绝经后激素替代治疗的妇女发生骨质疏松时某些细胞因子水平的改变

目的：旨在探讨健康和骨质疏松的激素替代治疗的绝经后妇女中全血细胞产生某些细胞因子水平的不同，论证这些细胞因子与绝经后骨质疏松的关系。对象：43名白人绝经后立即激素替代治疗的妇女，分为骨质疏松组（n＝12）和正常对照组（n＝31）。取全血，一半不作处理，作为对照组，一半加入多克隆的刺激剂，作为刺激组，培养4h或72h，使用ELISA法测定细胞因子IL－1β，IL-6，TNFα，INF-γ，GM-CSF和ILF。结果：在骨质疏松的绝经后激素替代治疗妇女中，较之无骨质疏松的同组人群，细胞因子IL－6水平升高，LFN－γ，LIF水平降低，结论：虽然同样绝经后即开始激素替代治疗，一些妇女依旧发生骨质疏松，本研究发现IL－6在这部分病人中可能是一种致病因素，而TNF－γ，LIF是一种保护因素。     

绝经后妇女脊柱骨质疏松的MRI诊断

绝经后妇女发生骨质疏松是十分常见的。有人曾统计45岁以上女性,29%有骨质疏松,70岁以上则更多,可达70%左右,故有称为绝经后骨质疏松[1]。以往诊断主要依靠Ｘ线检查,并结合临床化验和组织学检查确诊[1]。笔者对57例绝经后妇女脊柱骨质疏松的ＭＲＩ表现进行分析,目的在为本病的ＭＲＩ诊断及鉴别诊断提供依据。1　材料与方法搜集我院1996.8～1999.6间、50岁以上妇女、Ｘ线检查诊断明确、临床资料证实的脊柱骨质疏松病例57例。其中50～60岁15例、60～70岁28例、70岁以上14例,年龄最小50岁,最大81岁,平均68.6岁。检查设备采用深圳安科公司ＡＳＭ…     

绝经后骨质疏松妇女血清相关激素水平的改变

目的　通过分析绝经后骨质疏松妇女某些骨代谢相关激素的血清水平的改变 ,探讨其与绝经后骨质疏松的关系。方法　 6 2名绝经 2年以上妇女 ,测量腰椎骨密度 ,分为骨质疏松组 (30名 )和对照组 (32名 )。隔夜空腹取血测定血清LH、FSH、E1、E2 、DHEA、DHEA S、SHBG、GH、CT、PTH、2 5 (OH)D3 。结果　绝经后妇女骨质疏松组和对照组在年龄上无差异 (5 9 5 6± 6 6 5vs 5 9 35± 7 6 3,P>0 0 5 )。骨质疏松组体重指数BMI (2 4 2 7± 2 4 6 )低于对照组 (2 6 83± 4 16 ,P <0 0 5 )。绝经后妇女血清E1(r= 0 6 0 0 ,P <0 0 0 1)、DHEA(r= 0 70 8,P <0 0 0 1)、DHEAS(r = 0 5 82 ,P <0 0 0 1)与年龄负相关。骨密度与LH负相关 (r= 0 4 39,P <0 0 5 )。骨质疏松组与对照组相比 ,LH、SHBG显著增高 (P<0 0 5 ) ,DHEA、DHEAS显著降低 (P <0 0 5 )。FSH、CT、PTH、2 5 (OH)D3 、GH、E1、E2 差异无显著性。结论　绝经后妇女骨代谢相关激素血清水平的改变参与了绝经后骨质疏松的发病     

