0～16岁城乡儿童骨骼矿物质含量及影响因素的研究

使用单光子骨矿物测定仪，自１９９４年初到１９９５年底，分别在河南省扶沟县和新乡市测定了３３２名健康的０～１６岁城乡儿童右前臂１／３处桡骨和尺骨的骨矿物质含量（ＢＭＣ），采用逐步多元回归分析了多个独立变量对桡骨ＢＭＣ和测量部位骨宽度的影响。结果显示：桡骨和尺骨的ＢＭＣ、骨宽度（ＢＷ）、ＢＭＣ／ＢＷ和前臂长度均随年龄而增加，０～６岁城市儿童的ＢＭＣ高于农村儿童；桡骨ＢＭＣ与所测量部位的ＢＷ呈正相关，年龄、体重和身高对桡骨ＢＭＣ都显示出显著和独立的正影响；儿童的桡骨ＢＭＣ与年龄呈显著正相关；而桡骨ＢＭＣ与体重的比值与年龄呈显著负相关；测定部位桡骨ＢＷ和前臂长度随年龄的增加呈曲线增加。在以身高和体重调整后，性别、年龄和体重对桡骨ＢＷ的影响变得不显著，只有身高的影响显著。本研究证明儿童在０～１６岁范围，身高（而不是肥胖）是骨骼ＢＭＣ的主要决定因素。在比较儿童骨密度结果时，要参考多个变量，如ＢＭＣ、骨密度，ＢＭＣ／体重、ＢＭＣ／年龄等综合评价指标更有说明力。     

Early Nutrition during Hospitalization in Relation to Bone Health in Preterm Infants at Term Age and Six Months Corrected Age

Aim: to evaluate the potential association of macronutrient intake in the first postnatal weeks on bone mineral content (BMC) and bone mineral density (BMD) in extremely and very preterm infants. Methods: fifty-eight extremely and very preterm infants were included. Daily macronutrient intake was calculated in g kg⁻¹ day⁻¹ from birth up to 36 weeks postmenstrual age. A dual-energy X-ray absorptiometry whole body scan was used to assess BMC and BMD in preterm infants at term corrected age (TCA) and six months corrected age (CA). Results: fat intake (g kg⁻¹ day⁻¹) in the first four postnatal weeks was positively associated with BMC and BMD at TCA. At six months CA, protein and fat intake (g kg⁻¹ day⁻¹) in the first weeks of life were both individual predictors for BMD. Fat intake (g kg⁻¹ day⁻¹) in the first four postnatal weeks was significantly associated with BMC at six months CA. Conclusion: the association of macronutrient intake in the first postnatal weeks on BMC or BMD, at TCA and six months CA, suggest that early nutritional intervention immediately after birth and during early infancy is important for bone health in the first months of life.     

牛乳碱性蛋白对正常和去卵巢大鼠骨代谢的影响

目的探讨牛乳碱性蛋白(MBP)对正常大鼠和去卵巢大鼠骨代谢的影响。方法将60只去除卵巢雌性SD大鼠随机分为假手术、去卵巢对照以及去卵巢低、中、高剂量5组;将另外44只正常雌性SD大鼠随机分为正常对照、正常低、中、高剂量4组。分别采用10、20、30mg/kgbwMBP给大鼠连续灌胃90d,检测股骨近心端、中段和远心端骨密度,同时检测股骨中Ca、Mg、P等矿物元素含量。结果正常低剂量组大鼠股骨远心端骨密度显著高于正常对照组;而各剂量MBP对去卵巢大鼠的骨密度无显著作用;正常各组之间以及去卵巢组之间比较,骨矿物质含量虽无统计学差异,但可以观察到其水平上的上升趋势。结论10mg/kg.bw的MBP能提高正常生理状态下的峰值骨密度,以股骨远心端效果最好,但未见MBP对去卵巢大鼠骨密度的影响。MBP除影响骨骼中矿物元素含量外,还可能通过其他方式作用于骨代谢。     

