绝经前女性系统性红斑狼疮患者骨密度和骨代谢指标测定

目的 探讨绝经前女性系统性红斑狼疮(SLE)患者骨密度(BMD)和骨代谢指标的变化.方法 采用双能x线骨密度吸收仪(DEXA)测定178例绝经前女性SLE患者以及60例正常对照组的腰椎、股骨颈的骨密度以及T值,血钙、磷浓度,血清碱性磷酸酶(AKP)、血清骨钙素(BGP)、尿I型胶原交联氨基末端肽(NTX)水平,并将SLE组患者分为SLE初诊组与治疗组,分别对其数据进行统计分析.结果 SLE初诊组的腰椎BMD,股骨颈BMD及T值,血清AKP、尿NTX较正常对照组均无明显差异,而腰椎骨密度T值、血清BGP较正常对照组低(P＜O.05);SLE治疗组的腰椎BMD、T值和股骨颈1值,血清BGP低于正常对照组,但股骨颈BMD、血清AKP、尿NTX较正常对照组差异未达统计学意义;SLE治疗组的腰椎、股骨颈BMD与T值均显著低于SLE初诊组.SLE组的骨质疏松及骨量减少率分别为6.74%、16.85%.结论 绝经前SLE患者较同年龄正常女性易发生骨质疏松,血清BGP和腰椎骨密度可能较早反映骨质疏松的发生.     

2型糖尿病对老年绝经后女性骨质疏松性骨折风险的影响

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)对老年绝经后女性骨质疏松性骨折风险的影响,为预防骨质疏松性骨折及制订相关干预措施提供依据。方法 180例绝经后T2DM女性作为糖尿病组,180例健康绝经后女性作为对照组,比较两组的基本资料、T2DM史、骨折史,骨密度(BMD)、骨转化指标,并比较组间资料和指标差异,生存分析T2DM对骨质疏松性骨折风险的影响。结果糖尿病组腰椎BMD、股骨颈BMD、I型前胶原氨基端肽(procollagen 1 N-terminal peptide,P1NP)显著低于对照组(P0.05),β-Ι型胶原羧基端肽(beta C-terminal telopeptide,β-CTX)组间无显著差异(P0.05);糖尿病组有骨折史人数(率)为25(13.9%),高于对照组12(7.8%)(P0.05),骨折部位分布组间无显著差异(P0.05);生存分析显示T2DM无骨折生存率低于对照组(P0.05)。结论 T2DM可降低老年绝经后女性的骨密度,影响骨转化,可能增加骨质疏松性骨折的风险,应采取措施积极加强预防和干预。     

绝经后女性腰椎T值评分与椎体骨折的关系

目的探讨绝经后女性腰椎骨密度的T值评分与发生椎体骨折的关系。方法选择原发性骨质疏松症女性患者共74例,其中发生椎体骨折患者37例,无椎体骨折患者37例,所有受检者均行正侧位胸腰椎X线摄片证实。两组女性的出生年月、身高、体重、绝经年限等无显著性差异。用双能X线吸收仪(DXA)分别检测正位腰椎(L1-L4)及一侧股骨近段股骨颈的骨密度(BMD)值及T值,统计腰椎部位的T值评分(T-Score),以腰椎T值评分达≤-2.5可入选,并对两组腰椎的T值评分进行统计分析。结果骨折组腰椎T值评分明显低于非骨折组腰椎T值评分(P0.05)。结论绝经后女性发生椎体压缩性骨折与腰椎骨密度的T值评分降低相关。     

绝经后妇女椎体骨折与骨密度的对照研究

目的探讨绝经后妇女骨质疏松性椎体骨折与骨密度的关系。方法随机选择椎体骨折的绝经后妇女120例为骨折组，无椎体骨折的120例绝经后妇女为对照组。两组的年龄、身高、体重等差异无显著性，均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量腰椎（L2-4）前后位及髋部骨密度（BMD）和T值。结果骨折组腰椎及髋部BMD和T值均低于对照组（P≤0．05）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关，髋部骨密度值的降低在一定程度上也能提示骨折的危险性。绝经后骨质疏松妇女应重视BMD变化，预防椎体骨折的发生。     