不同剂量激素补充治疗对绝经后妇女血脂的影响

雌激素对绝经后妇女心血管的保护作用有2 5 %～ 3 0 %是通过改善血脂实现的 [1- 4]。结合雌激素 (倍美力 ,CEE) 0 .62 5 mg/d配伍安宫黄体酮 ( MPA) 2 mg/d是常用剂量 ,已被证明可改善血脂。本研究旨在讨论低剂量的 CEE( 0 .3mg/d)是否也有改善血脂的作用。一、资料与方法1 .研究对象 :从 1 998年 3月～ 1 999年 3月 ,收集 60名绝经 4年内的健康妇女 ,排除内分泌、肝肾、心脑血管、乳房恶性疾病及雌激素依赖性疾病 ,近 3个月未服用激素类药物。随机分为 3组 :A组 :每日服用 CEE 0 .62 5 mg MPA2 mg Ca-D60 0 mg;B组 :每日口服 CEE0…     

绝经后妇女骨质疏松认知与骨密度关系的研究

目的探讨绝经后妇女骨质疏松认知水平(了解骨质疏松概念且如何防治骨质疏松)与骨密度的关系。方法随机选择1048例福州汉族绝经后妇女问卷调查,骨质疏松认知组379例,无认知组669例,双能X线测定腰椎、股骨颈、大转子和Ward’s区骨密度。SPSS20.0统计软件分析认知组与不同部位骨密度的关系。结果 1认知组与无认知组比较,结果为年龄、月经初潮、怀孕次数、哺乳次数、文化程度、喝牛奶、日光照射、运动时间、腰椎BMD(骨密度)有统计学差异(P0.05)。通过协方差分析,认知组腰椎骨密度(0.752±0.105 g/cm~2)明显高于无认知组腰椎骨密度(0.734±0.098 g/cm~2),P0.01。2四个部位骨密度与影响因素进行相关分析,结果为腰椎骨密度与认知相关。骨质疏松影响因素为年龄、月经初潮、骨质疏松认知、哺乳次数、身高,可知认知为骨质疏松的重要影响因素。3无骨质疏松认知组OP患病率71.16%,认知组70.18%,两组比较无统计学差异P0.05。结论绝经后妇女骨质疏松认知水平与骨密度相关,认知组腰椎骨密度比无认知组高,提示加强认知教育对预防骨质疏松发生具有临床意义。     

绝经后妇女骨质疏松性骨折易发因素的流行病学研究

目的 探讨绝经后妇女骨质疏松性骨折的分布特征和易发因素。方法 以社区50-69岁绝经1年以上妇女为研究对象,问卷调查危险因素,双能X线骨密度仪测量骨密度(Bone MineralDensity,BMD),胸腰椎侧位X摄片分析椎体骨折,结合病史问询调查骨折发生。结果 绝经后妇女骨质疏松性骨折的发生率随年龄和绝经年限的延长而上升,尤其是绝经后的15-20年,骨质疏松性骨折的发生率明显升高。至少有一处以上骨折的绝经后妇女较无骨折妇女的年龄大、绝经年龄早、绝经年限长、生育次数多、哺乳月份长(P<0.01)。结论 绝经早、生育胎数多、哺乳时间长等因素是绝经后妇女骨质疏松性骨折的重要危险因素,可作为骨折高危人群的筛选指标以及制定相应干预措施的依据。     

尼尔雌醇防治绝经后及老年妇女骨质疏松的临床观察

对 2 0例绝经后妇女和老年妇女分别给予尼尔雌醇用药 3个月 ,并于给药前后分别测定空腹尿钙与肌酐 (Ca/Cr) ,羟脯氨酸与肌酐 (OHPr/Cr)比值以及血清碱性磷酸酶 (AKP)、雌二醇 (E2 )、降钙素 (CT)的值。以探讨尼尔雌醇减缓不同绝经年限妇女骨量丢失的作用机制。结果显示尼尔雌醇给药前后两组妇女血清E2 的水平未见明显变化 ,但其血清CT的水平均较给药前有程度不同的升高。空腹尿Ca/Cr、OHPr/Cr比值以及血清AKP水平均较给药前显著下降 (P <0 0 0 5及P <0 0 1)。故此提示 ,尼尔雌醇可能通过刺激甲状腺C细胞而增加CT的分泌或直接作用于骨组织等多种途径抑制骨质的吸收 ,维持其骨矿含量的相对稳定。因此 ,本研究在国内首次为尼尔雌醇用于减缓老年妇女骨质的丢失提供了一定的理论依据。     