大鼠骨矿物质含量与组织中钙水平的相关性研究

用ＳＤ１０００型单光子骨矿物测定仪研究了９８只１５周龄Ｗｉｓｔａｒ大鼠的股骨矿物质含量（ＢＭＣ）和骨密度（ＢＭＤ，ＢＭＣ／ＢＷ）与组织和血中钙含量的相关性。结果显示：雌、雄动物的身长、体重、骨宽度（ＢＷ）、ＢＭＣ、ＢＭＣ／体重、ＢＭＤ／体重及ＢＭＤ／身长均有显著性差异，活体ＢＭＤ与动物的钙总摄入量、身长、体重、及钙存留率显著相关（Ｐ＜０．０５）；ＢＭＣ与钙总摄入量、身长、体重、性别和肝脏钙含量显著相关（Ｐ＜０．０５）。多元回归分析表明：动物身长、体重、钙总摄入量和心脏钙含量与活体ＢＭＤ呈线性关系，动物身长和血浆钙含量与离体ＢＭＤ呈线性关系。活体测量结果ＢＭＣ、ＢＭＤ由于其与动物的生长发育、钙存留率及肌肉和血浆钙含量具有相关和直线关系，且简便易行、不需要处死动物，因而认为可以反映动物体内钙营养状况和骨质积累情况。     

The Relationship between Dietary Pattern and Bone Mass in School-Age Children

Early bone accrual significantly influences adult bone health and osteoporosis incidence. We aimed to investigate the relationship between dietary patterns (DPs), bone mineral content (BMC) and bone mineral density (BMD) in school-age children in China. Children aged six–nine years (n = 465) were enrolled in this cross-sectional study. DPs were identified by principal component factor analysis. Total body (TB) and total body less head (TBLH) BMC and BMD were measured using dual-energy X-ray absorptiometry. Five DPs were identified. After adjustment for covariates, multiple linear regression analysis showed that the “fruit-milk-eggs” dietary pattern was positively associated with TB (β = 10.480; 95% CI: 2.190, 18.770) and TBLH (β = 5.577; 95% CI: 0.214, 10.941) BMC, the “animal organs-refined cereals” pattern was associated with low TB BMC (β = −10.305; 95% CI: −18.433, −2.176), TBLH BMC (β = −6.346; 95% CI: −11.596, −1.096), TB BMD (β = −0.006; 95% CI: −0.011, −0.001) and TBLH BMD (β = −0.004; 95% CI: −0.007, −0.001). In conclusion, our study recommends home or school meals should be rich in fruit, milk, eggs with a moderate amount of vegetables, coarse grains and meat to promote bone development for school-age children.     

硒锌水平对染铅大鼠股骨中微量元素及矿物质含量的影响

目的　以大鼠为模型 ,观察饲料中添加不同亚硒酸钠 (Se 0 1、0 5和 1 0mg kg)、乳酸锌 (Zn 10、5 0和 2 0 0mg kg)对醋酸铅 (Pb 0、2 0 0mg kg)所致骨骼毒性的拮抗作用。方法　断乳一周Wistar雄性大鼠按体重随机被分成 10组 ,每组 10只。其中 10组添加了不同铁、锌和铅水平的饲料 ,12周后处死大鼠测定股骨生长发育有关指标 ,结果　染铅抑制大鼠骨骼的生长发育 ,降低骨骼中矿物质含量和骨密度 ,补充硒锌后能改善大鼠股骨的重量和长度 ,增加股骨矿物质含量和骨密度 ,同时降低骨铅含量。结论　需要进一步研究铅影响骨骼生长发育的机制     