50例绝经后高疾病活动期的女性类风湿关节炎骨密度的临床观察

目的观察绝经后高疾病活动期的女性类风湿关节炎患者骨矿物质密度水平的变化。方法收集50例绝经后女性RA患者一般临床资料,包括年龄、RA病程、绝经年龄、ESR、CRP、RF、抗CCP抗体、DSA28评分及雌二醇水平,应用双能X线吸收法(DXA)测定50例患者腰椎L_(1-4)和左髋关节部位的骨密度,分析其骨密度(BMD)的情况。结果 1.50例绝经后女性RA的DSA28评分大于5.1,属高疾病活动期,骨质疏松组发生率52%;远高于骨量减少组(30%)及骨密度正常组(18%)。2.骨质疏松组的绝经年龄比非骨质疏松组明显提前(P=0.005),抗CCP抗体水平明显升高(P=0.037),有统计学意义,但在年龄、病程、RF、DSA28评分及雌激素方面两者无统计学差异。3.Logistic回归分析结果显示抗CCP抗体(OR值1.025,P=0.041)是绝经后高疾病活动女性RA骨质疏松的独立危险因素。4.骨质疏松组,腰椎总骨密度较髋关节显著降低(P0.001);腰椎组内比较以腰1椎体BMD最低,而后依次为腰2,腰3、腰4(P=0.0003),左髋关节组内比较以大转子BMD最低,而后依次为股骨颈、小转子(P0.0001)。结论绝经后高疾病活动期的女性RA患者存在明显的骨质疏松,以腰椎骨密度(特别L_1)下降最明显;抗CCP抗体可能是高疾病活动期的女性类RA患者发生骨质疏松的危险因素。     

绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系。方法选择骨质疏松性椎体骨折的绝经后妇女23例为骨折组,无椎体骨折的25例绝经后骨质疏松妇女为对照组。两组的年龄、绝经年限、身高、体重、体重指数差异无显著性,均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量的腰椎（L2-4）前后位骨密度（BMD）、骨矿含量（BMC）和T值。结果骨折组BMD、BMC和T值均低于对照组（P〈0.01）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关。绝经后骨质疏松妇女应重视BMD变化,预防椎体骨折的发生。     

骨折风险评估工具（FRAX® )在评价绝经后女性骨密度的临床意义

目的探讨骨折风险评估工具(FRAX)在评价绝经后女性骨密度变化中的作用。方法 2014年12月至2015年12月完成双能X线骨密度测定的绝经后女性166例,问卷采集信息,应用FRAX计算代入或不代入股骨颈骨密度时各研究对象10年内骨质疏松性骨折概率,并结合骨密度测定结果、OSTA及IOF 1 min测试题进行统计学分析。结果 1骨量异常组年龄较高、体重较轻、BMI较低、身高变化较多、绝经年限较长,两组间具有既往骨折史的人数差异有统计学意义。2有或无BMD时,骨量异常组10年内骨质疏松性骨折概率均显著高于骨量正常组。3有或无股骨颈BMD时,FRAX预测值与股骨颈骨密度T值之间均呈显著负相关,而有和无股骨颈BMD的FRAX预测值之间呈显著正相关。4随着年龄或骨质疏松风险的增长,骨量异常发生率逐渐上升,10年内骨质疏松性骨折概率显著升高。5不代入BMD时,10年内主要骨质疏松性骨折概率识别骨量异常的ROC曲线的AUC为0.705(P0.001),cutoff值为3.75%,准确度为中等;10年内髋骨骨折概率识别骨量异常的ROC曲线的AUC为0.743(P0.001),cutoff值为1.75%,准确度中等。结论 FRAX能够反映机体骨密度变化,全面评估骨折风险,并可作为一项基本的筛检工具,应用于识别绝经后女性骨质疏松的高危人群。     

应用FRAX联合腰椎或股骨颈骨密度评估中老年女性骨折风险的临床研究

目的探讨应用FRAX联合腰椎或股骨颈骨密度评估中老年女性骨折风险。方法选取2017年3月至2018年6月在连云港市第一人民医院行骨密度检查的女性337例,收集其个人基本信息、FRAX风险评估值及腰椎和股骨颈骨密度,按照骨密度及年龄分组,根据上述资料计算10年内主要部位骨质疏松性骨折概率和10年内髋部骨折概率,比较FRAX联合腰椎或股骨颈骨密度评估骨折风险的差异。结果无论代入股骨颈骨密度还是腰椎骨密度计算骨折风险,骨质疏松组的骨折风险均高于骨量减少组(P0.05);②无论是在骨质疏松组还是在骨量减少组,采用股骨颈骨密度计算的骨折风险均高于采用腰椎骨密度计算的值(P0.05)。③进一步分析显示,不同年龄组采用股骨颈骨密度计算出的骨折风险均高于采用腰椎骨密度计算的值(P0.05)。结论对于不同年龄组的骨量异常女性,FRAX联合股骨颈骨密度预测的骨折风险高于联合腰椎骨密度预测的骨折风险。     