盐酸雷洛昔芬治疗绝经后妇女骨质疏松临床研究

目的研究盐酸雷洛昔芬(Raloxifene HCL,RLX)治疗绝经后骨质疏松妇女临床疗效,骨密度、血生化指标及血脂的影响。方法选择2010年1月-2013年1月在我科住院绝经后骨质疏松患者共90例,每人每天服用元素钙600 mg,活性维生素D 0.5μg作为基本补充剂,每日服用盐酸雷洛昔芬60 mg,共治疗12个月。观察指标为:腰椎、髋部骨密度;骨标志物、血生化指标。骨密度测定采用双能X线吸收法,骨标志物测定采用酶联免疫吸附法,血生化检测应用酶法。结果研究结束时,腰椎骨密度0.848±0.167,Ward三角骨密度0.536±0.126,较治疗前0.842±0.181、0.500±0.112均有显著提高,差异具有统计学意义;治疗后,血清CTX、BGP均较治疗前显著降低,而PTH较治疗前升高;治疗前后两组血脂水平无显著差异。结论盐酸雷洛昔芬能够显著增加绝经后骨质疏松妇女腰椎和髋部的骨密度,显著降低骨转换率,对绝经后妇女骨质疏松治疗效果较好。     

用BGP、BMC诊断绝经后妇女骨质疏松的研究

用ＢＧＰ、ＢＭＣ诊断绝经后妇女骨质疏松的研究郭海，赵秉英本文用ＲＩＡ测定１００例绝经后妇女的血清骨钙素（ＢＧＰ）及骨矿物质（ＢＭＣ）的量，目的在为绝经妇女骨质疏松的诊治提供新的临床资料。材料和方法：①１００例绝经后妇女，年龄５１～６６岁，平均年龄５８...     

绝经后妇女骨质疏松的运动康复疗法处方

女性骨质疏松发病较早，引起骨质疏松的相关因素是40岁以后成骨细胞的骨形成功能降低，并随年龄增长加重，高龄妇女维生素摄人及合成减少，钙的吸收随之降低，绝经期后雌激素水平不足，骨质丢失加重，常见为脊椎骨质疏松，临床表现为脊柱变形，腰背疼痛，肌力低下，步行障碍。有研究表明，每天运动15min比不运动的人全身骨盐量12个月期间增加5％，因此对于女性绝经期骨质疏松可做如下的有益的康复运动训练，以延缓骨质疏松的发生及减轻症状。     

激素替代联合二磷酸盐预防和治疗绝经后骨质疏松症疗效的系统评价

目的 评价联合与单一用激素替代和二磷酸盐预防和治疗绝经后骨质疏松的疗效性和安全性.方法 计算机检索MEDLINE(1966～2008.10)、Embase(1984～2005)、PubMed(1966～2008.10)、Cocharane图书馆(CENTRAL 2008年第三期)、中国生物医学文献光盘数据库(1978～2006年)和中国期刊全文数据(1979～2008.10),并手工检索相关领域其他杂志.对纳入文献进行质量评价.数据分析采用RevMan 5.0,对于异质性小的研究合并效应量.结果 共纳入13 个随机对照试验,包括3341 例患者.Meta 分析结果显示:①联合治疗组与二磷酸盐单一用药组比较,在增加腰椎骨密度和减少骨折风险方面无明显差别,在降低骨转化标志物及药物副作用方面无优势.②联合治疗组与激素替代单一治疗组比较,在增加腰椎骨密度、药物副作用方面具有明显优势,在减少骨折风险、降低骨转化标志物方面无明显差别.结论 激素替代联合二磷酸盐预防和治疗绝经后骨质疏松症疗效优于激素替代单一治疗,但与二磷酸盐单一治疗比较并没有优势,且副作用明显增加.     

