140例移植肾受者骨质丢失原因分析

目的研究调查移植肾受者骨密度并分析其主要影响因素。方法选取移植肾功能正常的受者140例,其中50例患者移植前检测血钙、磷、甲状旁腺激素、骨钙素、活性维生素D、尿钙和尿吡啶啉,双能X线吸收法测定腰椎和股骨近端骨密度。结果移植前患者钙、磷代谢异常明显,移植后血钙、磷、甲状旁腺激素、骨钙素、活性维生素D等均有明显改善,但尿钙／肌酐和尿吡啶啉／肌酐有增高趋势,股骨骨密度明显下降。平均每日激素用量为移植后尿钙／肌酐的主要预测因素。每日环孢素用量、体重指数与移植受者各部位骨密度明显正相关。累计激素用量是肾移植绝经女性病人腰椎和股骨颈骨密度的不良预测因素。结论患者肾移植后骨量减少和骨质疏松的发生率较高。骨质吸收增加可能是其主要原因。激素是移植。肾受者尤其绝经女性骨质吸收增加的主要因素之一。     

糖皮质激素诱发骨质疏松的类风湿关节炎患者血清25-羟维生素D的表达与骨密度的关系

目的探讨糖皮质激素诱发骨质疏松的类风湿关节炎患者血清25-羟维生素D[25-(OH)D]的表达与骨密度的关系。方法糖皮质激素诱发骨质疏松的类风湿关节炎患者72例作为研究组,其中活动期32例、稳定期40例,另选同期健康体检的无类风湿关节炎志愿者30例作为对照组。检测各组骨密度、血清25-(OH)D、血钙、血磷、骨钙素,并分析其相关性。结果研究组血清25-(OH)D、骨钙素及腰椎、股骨颈、全髋骨密度值低于对照组(P<0.05),两组血钙、血磷比较无统计学意义(P>0.05)。活动期类风湿关节炎患者血清25-(OH)D、骨钙素及腰椎、股骨颈、全髋骨密度值低于稳定期(P<0.05),两组血钙、血磷比较无统计学意义(P>0.05)。Pearson相关分析显示骨质疏松的类风湿关节炎患者血清25-(OH)D与腰椎、股骨颈、全髋骨密度值呈正相关(r=0.332、0.728、0.731,均P<0.05),骨钙素与腰椎、股骨颈、全髋骨密度值呈正相关(r=0.307、0.630、0.637,均P<0.05)。结论糖皮质激素诱发骨质疏松的类风湿关节炎患者血清25-(OH)D、骨钙素水平明显降低,活动期患者25-(OH)D、骨钙素、骨密度值低于稳定期患者,患者血清25-(OH)D、骨钙素水平与腰椎、股骨颈、全髋骨密度值呈正相关。     

唑来膦酸对骨质疏松模型大鼠骨密度及骨代谢的影响

目的探讨唑来膦酸对骨质疏松模型大鼠骨密度及骨代谢的影响。方法将48只雌性SD大鼠按照随机数字法随机分为空白对照组、模型对照组、低剂量组(5 mg/kg)及高剂量组(10 mg/kg),每组12只。治疗结束12 w后,测定大鼠股骨骨密度、股骨抗弯力、子宫指数及双肾指数,检测血清骨钙素、1,25-二羟基维生素D3〔1,25(OH)2D3〕、血钙、血磷水平。结果与空白对照组比较,模型对照组及低剂量组大鼠骨密度、抗弯力、血清骨钙素、1,25(OH)2D3、血钙、子宫指数及双肾指数明显偏低(P<0.05),而高剂量与空白对照组比较无统计学差异(P>0.05);与模型对照组比较,低剂量组和高剂量组大鼠骨密度、抗弯力、血清骨钙素、1,25(OH)2D3、血钙、子宫指数及双肾指数明显偏高(P<0.05);与低剂量组比较,高剂量组明显偏高(P<0.05)。结论唑来膦酸10 mg/kg剂量能明显改善骨质疏松模型大鼠的骨密度及骨代谢水平,升高子宫及双肾指数,对骨质疏松模型大鼠具有较好的治疗效果。     

