羧化不全骨钙素——值得关注的骨代谢生化指标

近年来 ,维生素Ｋ依赖性骨蛋白———骨钙素 ,尤其是骨钙素羧化程度与骨健康的关系在骨代谢生化指标的研究中引起广泛关注。一些研究结果发现血清羧化不全骨钙素(ｕｎｄｅｒｃａｒｂｏｘｙｌａｔｅｄｏｓｔｅｏｃａｌｃｉｎ ,ｕｃＯＣ)水平是反映机体维生素Ｋ营养状态的敏感指标 ,而且与骨转换、骨密度和髋部骨折有关 ,提出是否可能用ｕｃＯＣ作为预测髋部骨折危险性的生化指标。现将有关研究概述如下。一、骨钙素和羧化不全骨钙素骨钙素 (ｏｓｔｅｏｃａｌｃｉｎ ,ＢｏｎｅＧｌａｐｒｏｔｅｉｎ ,ＢＧＰ)是由成骨细胞和成牙质骨细胞合成的…     

血清羧化不全骨钙素对绝经后女性骨质疏松症诊疗意义的探讨

目的检测绝经后女性血清羧化不全骨钙素(ucOC)的水平,并探讨其影响因素及其对绝经后女性骨质疏松症诊疗的意义。方法选择南京医科大学附属南京医院2015年07月至2016年12月在骨科门诊就诊的绝经后女性患者108例,依据骨密度检查将这些患者分为骨质疏松组与非骨质疏松组;记录其年龄、身高、体重、体重指数(BMI)、绝经年龄、骨密度(BMD)等相关资料;抽取外周血测定碱性磷酸酶(ALP)、血钙、血磷、羧化不全骨钙素(ucOC)的水平,并对上述资料进行相关的统计学分析。结果绝经后女性骨质疏松组患者的血清ucOC水平与非骨质疏松组相比差异有统计学意义(P0.05);血清ucOC水平是骨质疏松症的影响因素(OR=2.806,P0.05)。(2)血清ucOC水平与腰椎骨密度呈负相关(r=-0.395,P0.05),但与髋关节骨密度无显著相关性(r=-0.248,P0.05)。结论血清ucOC水平的变化与绝经后女性骨质疏松症的发生关系密切,血清高ucOC水平是绝经后女性骨质疏松症发生的危险因素;推断血清ucOC水平对于绝经后女性骨质疏松症早期的预测和筛查具有参考意义     

维生素D与2型糖尿病患者静力性平衡的相关性分析

目的分析2型糖尿病患者不同维生素D水平组之间静力性平衡指标的差异,探讨维生素D对平衡功能的影响。方法对86名年龄32~78岁的2型糖尿病患者进行研究,测定体重指数、跟骨骨密度、25(OH)D3水平等指标,应用Foot Scan Balance7.7平板式足底压力测试系统评估静力性平衡功能,获得压力中心的移动轨迹总长度(TTW)及包绕95%压力中心移动轨迹在内的椭圆面积(EA)两项平衡参数,分析维生素D对平衡参数的影响。结果 86名受检者平均年龄(54.99±10.19)岁,男女比例40∶46,按照25(OH)D3水平分为3组:严重缺乏组(10 ng/ml,n=32);缺乏组(≥10 ng/ml而20 ng/ml,n=40);不足组(≥20 ng/ml而30 ng/ml,n=14)。维生素D严重缺乏组压力中心移动轨迹总长度(TTW)及包绕95%压力中心移动轨迹在内的椭圆面积(EA)明显高于不足组,差异存在统计学意义[(10.66±4.42)mm对(97.0±20.1)mm;(11.55±8.78)mm2对(6.58±2.68)mm2,P0.05]。多元逐步回归分析显示25(OH)D3水平与压力中心移动轨迹总长度(TTW)及包绕95%压力中心移动轨迹在内的椭圆面积(EA)成负相关,相关系数分别为-1.835和-0.247,P0.05。且独立于年龄、性别、跟骨骨密度等因素。结论糖尿病患者中维生素D水平同静力性平衡之间存在独立负相关,对糖尿病患者进行维生素D的筛查及补充仍有待进一步研究。     