钙摄入量对青春前期女童骨量增长的影响—两年随机干预实验

目的研究不同钙摄入量对于青春前期女童骨量增长的影响,为该人群钙适宜摄入量的修订提供科学依据。方法以年龄10.0±0.7岁的241名青春前期健康女童为对象,设计普通膳食组、牛奶补充组和钙剂补充组三组,总钙摄入量分别为600、900和1200mg/d,进行2年干预,采用多次称量及3d膳食询问法获得2年间日均膳食钙摄入量,使用双能X线骨密度仪测量干预前后全身、腰椎及近端股骨骨矿物密度和骨矿物含量。结果2年间三组的平均钙摄入量分别为552±61、864±139和1166±207mg/d;日均钙摄入量与全身、多位点骨矿物含量和骨矿物密度显著正相关;当日均钙摄入量达到864mg/d时,全身骨矿物含量增加值显著高于钙摄入量为552mg/d膳食组;当日均钙摄入量达到1166mg/d时,股骨颈骨矿物含量及骨矿物密度和腰椎骨矿物密度的增加值显著高于未达到1166mg/d的干预组。结论9～11.5岁的青春前期女童钙摄入量达到1166mg/d,全身特别是负重部位能获得较高骨矿物含量和骨矿物密度增长,提示青春前期钙适宜摄入量可能为1200mg/d。     

骨质疏松误诊与漏诊原因分析

讨论了骨骼密度和形状随骨量减少而变化的特点，分析了骨密度参数的物理意义以及与骨密度相关的其它参数，介绍了临床上常用骨密度仪的原理及性能。本探讨了以骨密度为指标在骨质疏松诊断过程中造成误诊与漏诊的原因，最后介绍了与骨质疏松程度相关的骨强度指标，以及骨强度指标克服骨密度指标所造成误诊与漏诊的原理。     

补充钙、维生素D及镁、锌、铜对大鼠骨密度和骨强度的影响

目的观察在补充钙、维生素D的同时补充镁、锌、铜对大鼠骨密度和骨强度的影响。方法30只初始体重65～75g的清洁级断乳Wistar雄性大鼠,根据体重随机分为3组,即低钙饲料对照组、受试物低剂量实验组和高剂量实验组,每组10只。实验周期为12周。测定右侧股骨长度、重量、股骨骨密度及骨钙含量,左侧股骨最大载荷、最大挠度、弹性能量吸收、最大应力、弹性模量。结果低、高剂量实验组大鼠的股骨重量、股骨远心端和股骨中点的骨密度、股骨钙含量、股骨的最大载荷和弹性能量吸收均显著高于低钙对照组(P<0.05)。结论补充钙、维生素D及镁、锌、铜能明显增强大鼠股骨的骨密度、骨强度,提示对延缓骨骼的老化有一定的作用。     

一种单片机控制的X片人体骨矿物质含量测量仪的研制

本文介绍了一种通过扫描骨骼Ｘ光片来测量人体骨矿物质含量的新仪器，其数据的采集、处理和结果打印均由单片机控制。该仪具有体积小、精度高、性能稳定、价格便宜和智能化等特点。     

骨密度测定方法及最新进展

随着骨质疏松等骨骼疾病日益受到关注，骨骼状况测定显得越来越重要。大量流行病学研究和临床生理、生化指标显示，骨密度（BMD）与骨骼疾病关系密切，本文介绍了现有的BMD测定方法及骨骼状况测定的最新进展。     

打压植骨人工股骨头置换术治疗高龄不稳定股骨粗隆间骨折

目的 探讨通过打压植骨重建股骨粗隆部结合人工股骨头置换术治疗高龄老人不稳定性股骨粗隆间骨折的疗效.方法 自2005年1月至2008年12月,通过打压植骨重建股骨粗隆部结合人工股骨头置换术治疗高龄老人合并严重骨质疏松的不稳定性股骨粗隆间骨折21例.结果 按Harris评分标准进行功能评定:优14例,良5例,可2例,优良率达90.4%,未出现股骨粗隆骨折不愈合,无感染、脱位、假体松动.结论 通过采用打压植骨技术重建股骨粗隆部结合人工股骨头置换术治疗高龄不稳定性股骨粗隆间骨折是一种较好的方法.

Abstract：

Objective To evaluate the therapeutic effects of the integration of impaction bone grafting reconstructing femur trochanter and femoral head arthropalsty in the treatment of unstable intertrochanteric fractures in aged patients. Methods From January 2006 to December 2008,21 cases unstable intertrohanteric fractures with serious osteoporosis were treated with impaction bone grafting reconstructing the femur trochanter and femoral head arthropalsty. Results Functional assessment based on the Harris score ,great in 14 cases, good in 5 cases, medium in 2 cases. The excellent and good rate was 90. 4%. Conclusion The integration of impaction bone grafting reconstructing femur trochanter and femoral head arthropalsty is convenient to treat unstable intertrochanteric fractures in aged patients.     