骨质疏松预防与自我管理课程对绝经后女性骨质疏松认知及健康行为的影响

目的评价骨质疏松预防与自我管理课程(osteoporosis prevention and self-management course,OPSMC)对绝经后女性骨质疏松认知及健康行为的影响。方法将2011年7月-2012年7月在沈阳军区总医院就诊的267名绝经后妇女随机分为干预组133例和对照组134例。干预组采用OPSMC规定课程,对照组同步实施与骨质疏松无关的健康宣教。干预前及3个月后分别采用骨质疏松症知识问卷(OKT)、骨质疏松症自我效能量表(OSES)和自设的骨质疏松健康行为问卷对两组受试者进行评价。结果 2组受试者OKT和OSES评分在不同时间点差异有统计学意义(P0.001),不同干预方式对OKT和OSES评分影响不同(P0.001),干预与时间点之间有交互作用(P0.001)。在3个月时,干预组更加重视补充钙剂(19.5%vs1.8%,P0.01)、维生素D(14.4%vs 0.9%,P0.01)、含钙食物摄入(15.3%vs 2.7%,P0.01)、每周锻炼次数(9.3%vs0.9%,P0.01)及强度(27.9%vs 8.8%,P0.01)。结论 OPSMC是一种有效的骨质疏松健康干预措施,短期内可以提高绝经后女性骨质疏松认知水平,促进健康行为。     

Effects of low-dose long-term HRT on serum lipids in postmenopausal women

<正>Objective: To study the effects of low-dose and long-term hormone replacement therapy (HRT) on blood lipids in postmenopausal women. Methods: (1) 141 postmenopausal female medical staffs aged from 50 to 87 years with average 68 years were from Peking Union Medical college Hospital, among them 63 were treated with low-dose HRT for 5-31 years as HRT group, and other 78 postmenopausal women matched with age as the control group. (2) withdrew vein blood from objects on fasting for 12-14 h and serum was separated for determining serum concentration of lipid, lipoprotein and apolipoprotein. (3)data were analyzed with SPSS statistical software for statistical significance by P<0. 05. Results:In comparison with control, the levels of TG, HDL-C, LDL-C, apoA Ⅰ, Lp(a) of HRT group had no statistical significance,but the levels of TC, TC/HDL-C, ApoE, ApoC Ⅲand ApoB were significantly lower. Conclusion:The levels of TC, LDL-C, ApoB, ApoC Ⅲ, ApoE decreased significantly in postmenopausal women receiving low-dose and long-term HRT. The decrease in the levels of blood lipids may provide cardiovascular protection and reduce the risk of cardiovascular events.     

低剂量与长期性激素替代疗法对绝经后妇女血脂水平的影响

目的探讨绝经后妇女低剂量与长期的性激素替代疗法(HRT)对血脂水平的影响。方法研究对象为北京协和医院女职工141人,年龄50~87岁、平均68岁,其中绝经后低剂量HRT 5~31年63人为HRT组。以年龄匹配78人为对照组。空腹12~14 h取静脉血,分离血清,检测血脂、脂蛋白和载脂蛋白等九项指标。结果HRT组与对照组比较:甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白AⅠ(ApoAⅠ)、脂蛋白(a)[Lp(a)]两组之间差异无统计学意义;总胆固醇(TC)、TC/HDL-C、载脂蛋白E(ApoE)、载脂蛋白CIII(ApoCIII)和载脂蛋白B(ApoB)差异有统计学意义。结论绝经后妇女经低剂量与长期的HRT可使TC、ApoB、ApoCIII、ApoE、TC/HDL-C水平明显下降。血脂水平的下降对心血管系统有保护作用,并可降低心血管事件发生和发展的危险性。     