脂代谢及血清骨钙素水平与骨质疏松症的相关性分析

目的探讨脂代谢与血清骨钙素(osteocalcin,OSC;bone glaprotein,BGP)水平与骨质疏松症的相关性。方法选取2014年3月至2015年3月我院风湿科门诊患者及体检科收治的体检者,观察组为418例确诊骨质疏松症患者,对照组为无骨质疏松症状的396例健康者。分析两组患者脂代谢及血清骨钙素水平与骨质疏松症相关性。结果观察组的总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白(LDL-L)高于对照组,高密度脂蛋白(HDL-L)水平、血清骨钙素水平降低,具统计学意义,且骨钙素和TG呈负相关。结论脂代谢障碍、血清骨钙素的减少具有影响骨代谢、加快骨吸收的作用,并由此影响骨质疏松症的发病。     

维生素D与早发性卵巢功能不全患者卵巢功能相关性的研究进展

卵巢是卵泡发育及成熟的场所,是维持女性特征及孕育新生命的器官.年龄因素引起的卵巢衰老是无法抗拒的事实,然而临床上因卵巢功能减退(diminished ovarian reserve,DOR)而就诊的年轻患者日益增多.DOR不仅影响女性的生育能力,还增加了心血管、骨质疏松、抑郁等疾病的发生率,影响女性的生理及心理健康.女...     

全髋关节置换术后患者跌倒恐惧及影响因素分析

目的 了解全髋关节置换术后患者跌倒恐惧状况,以有效预防患者跌倒、提高术后康复效果.方法 选取209例全髋关节置换术后患者为研究对象,采用国际跌倒效能感量表、康复锻炼自我效能量表进行横断面研究.结果 患者跌倒恐惧得分33.44±7.88,康复锻炼自我效能得分62.83±21.15;跌倒恐惧与康复锻炼自我效能呈负相关(r=-0.520,P＜0.01);年龄、近一年跌倒次数、并存慢性病数量、康复锻炼自我效能是患者跌倒恐惧的影响因素(均P＜0.01),可解释患者跌倒恐惧总变异的47.0％.结论 全髋关节置换术后患者容易产生跌倒恐惧心理,医护人员应充分评估患者跌倒恐惧状况,实施针对性护理干预与健康教育,有效预防跌倒发生,促进患者术后功能锻炼的开展.     

小腿交通静脉功能不全与慢性静脉功能不全相关性的研究

目的探讨交通静脉功能不全(IPV)中功能不全交通静脉的分布及其在慢性静脉功能不全(CVI)过程中的角色。方法 46例确诊为CVI患者,临床症状:有坠胀感35例,无坠胀感11例,伴有皮肤瘙痒24例,无皮肤瘙痒22例,有夜间抽筋症状6例,无夜间抽筋40例。46例患者(46条肢体)CEAP分期:C2(19例)、C3(6例)、C4a(11例)、C4b(5例)、C5(3例)、C6(2例)。用多普勒超声定位IPV,测量交通静脉到足底的距离,以大、小隐静脉主干进行内外分区,将小腿分为三段、共八个区段进行记录,数据进行统计分析。结果共记录305个功能不全交通静脉,其中大隐静脉内上(19个)、大隐静脉内中(62个)、大隐静脉内下(34个)、小隐静脉外上(17个)、小隐静脉外中(52个)、小隐静脉外下(6个)、大隐静脉主干(64个)、小隐静脉主干(51个)。小隐静脉外上区段的交通静脉与抽筋,小隐静脉外中区段的交通静脉与CEAP-C分期、皮肤瘙痒,大隐静脉主干区段的交通静脉与抽筋间的关系具有统计学意义(P≤0.05)。结论功能不全交通静脉主要分布于小腿中段及大小隐静脉主干,且与CVI的临床症状相关。     

孕妇孕期活动量与跌倒恐惧的相关性及影响因素分析

目的 探讨孕妇孕期活动量水平及与跌倒恐惧的关系,为孕妇孕期活动干预提供参考.方法 对产科门诊常规产前检查的439例孕妇采用一般资料调查表、孕期身体活动调查问卷、国际版跌倒效能量表进行问卷调查.结果 孕妇孕期总活动能量消耗为72.16(39.62,103.28)MET/(h·周),跌倒恐惧总分为39.50±12.52;孕...     

脑性胃肠功能不全165例临床分析

目的 探讨改善脑性胃肠功能不全(CGID)的预后措施.方法 收集近两年急性颅脑损伤和脑血管意外病例共363例,其中有CGID 165例,依据其临床表现分Ⅰ～Ⅳ级.2008年4月以后收治的病例(治疗组)均于早期即预防性应用大黄、丹参和抗酸剂,与此前一年收治的病例(对照组)比较(χ2检验).结果 CGID分级与Glasgow计分呈负相关,即Glasgow计分愈少则CGID分级愈高;预防用药对CGID的发生和发展有较好的防治作用.结论 CGID的分级有临床实用价值,预防用药能改善CGID患者症状、体征和预后.     