中药内服治疗原发性骨质疏松的系统评价

目的探讨内服中药治疗原发性骨质疏松的疗效。方法计算机检索Cochrane Library、MEDLINE、EMbase、CBM、CNKI、VIP等数据库,人工检索相关临床随机对照研究文献,依据统一的纳入排除标准,对纳入研究的文献质量进行评估。采用Rev Man5.3进行Meta分析,对患者用药后总体疗效、腰椎、股骨颈、股骨大粗隆、ward三角、跟骨骨密度以及肝肾功能、血液流变学指标进行评价。结果纳入9篇文献,共计1 372例原发性骨质疏松患者。内服中药治疗组较对照组总体有效率高(P<0.01);内服中药能够显著提高患者腰椎和股骨颈骨密度(P<0.01),但股骨粗隆、ward三角以及跟骨密度无统计学差异(P>0.05)。此外,中药能够增加患者血清中骨钙素、1,25(OH)2D3含量,同时改善血液流变学相关指标。结论内服中药对原发性骨质疏松具有一定疗效。     

慢性饮酒、吸烟与骨质疏松的相关性研究

目的 探讨长期大量慢性饮酒、吸烟等不良生活方式与骨质疏松的关系.方法 以乏力、腰背痛、双下肢酸困为主诉,且有长期大量慢性饮酒史、吸烟史,无其他慢性疾病史的年轻男性患者45例为观察对象,测定其血钙(Ca)、血磷(P)和血肌酐(Cr)、尿素氮(BUN)、血糖(Glu)、天门冬酸氨基转移酶(AST)、丙氨酸基转移酶(ALT)、血清碱性磷酸酶(ALP)、甲状腺功能、全段甲状旁腺激素(iPTH)、1,25-二羟维生素D3[1,25-(OH) 2D3]、双能X线骨密度仪测定腰椎L1-4及左侧股骨近段(包括颈、股骨颈上部、大粗隆)骨密度(BMD),分析饮酒、吸烟对骨量的影响.以感冒发热就诊、年龄相当、无饮酒、吸烟史及慢性疾病史的45例男性为对照组.结果 观察组1,25(OH)2D3水平均降低,血钙水平偏低,血磷正常,碱性磷酸酶呈不同程度地升高,骨密度T值提示观察组27例骨质疏松,12例骨量减少,6例正常骨量;而对照组仅有6例为骨量减少,1例骨质疏松,38例为正常骨量,两组比较差异有统计学意义(P＜0.05).结论 长期慢性大量饮酒吸烟影响骨量,甚至易导致骨质疏松.     

阿伦膦酸盐预防激素相关性骨量丢失的前瞻性研究

目的 研究阿伦膦酸盐预防激素相关性骨质疏松的作用.方法 将21例需要长期服用糖皮质激素的风湿病患者随机分为治疗组和对照组.对照组在应用糖皮质激素治疗同时给予乐力(氨基酸鳌合钙加维生素D)1粒,每天2次,口服;治疗组在对照组药物的基础上,加用阿伦膦酸盐10 mg,每天1次或70 mg,每周1次,口服.所有患者在治疗前和治疗后3、6、12月,应用双能X线吸收法测定腰椎及股骨颈的骨密度(BMD).结果 对照组在糖皮质激素治疗后3、6、12个月BMD与自身治疗前比较明显下降(P<0.01);治疗组腰椎的BMD与自身治疗前比较有上升趋势(12个月时有统计学差异,P<0.05),股骨颈的BMD治疗后3、6个月与自身治疗前比无变化(P>0.05),12个月有轻度降低(P<0.05).结论 单予钙剂加维生素D不能有效预防糖皮质激素相关性骨质疏松的发生,加用阿伦膦酸盐则可有效延缓糖皮质激素相关性骨量丢失.     

雷洛昔芬与大豆异黄酮对绝经后妇女骨代谢影响的比较

目的 比较雷洛昔芬与大豆异黄酮对绝经后妇女骨代谢指标及骨密度的影响.方法 75例健康绝经后妇女随机均分为3组.雷洛昔芬组每日口服雷洛昔芬60 mg,大豆异黄酮组每日口服大豆异黄酮90 mg,安慰剂组口服安慰剂.并于服药前及服药12个月后各进行1次骨密度、骨代谢生化指标的测定.结果 用药后雷洛昔芬组桡骨骨密度升高,血清钙、碱性磷酸酶、骨钙素(BGP)、尿钙/尿肌酐比值水平下降(P＜0.05);大豆异黄酮组仅碱性磷酸酶、BGP水平下降(P＜0.05).雷洛昔芬组和大豆异黄酮组各指标均无显著性差异(P＞0.05).结论 雷洛昔芬较大豆异黄酮对防治绝经后妇女骨质疏松疗效可能更明显一些.     