探讨Z值诊断股骨近端骨质疏松的意义

目的探讨应用Z值（Z-score）诊断绝经前妇女和小于50岁男性股骨近端骨质疏松症（Osteoporosis,OP）的意义。方法在北京城区2744例正常人群中选择受检者,以股骨近端为测量点进行骨密度（Bone mineral density,BMD）测量观察在受试者中应用Z值对OP的诊断意义并与T值诊断OP的患病率比较。结果受试者应用Z值诊断OP患病率较应用T值诊断明显降低,但男性在50岁以后出现患病率加速趋势。结论应用Z值诊断绝经前妇女和小于50岁男性股骨近端OP可以避免过早的诊断OP,但其与骨折风险的相关性将有待于进一步研究。     

胎婴儿骨代谢研究进展

本文介绍了早产儿代谢性骨病发病基础及现状,主要论述了早产儿出生前后矿物质代谢特点,指出早产儿代谢性骨病发生的原因与宫内及宫外环境因素密切相关。     

大豆异黄酮摄入显著抑制女性骨丢失:随机对照研究的meta分析

目的采用meta分析方法研究大豆异黄酮摄入对骨丢失影响。方法搜索MEDLINE、中国期刊网等中外数据库,收集了考察大豆异黄酮摄入与尿脱氧吡啶酚(Dpyr)、血清骨特异性碱性磷酸酶(BAP)、脊椎骨骨密度(SBMD)相关的随机对照研究,并对符合纳入标准的研究进行了meta分析。结果纳入18篇研究,978个研究对象。与对照组相比,大豆异黄酮组尿Dpyr的浓度显著降低,其效应值为-2.08nmol/mmol(95%CI:-3.82～0.34);血清BAP的浓度显著升高了1.48μg/L(95%CI:0.22,2.75),大豆异黄酮摄入组SBMD显著增加了20.6mg/cm2(95%CI:4.5～36.6)。当大豆异黄酮摄入量大于90mg/d或持续时间6个月时,对SBMD的影响效应值分别为28.5mg/cm2(95%CI:8.4～48.6)和27mg/cm2(95%CI:8.3～45.8)。结论大豆异黄酮干预能显著地抑制骨吸收和刺激骨形成,从而改善骨质量,防止妇女骨质疏松的发生。     

骨密度仪的工作原理与质量控制

目的介绍常见几种骨密度仪的工作原理及各自的特点、骨密度仪的质量控制及故障记录的方法。方法分析几种常见的骨密度仪的工作原理。结果通过分析，掌握骨密度仪的工作原理，临床能根据自身需要购买骨密度仪。质量控制分析能对维修工程师和医技人员有所帮助。并通过对质量控制的总结，了解质量控制对医疗设备的重要性。结论原理图是了解仪器设备的慕础，日常维修记录在质量控制中必不可少。     

中老年人前臂骨密度变化及其影响因素分析

目的了解中老年人前臂骨密度的状况，分析影响中老年人骨密度的因素。方法在上海市徐汇区田林、枫林、斜土3个街道，采用单能X线骨密度仪测量中老年人左前臂远端1／3桡骨总体、尺骨总体，以及桡尺骨间距为8mm处的桡骨远端、前臂桡骨超远端等部位的骨密度值。结果4个测量部位的骨密度均随年龄增加而下降，女性下降速率快于男性；同一年龄、同一部位的男性骨密度平均值大于女性；4个部位中以前臂远端1／3桡骨总体骨密度最高；除男性60岁～骨量减少的现患率低于55岁～外，前臂远端1／3桡骨总体骨量减少的现患率及骨质疏松症的现患率均随年龄的增加而上升。多因素Logistic回归显示，男性患骨量减少的可能性是女性的0．19倍；以50岁～为参照，55岁～、60岁～、65～71岁与之比较，OR分别为3．17，5．13，15．03；月均收入在1000元以上与1000以下的比较，OR为0．70；补充钙片者与没补充钙片者比较，OR为1．36。结论中老年人骨密度减少的现患率较高，骨密度减少与性别、年龄、月均收入、补充钙片等有关。     

Association between Dietary Conjugated Linoleic Acid and Bone Mineral Density in Postmenopausal Women

Objective: To determine if dietary conjugated linoleic acid (CLA) is associated with bone mineral density (BMD) of different skeletal sites in postmenopausal women.