Significant inverse relationship between serum undercarboxylated osteocalcin and glycemic control in maintenance hemodialysis patients

Summary

Increased levels of serum undercarboxylated osteocalcin, which were associated with bone metabolism markers, correlated inversely with indices of glucose metabolism (plasma glucose, hemoglobin A1C, and glycated albumin) in hemodialysis patients with abnormalities of bone metabolism.

Introduction

Undercarboxylated osteocalcin (ucOC), a possible marker of bone metabolism and one of the osteoblast-specific secreted proteins, has recently been reported to be associated with glucose metabolism. We tested the hypothesis that ucOC levels are associated with indices of glucose metabolism in chronic hemodialysis patients with abnormalities of bone metabolism.

Methods

Serum ucOC, bone alkaline phosphatase (BAP, a bone formation marker), and tartrate-resistant acid phosphatase-5b (TRACP-5b, a bone resorption marker) were measured in 189 maintenance hemodialysis patients (96 diabetics and 93 non-diabetics), and their relationships with glucose metabolism were examined.

Results

ucOC correlated positively with BAP (ρ?=?0.489, p?<?0.0001), TRACP-5b (ρ?=?0.585, p?<?0.0001) and intact parathyroid hormone (iPTH; ρ?=?0.621, p?<?0.0001). Serum ucOC levels in the diabetic patients were lower than those of non-diabetic patients (p?<?0.001), although there were no significant differences in serum BAP or TRACP-5b between diabetic and non-diabetic patients. Serum ucOC correlated negatively with plasma glucose (ρ?=??0.303, p?<?0.0001), hemoglobin A1C (ρ?=??0.214, p?<?0.01), and glycated albumin (ρ?=??0.271, p?<?0.001), although serum BAP or TRACP-5b did not. In multiple linear regression analysis, log [plasma glucose], log [hemoglobin A1C], and log [glycated albumin] were associated significantly with log [ucOC] after adjustment for age, gender, hemodialysis duration, and body mass index but were not associated with log [BAP], log [TRACP-5b], or log [intact PTH].

Conclusion

Increased levels of serum ucOC, which were associated with bone metabolism markers, were inversely associated with indices of glucose metabolism in hemodialysis patients.     

Impaired gamma carboxylation of osteocalcin in elderly women with type II diabetes mellitus: relationship between increase in undercarboxylated osteocalcin levels and low bone mineral density

We conducted a cross-sectional examination of the role of serum vitamin K levels as they relate to bone metabolism in elderly women with type II diabetes mellitus (DM). Eighty-five elderly women with type II DM were enrolled. Three fractions of vitamin K, phylloquinone (PK), menaquinone 4 (menatetrenone; MK 4), and menaquinone 7 (MK 7), along with undercarboxylated osteocalcin (UcOC), intact osteocalcin (IOC), urinary deoxypyridinoline (udpd), urinary type I collagen N-telopeptide (NTx), and intact parathyroid hormone (IPTH) were measured. Bone mineral density was measured in the lumbar spine (LSBMD) by dual-energy X-ray absorptiometry (DXA), and T scores or Z scores were calculated. The patients were divided into two groups by T score, under –2.5 (osteoporotic group) and over –2.5 (non-osteoporotic group). UcOC levels in osteoporotics patients were significantly higher than those in the non-osteoporotic group (3.09 ± 3.94 vs 1.82 ± 1.76ng/ml, P = 0.02). The correlation between Z score and logarithmic UcOC/IOC levels in type II DM showed a negative trend (P = 0.07) and a significantly and negatively association with logarithmic NTx (r = –0.38; P = 0.001). In osteoporotic DM, the UcOC/IOC ratio was significantly correlated with the Z score (r = –0.61; P 0.05). Furthermore, logarithmic UcOC/IOC showed a negative correlation with logarithmic MK 7 (r = –0.50; P = 0.001). In conclusion, the reduction in LSBMD in elderly women with type II DM may be associated, in part, with a defect in -glutamylcarboxylation by vitamin K.     