绝经期骨质疏松雌激素替代治疗临床研究

１９９５￣１９９８三年中,对绝经期骨质疏松（ＭＯＰ）１１１例进行为期２年的前瞻性雌激素替代治疗（ＨＲＴ）研究,其中５６人应用利维爱（Ｌｉｖｉａｌ）为研究组,５５人应用尼尔雌醇为对照组,经过２年随诊,终点结论是ＨＲＴ对缓解更年期症状,提高患生活质量,增加骨密度（ＢＭＤ）都有效果,但研究组明显优于对照组,具有统计学意义。ＨＲＴ的副作用为血：治疗组５．３５％,对照组１０．９％,乳房胀痛：治疗组７．１４     

Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women

Randomized, double-blind, controlled studies have shown that treatment with risedronate reduces the risk of vertebral fracture in postmenopausal women with established vertebral osteoporosis. They also show that the drug decreases the risk of non-vertebral fractures in women with osteoporosis. The aim of this study was to investigate the cost-effectiveness of risedronate in postmenopausal women with osteoporosis. A Markov model was applied to a UK setting. Treatment effects were computed by meta-analysis of randomized, controlled trials and given over 5 years to subjects aged between 60 and 80 years. Quality-adjusted life years (QALYs) and life years gained were used as outcome measures. Intervention with risedronate was cost-effective in women aged 60 years and older. Cost savings were also found for postmenopausal women aged 70 years and older with established vertebral osteoporosis (a prior spine fracture and BMD T-score –2.5 SD). This treatment was cost-effective for women aged 65 years and older who had a prior vertebral fracture and a BMD T-score at the threshold of osteoporosis (T-score=–2.5 SD), and in women with a T-score–2.5 SD, but without a prior vertebral fracture. In women aged 60–80 years and at the threshold of osteoporosis (T-score=–2.5 SD) but without a prior vertebral fracture, treatment exceeded the threshold for cost-effectiveness. However, if an additional, independent risk factor was assumed (e.g., corticosteroid use) treatment became cost-effective.     

Low dose and short-term therapy of tibolone reduces the cardiovascular disease risk in postmenopausal women

<正>Objective:To investigate the effects of low dose tibolone short-term therapy on clinic, endocrine and markers of cardiovascular disease in healthy postmenopausal women. Methods: A prospective study involved a total of 42 eligible postmenopausal women. 22 cases as group A and 20 cases as group B. Complete baseline work-up including Kupperman score, body mass index (BMI), gonadotropin (FSH, LH) , estrogen (E2), testosterone (T) , sex hormone binding globulin (SHBG), plasminogen activator inhibitor type 1 (PAI-1), tissue plas-minogen activator (tPA), high-sensitivity C-response protein (hs-CRP), nitrogen oxide (NO) and fasting lipid, glucose(FPG) , insulin(FINS) were performed in all subjects. Postmenopausal women in group A were treated with 1. 25 mg tibolone daily. Women in group B were treated with 0. 625 mg tibolone daily. Women both in group A and group B were given calcium 600 mg with vitamin D 125IU per day. At the end of the 12-weeks therapy, subjects were re-evaluated and above parameters were measured. Results: No significant differences between group A and group B were found at baseline. Twenty-eight cases (fourteen cases in each group) completed the study. Kupperman score decreased from (22. 1±8. 0) and (25. 4±7. 5) to (7. 7±4. 5) and (5. 2±4. 5) and plasminogen activator inhibitor type 1 decreased from (95. 8±32. 4)μg/L and (102. 9±42. 6)μg/L to (72. 2±39. 6)μg/L and (79. 9±30. 1)μg/L significantly in group A and group B respectively after treatment. In group A, Blood pressure decreased significantly from (120±10)/(83±6) mmHg to (110±14)/(77±9) mmHg (P<0. 05), testosterone increased significantly from (0. 6±0. 4) nmol/L to (1. 3±1. 1) nmol/L (P<0. 05), free testosterone increased from (0. 001±0. 002) nmol/L to (0. 003±0.003) nmol/L significantly (P<0. 01), SHBG decreased from (7. 6±4. 9) nmol/L to (4. 3±2. 9) nmol/L significantly (P<0. 05) , total cholesterol decreased from (5. 4±0. 8) mmol/L to (5. 0±0. 8) mmol/L significantly (P<0. 01) , ApoA decreased from (1. 8±0. 3) mg/dl to (1. 7±0. 3) mg/dl significantly (P<0. 05) , fasting glucose decreased from (5. 6±0. 8) mmol/L to (3. 9±1. 1) mmol/L significantly (P<0. 01) and no significant differences in BMI, FSH, LH, E2, tPA, hs-CRP, NO, TG, HDL-C, LDL-C, apoB were found after treatment. In group B, there were no significant differences in other parameters found after treatment except Kupperman score and PAI-1. Conclusions: 1. 25 mg/d tibolone short-term therapy was associated with improved fibrinolyt-ic factors and decreased Kupperman score, blood pressure, total cholesterol and fasting blood glucose level. 0. 625 mg/d tibolone therapy resulted in decrease Kupperman score and improvement of fibrinolytic factors. These changes relieve climacteric symptoms and may have some benefits on preventing the development of cardiovascular disease. An increased testosterone and free testosterone levels in 1. 25 mg dose of tibolone therapy may increase energy level, general well-being and sexual desire in postmenopausal women. Low dose tibolone replacement therapy is a convenient effective HRT for postmenopausal women     