女性骨代谢转换生化指标和骨密度随龄变化及其相互关系

目的 观察女性血清骨钙素、Ⅰ型胶原N-末端肽(NTx)、尿脱氧吡啶啉(DPD)和骨密度(BMD)随年龄变化的规律，探讨骨转换生化指标和BMD的关系。方法 采用酶联免疫吸附法测定895例女性血清骨钙素、NTx和尿DPD；用Hitachi 7170A全自动生化分析仪测定尿肌酐；采用双能X线骨密度仪测定1～4腰椎后前位(L1-4)和左侧髋部股骨颈BMD。结果血清骨钙素、NTx和尿DPD与年龄相关，用三次回归方程拟合的决定系数R^2为0.060～0.243(P—0.000)。骨钙素、NTx和尿DPE)在30～39岁降低至最低水平，40～59岁显著升高，随后维持在较高水平。骨钙素、NTx和尿DPD3个指标呈显著性相关(r=0.118～0.346，P=0.000)。骨钙素、NTx和尿DPD与腰椎和股骨颈BMD呈负相关(r=-0.120～-0.347，P=0.001～0.000)，高骨转换型绝经后妇女腰椎和股骨颈原发性骨质疏松症的患病风险为1．6～3．6。用三次回归方程或复合模型拟合骨钙素、NTx、尿DPD伴随L1-4和股骨颈BMD变化的决定系数为0.008～0.275(P=0.007～0.000)。结论 女性年龄依赖性骨转换生化指标和BMD呈负相关；绝经后妇女高骨转换状态是原发性骨质疏松症患病的危险因素。     

老年2型糖尿病患者骨密度和骨代谢研究

目的探讨老年2型糖尿病患者骨密度（BMD）和骨代谢的特点及其影响因素。方法选择65例老年2型糖尿病患者和68例健康老年体检者,应用双能X-线骨密度仪测定腰椎（L1-L4）和股骨颈BMD,同时检测空腹血清骨钙素（BGP）、血钙（Ca）、血磷（P）、甲状旁腺激素（PTH）和晨尿脱氧吡啶啉（DPD）。结果糖尿病组的腰椎、股骨颈BMD和BGP低于健康对照组,PTH、P和DPD高于健康对照组。结论老年2型糖尿病患者骨形成减少,骨吸收增加,骨质疏松症发生率高。     

1,25(OH)_2D_3对去卵巢大鼠骨组织成骨细胞、骨细胞凋亡的影响

目的观察1,25(OH)_2D_3对去卵巢大鼠骨组织中成骨细胞、骨细胞凋亡的影响。方法 36只雌性SD大鼠随机分成四组,对尼尔雌醇组和1,25(OH)_2D_3组分别给予尼尔雌醇(0.1mg/kg)和1,25(OH)_2D_3(0.05μg/kg)治疗12周。12周后,以DXA法测定大鼠全身的骨密度;放射免疫法测定各组大鼠血清中骨钙素及雌二醇的水平;处死各组大鼠,采用3′-OH末端DNA原位标记技术和透射电镜检测骨细胞、成骨细胞凋亡。结果 12周后,去卵巢组大鼠的骨密度和血清雌二醇水平明显降低,骨钙素含量升高,与假手术组相比,差异有显著性(P0.05)。1,25(OH)_2D_3可以增加去卵巢大鼠的全身骨密度和血清骨钙素含量(P0.05),但是不增加血清雌二醇的水平(P0.05)。1,25(OH)_2D_3可以抑制骨细胞、成骨细胞凋亡,与去卵巢组相比差异有显著性(P0.05)。结论 1,25(OH)_2D_3对去卵巢大鼠骨质疏松症具有防治作用,其部分机制可能为1,25(0H)_2D_3抑制了骨细胞、成骨细胞凋亡,从而调节骨重建。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.