2型糖尿病患者血清骨钙素与骨骼肌指数的相关性研究

目的 探讨2型糖尿病患者血清骨钙素(OC)水平与骨骼肌指数(SMI)的相关性。方法 选取2型糖尿病患者550例,收集一般资料、实验指标,使用双能X线吸收法(DXA)测量人体成分：四肢骨骼肌质量、骨密度和全身脂肪百分比。根据SMI分为SMI正常组、SMI减少组,分析SMI的影响因素。结果 SMI减少组的男性患者比例、吸烟史、饮酒史、合并骨质疏松症患者比例均高于SMI正常组,BMI、白蛋白、TG、PTH、腰椎BMD、股骨颈BMD、髋部BMD、SMI、全身脂肪百分比低于SMI正常组(P<0.05)。男性的SMI、腰椎BMD、股骨颈BMD、髋部BMD均高于女性,而OC、全身脂肪百分比均低于女性(P<0.01)。纳入年龄、性别、BMI、全身脂肪百分比、HbAlc、白蛋白、UA、25(OH)D等因素,OC与SMI呈正相关(P<0.01)。结论 2型糖尿病患者血清骨钙素水平和骨骼肌指数呈正相关。血清骨钙素水平可能影响骨骼肌质量,是骨骼肌指数的影响因素之一。     

孕中期骨钙素水平与妊娠期糖尿病的关系研究

目的探究孕中期骨钙素水平与妊娠期糖尿病的关系,为妊娠期糖尿病的预防和治疗提供相应的对策与措施。方法本研究根据孕24～28周的75 g葡萄糖耐量试验结果选取病例组(妊娠期糖尿病组,gestational diabetes mellitus,GDM)和对照组(血糖正常组),收集研究对象的基础信息、孕24～28周产检的相关信息及血液标本,并进行血清骨钙素的检测。采用趋势性卡方检验分析不同骨钙素水平下GDM发生率的变化趋势,并采用多重线性回归分析骨钙素水平与妊娠期糖尿病的关系。结果妊娠期糖尿病组的骨钙素水平高于血糖正常组,进一步的分析发现,随着骨钙素水平的升高,GDM的发生风险逐步提高(趋势性卡方检验P0.001)。多重线性回归分析表明,调整了年龄、孕早期体质量指数(bone mass index, BMI)、舒张压后,骨钙素每提升一个单位,GDM的发生风险增加0.29倍,OR值和95%CI值分别为1.29和1.12～1.48,P值为0.000。结论孕中期骨钙素水平与妊娠期糖尿病发生呈正相关关系,可增加妊娠期糖尿病的发生风险。     

Vitamin K<Subscript>2</Subscript> (menaquinone 4) reduces serum undercarboxylated osteocalcin level as early as 2 weeks in elderly women with established osteoporosis

 Twenty elderly osteoporotic women with vertebral fracture(s) were randomly allocated to two groups; women in the MK₄ group received calcium with menaquinone 4 (MK₄) at a dose of 45 mg/day for 2 weeks, and women in the control group received calcium alone for the same period. Serum intact osteocalcin (OC) and undercarboxylated osteocalcin (uc-OC) levels were measured by immunoradiometric assay and enzyme immunoassay, respectively, at baseline and on the 7th and 14th days following the start of the treatment. There were no differences in the baseline data including age, weight, phylloquinone, menaquinone 4, menaquinone 7, OC, and uc-OC levels between the MK₄ group and the control group. Administration of MK₄ significantly raised the MK₄ level from 0.20 ± 0.10 (mean ± SE) pg/ml to 15.09 ± 5.62 pg/ml (P < 0.04), and reduced serum uc-OC levels from 2.80 ± 0.93 ng/ml to 1.76 ± 0.56 ng/ml (P < 0.05) at the end of the study, respectively. No significant changes in these levels were observed in the control group. Serum OC levels were stable during the period in both groups. In this randomized prospective study, the MK₄ group shows a reduction in the serum uc-OC level within 2 weeks without any significant change in OC, suggesting that the uc-OC is changed to carboxylated OC. This early effect of MK₄ on bone metabolism may be estimated by the measurement of serum uc-OC in elderly osteoporotic women with vertebral fractures. Received: January 21, 2002 / Accepted: November 6, 2002 Offprint requests to: T. Miki     

