28–0.54, P < 0.05). Truncal fat mass correlated positively with total body BMC and BMD at total hip and femoral neck (r = 0.33–0.40, P < 0.001). When a stepwise regression model was fitted, lean mass remained the strongest predictor of total body BMD, total body BMC, and total spine BMD (regression coefficients = 0.004–0.008 g/cm² per 1-kg change in lean mass, P < 0.001). Similarly, crude BMD and BMC increased across the tertiles of lean mass (P trend < 0.05). We show that lean mass is the strongest predictor of total body BMC and BMD at different sites, although positive correlations with fat mass also exist.