绝经后妇女膝关节骨性关节炎与骨质疏松症的相关性研究

目的探讨绝经后妇女膝关节骨性关节炎与骨质疏松症的相关性。方法对134例绝经后妇女膝关节骨性关节炎患者行年龄、体重、身高及体重指数的计算和骨密度的测定。行双膝关节负重正位X线拍片,按照骨关节炎Kellgren分级标准将骨性关节炎患者分为4级,根据患者的临床症状和X线表现不同把4级骨性关节炎分成轻度组和重度组。分析膝关节骨性关节炎与其伴发的骨质疏松症的相关性。结果绝经后妇女患者的骨密度与年龄呈负相关,与体重、身高及体重指数呈正相关。重度组和轻度组相比较在身高、体重及体重指数上无显著性差异(P0.05),在年龄与股骨颈骨密度上有极显著性差异(P0.01)。股骨颈骨密度线性回归分析表明年龄对股骨颈骨密度的影响较大,因此用协方差分析排除年龄混杂因素对股骨颈骨密度的影响,重度组和轻度组在股骨颈骨密度上仍有显著性差异(P0.05)。结论绝经后妇女骨质疏松症与膝关节骨性关节炎的严重程度密切相关,膝关节骨性关节炎越严重,骨密度越低。骨性关节炎可能是骨质疏松症发生或加重的危险因素之一。     

DXA、QCT和SPA方法测量47例绝经后妇女骨质疏松症的比较

以骨密度测量应用最广的３种方法（ＤＸＡ─双能ｘ线吸收法，ＱＣＴ─定量ＣＴ法和ＳＰＡ─单光子吸收法）测量绝经后妇女的骨矿密度，比较其测量值、诊断结果和相关关系。首先用ＳＰＡ法测量绝经后妇女１８１例，诊断骨质疏松（ＯＰ）４７例。三种方法测量骨矿密度的均值分别低于峰值骨量的Ｍ─２ｓ的９％、２１．４％和２１％，且ＤＸＡ和ＱＣＴ两种方法测量的均值都在骨折阈值范围内。ＤＸＡ和ＱＣＴ诊断４７例ＯＰ之间无显著性差异，当排除椎骨骨质增生后的ｘ２＝０．２３７，且ＤＸＡ和ＱＣＴ测量值之间为正相关，ｒ＝０．７９９，而ＤＸＡ、ＱＣＴ和ＳＰＡ之间的相关系数，ｒ＝０．１８５和０．２８５，ＤＸＡ诊断ＯＰ的敏感性为８６．６％，特异性为７０％。