骨钙素水平与超重、2型糖尿病、高血压和HDL-C的关联分析

目的探究骨钙素水平与肥胖、2型糖尿病、高血压和高密度脂蛋白之间的相关性。方法选取2015年1月至2017年12月于我院内分泌科确诊的2型糖尿病合并原发性高血压患者82例、体检中心体检结果超重且无高血压以及糖尿病史者129名、诊断为原发性高血压且血糖正常者135例作为研究对象,收集所有研究对象的基本资料,并采取空腹血检查其骨钙素水平、血糖水平、血浆脂质水平,采用多重线性回归探究影响骨钙素水平的相关因素。结果单因素简单线性回归结果表明,骨钙素(osteocalcin,OC)与体质量指数(body mass index,BMI)值、腰围、HbA1c呈正相关,而与收缩压、高密度脂蛋白(HDL-C)呈负相关;多重线性回归结果表明,OC水平与BMI值、HbA1c、收缩压、HDL-C独立相关,其中OC与BMI值和HbA1c呈正相关,而与收缩压、HDL-C呈负相关。结论本研究表明超重和2型糖尿病与OC水平呈独立负相关,收缩压和HDL-C与OC水平呈独立正相关。     

Effects of 24 Months of Growth Hormone (GH) Treatment on Serum Carboxylated and Undercarboxylated Osteocalcin Levels in GH-Deficient Adults

We studied the effect of growth hormone (GH) replacement on bone mineral density (BMD) and some parameters of bone metabolism, including undercarboxylated osteocalcin (ucOC), an independent predictive marker of fracture risk, which has not been previously determined or compared during GH treatment. Measurements were performed at baseline and after 6, 12, 18 and 24 months of the initiation of the GH therapy in 21 adult patients with GH deficiency. Significant increases were observed in BMD after 1 year at the lumbar spine and after 1.5 years at the femoral neck. Serum total OC and carboxylated (c) OC increased and reached the maximum at 6 months, but the values remained over the baseline at both 12 and 18 months. The ucOC:total OC ratio changed contrarily: it decreased at 6 months, then increased again and reached the baseline level during the next 18 months. Serum calcium (Ca), phosphate (P) and total alkaline phosphatase (ALP) levels increased after 6 months, thereafter the Ca and P values decreased, while the total ALP remained elevated until 12 months. Serum parathormone decreased at 12 months and increased again thereafter. GH replacement therapy is associated with improvement of ucOC, a marker of fracture risk, which in addition to the increase of BMD, might contribute to the beneficial effect of GH replacement therapy on bone metabolism.     

Mitral annular calcification and the serum osteocalcin level in patients with chronic kidney disease

Objective: To determine the relationships between inflammatory mediators, mitral annular calcification (MAC), and osteocalcin in patients with chronic kidney disease (CKD). Materials and methods: Echocardiographic data for 60 patients diagnosed as CKD were retrospectively evaluated. The patients were divided into 2 groups; patients with MAC (MAC+ group) and patients without MAC (MAC? group). The relationships between biochemical markers—including osteocalcin—and MAC were evaluated. Results: The study included 19 female and 41 male patients. In all, 29 patients were MAC+ and 31 were MAC?. High-sensitive C-reactive protein (hsCRP) and osteocalcin levels were significantly higher in the MAC+ group (p?0.05). The eGFR was lower, serum calcitonin (we could not obtain calcitonin data for 15 patients), Ca, PO4, CaxPO4, the erythrocyte sedimentation rate, red cell distribution width, the neutrophil/Lymphocyte rate, and PTH were higher in the MAC+ group; however, the differences between the groups were not significant (p?>?0.05). The mitral E/A ratio, mitral peak Ea velocity, tricuspid E/A ratio, hsCRP, and the osteocalcin level were strongly correlated with MAC. Multivariate logistic regression analysis showed that only the osteocalcin level and mitral E/A ratio were independent variables, each with an independent effect on MAC. Conclusion: CKD patients in the MAC+ group had higher osteocalcin levels than those in the MAC? group, and left ventricular diastolic dysfunction was more common in the MAC+ group.     

骨质疏松骨折血清骨钙素和尿脱氧吡啶酚变化的研究

目的了解骨质疏松骨折患者在骨折愈合过程中骨代谢的变化,更好地指导临床有效的治疗。方法对80例骨折患者愈合过程中血清骨钙素和尿脱氧吡啶酚变化进行观察。结果骨质疏松性骨折后骨钙素呈增高趋势,可超出正常值范围。第3周达到最高峰,第6周逐渐下降到正常值范围;骨质疏松性骨折后尿脱氧吡啶酚亦呈增高趋势,完全超出正常值范围。第6周达到最高峰,第9周逐渐下降但未完全回复正常范围。结论骨质疏松骨折患者早期骨转换都很活跃,血清骨钙素和尿脱氧吡啶酚均增高,尿脱氧吡啶酚的增高较血清骨钙素的增高显著,骨吸收持续影响较大,骨代谢处于失偶联的状态。若早期能有效地控制骨吸收将有利于加强骨形成的能力,最终有利于缩短骨折愈合时间。