凝溶胶蛋白与绝经后女性股骨颈及腰椎骨密度的相关性研究

目的探讨凝溶胶蛋白(GSN)在绝经后女性血浆中的水平并分析与股骨颈及腰椎骨密度(BMD)的相关性。方法选取我院2015年1月至2019年5月期间在我院正常体检人员。纳入绝经后女性110名。与此同时,在我院体检中心选择非绝经期女性110例。采用Hologic?QDR-4500 DXA骨密度仪测定股骨颈、腰椎(L_1-L_4)的BMD。BMD数据以g/cm~2和T评分表示。T评分-2.5定义为骨质疏松症,T评分在-1～-2.5间定义为骨量减少,T评分-1定义为骨密度正常(正常BMD组)。骨质疏松症或骨量减少定义为低BMD组,骨密度正常定义为正常BMD组。采用酶联免疫吸附试验(ELISA)测定GSN水平。结果绝经后女性年龄、SBP、DBP、TC、FBS高于绝经前女性(P0.05);而股骨颈-BMD、腰椎(L_1-L_4)-BMD、GSN低于绝经前女性(P0.05)。股骨颈-BMD组中,低BMD组的年龄、吸烟比例、TC、FBS、GSN高于正常BMD组(P0.05);而BMI、HDL低于正常BMD组(P0.05)。腰椎(L_1-L_4)-BMD组中,低BMD组的年龄、TC、FBS、GSN高于正常BMD组(P0.05);而BMI、HDL低于正常BMD组(P0.05)。股骨颈-BMD与年龄、吸烟、FBS、pGSN呈负相关(r=-0.435、-0.301、-0.243、-0.609),与HDL、BMI呈正相关(r=0.395、0.365)。腰椎(L_1-L_4)-BMD与年龄、p GSN呈负相关(r=-0.463、-0.433),与BMI呈正相关(r=0.398)。年龄、BMI、GSN是股骨颈-BMD独立影响因素;年龄、GSN是腰椎(L1-L4)-BMD独立影响因素。结论 GSN是股骨颈-BMD、腰椎(L_1-L_4)-BMD的独立影响因素。因此,GSN水平升高可能预测绝经后女性骨质疏松症的发生及进展。     

基于定量CT对绝经后无症状冠心病患者腰椎骨密度与冠脉钙化的相关研究

目的 探讨无症状绝经后老年冠心病患者腰椎骨密度改变与冠状动脉钙化的关系并分析相关因素.方法 对112例绝经后无症状老年冠心病患者进行腰椎骨密度(BMD)的定量CT(QCT)测定,同时检测冠状动脉钙化积分(CS),并通过填写调查表了解患者的一般情况、生活习惯及其他影响冠状动脉钙化的因素.将所有患者骨密度T值分为骨量正常组、骨量减少组和骨质疏松组.采用方差分析法比较三组的临床数据及骨密度,用多元线性回归方法和多元相关分析有关因素与CS之间的关系.结果 骨质疏松组较骨量减少组、骨量正常组的年龄增大,且差异有显著性(P＜0.05),绝经年限在正常组与骨质疏松组比较中差异具有显著性(P＜0.05),BMD、冠脉总钙化积分值(TCS)三组比较存在显著性的差异(P＜0.05).而血磷(P)、高密度脂蛋白(HDL)骨质疏松组虽然较骨量减少组、骨量正常组减低,但组间比较差异无显著性(P＞0.05).多元线性回归显示年龄、HDL、腰椎BMD、甘油三脂(TG)对TCS有影响且P＜0.05,其中年龄、TG是冠状动脉钙化的危险因素,HDL、腰椎BMD是其保护因素,多元相关分析得出腰椎BMD与TCS存在负相关关系.结论 绝经后无症状老年冠心病患者骨量异常者较正常者有较高发生冠状动脉钙化的危险性,且低骨量或骨质疏松可能会和传统的危险因素一样用来预测心血管疾病的发生、发展.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。