Methods: A cross-sectional analysis in 136 Caucasian, healthy, postmenopausal women, mean age 68.6 years. BMD and soft tissue were assessed by dual energy x-ray abosorptiometry (DXA). Energy, calcium, protein, fat, CLA and other relevant nutrients were estimated using 3 day dietary records. Supplement use was recorded as well. Current and past physical activity were determined using the Allied Dunbar National Fitness Survey for older adults.

Results: CLA (63.1 ± 46.8 mg, mean ± SD) was a significant predictor of Ward’s triangle BMD (p = 0.040) in a multiple regression model containing years since menopause (18.5 ± 8.4 y), lean tissue, energy intake (1691 ± 382 kcal/day) dietary calcium (873 ± 365 mg), protein (70.6 ± 18.6 g), fat (57.9 ± 23.9 g), zinc (19.2 ± 13.6 mg), and current and past physical activity, with R²_adj = 0.286. Subjects were also divided into groups below (Group 1) and above (Group 2) the median intake for CLA. Group 2 had higher BMD in the forearm, p = 0.042, and higher BMD in the hip, lumbar spine and whole body, however statistical significance was not reached.

Conclusion: These findings indicate dietary CLA may positively benefit BMD in postmenopausal women. More studies are warranted examining the relationship between dietary CLA and BMD.     

铁和锌对染铅大鼠股骨矿物质含量和骨密度的影响

目的　以大鼠为模型 ,观察饲料中添加不同铁 (1 0、5 0和 2 5 0mg kg)和锌 (1 0、4 0和 2 0 0mg kg)水平对低剂量铅 (0和 2 0 0mg kg)毒性的拮抗作用。方法　断乳一周Wistar雄性大鼠按体重随机被分成 1 1组 ,每组 1 0只。其中 1 0组饲以不同铁、锌和铅水平的饲料 ,另设 1组为未染铅正常对照 ,饲以基础正常饲料 ,1 2周后处死大鼠测定股骨生长发育有关指标。结果　研究发现 ,铅污染抑制大鼠骨骼的生长发育 ,能降低骨骼中矿物质含量和骨密度 ,补充铁锌后能改善大鼠股骨的重量和长度 ,增加股骨矿物质含量和骨密度 ,同时会增加骨铅含量。提示　需要进一步研究铅影响骨骼生长发育的机制     

Effects of isoflavone supplementation on the bone mineral density of growing female rats

This study was focused on whether or not isoflavones affect the increase in bone mineral density of growing females. Female Sprague-Dawley rats (60 ± 5 g) were randomly assigned to two groups and provided control diets (control group) or isoflavone-supplemented diet (IF group, 57.8 mg isoflavones/100 g diet) for 9 weeks in growing female rats. Measurements of Bone Mineral Density (BMD) and Bone Mineral Content (BMC) on the experimental animals were executed in the 3^rd, 6^th, 9^th weeks. In result, there was no significant difference in spine BMD between the isoflavones supplemented group and the control group. But, the IF group tended to have higher BMD than the control group in between 3 and 9 experimental weeks, and the striking difference could be shown in the 6^th week of feeding. In case of femur BMD, the effects of added isoflavones appeared in the 6^th week of feeding, and it became intensified in the 9^th week of feeding to the extent that the BMD in the IF group was significantly higher than that of the control group (p<0.05). In conclusion, isoflavone supplementation increased spine BMD per weight in the 6^th week of feeding, and affected the increase of femur BMD in the 9^th week. The result of the experiment implies that it affects positively the formation of spine and femur BMD of growing female rats. The study also suggests that the effects of isoflavone on the pattern of BMD formation might differ from the parts of bones.