老年股骨颈骨折患者骨代谢改变的观察

目的股骨颈骨折患者骨代谢指标观察,与正常人比较,以了解股骨颈骨折与骨质疏松症的关系.方法用亲和渗透和全血干化学技术和酶联免疫化学发光法测定18例股骨颈骨折(男8例,女10例)患者骨源性碱性磷酸酶(ABLP)和尿脱氧吡啶酚(DPD).浓度并与正常人进行比较.结果男、女组股骨颈骨折患者骨源性碱性磷酸酶分别为(183.33±23.00)和(188.89±35.33),尿DPD分别为(281.11±84.15)和(294.31±76.94).男女股骨颈骨折组BALP和DPD水平与对照组比较有显著差异(P＜0.05),DPD浓度男女观察组与对照组比较均有非常显著差异(P＜0.01).结论老年人股骨颈骨折发生与骨质丢失有一定的关系,提示预防老年人股骨颈骨折首先预防骨质疏松症的发生.     

唑来膦酸治疗35例原发性骨质疏松症的疗效及观察

目的观察唑来膦酸治疗原发性骨质疏松症的临床疗效及安全性。方法应用唑来膦酸注射液治疗35例57～85岁原发性骨质疏松症患者,分别观察治疗前后患者骨痛的缓解情况、血钙、磷、碱性磷酸酶、骨钙素、尿DPD/Cr变化情况。采用双能X线骨密度仪测定患者治疗前后骨密度。观察患者治疗后不良反应的发生情况。结果全部患者骨痛症状明显改善,总优良率达100%。血钙、磷、碱性磷酸酶、骨钙素无显著变化,尿DPD/Cr较治疗前显著降低(P<0.01)。骨密度较治疗前显著增加(P<0.01),35例患者均无明显不良反应发生。结论唑来膦酸是治疗原发性骨质疏松症的安全有效性药物。     

危重病患者尿微量白蛋白水平变化与APACHE Ⅱ评分的关系

目的：探讨危重病患者尿标本中微量白蛋白(MA)水平的变化与APACHEⅡ评分及疾病严重程度和预后的关系。方法：采用速率散射比浊法检测尿MA,全自动生化分析仪检测尿肌酐(Cr),APACHEⅡ评分采用相应软件。结果：正常对照组尿MA/Cr水平为1．8+0．4mg/mmolCr,危重病患者组进入ICU 6h尿MA/Cr水平为11．7士9．7mg/mmolCr,两者比较有显著性差异(P＜0．01)。尿MA/Cr比率与APACHEⅡ评分有良好的相关性。死亡组与存活组患者MA/Cr比率分别为24．5±15．1mg/mmolCr和8．3±2．4mg/mmolCr,两者比较差异显著(P＜0．01)。结论：早期检测尿微量白蛋白与APACHEⅡ评分均能不同程度地反映危重病患者病情及预后,两者同步测定有助于更准确地判断患者的病情及预后和决定IC收治标准、治疗范围和强度,在临床上推广应用有实用参考价值。     

高血压病患者血清骨钙素、碱性磷酸酶、钙、磷、镁变化

为了解高血压病患者骨代谢变化,检测其血清钙、磷、镁、碱性磷酸酶、骨钙素水平。结果表明;女性高血压病患者血磷、血碱性磷酸酶、骨钙素比男性高血压病患者显著升高,血镁比正常女性显著升高。男、女性高血压病患者骨钙素与正常对照组比较均无显著性差异。高血压病人骨代谢障碍与骨钙紊关系须进一步研究,高转化型骨代谢障碍可能性大。     

348例婴儿骨源性碱性磷酸酶测定结果分析

目的检测婴儿血中骨源性碱性磷酸酶(BAP)活性,籍以筛查或早期发现维生素D(VitD)缺乏的婴儿,并辅助诊断因钙营养不良引起的骨钙化障碍或其他原因引起的代谢性骨病。并且早预防,早干预治疗。方法北京中生金域诊断技术有限公司提供的小儿骨源性碱性磷酸酶(NBAP)试剂盒,采用免疫渗滤和全血干化学技术原理,采末梢血进行测定。结果有临床症状的348例中≤200 U/L的5例,1.4%;200~300 U/L(不含)的129例,37.1%;≥300 U/L的214例,61.5%。结论结果显示,有临床症状的婴儿中BAP活性高于正常者十分多见,应引起重视,做好筛查,积极预防,系统管理,合理喂养,科学补充VitD。     

绝经后妇女骨代谢指标与骨折风险骨密度相关性研究

[目的]探讨绝经后妇女骨代谢指标,血清骨钙素(bone gamma-carboxyglutamic-acid-containing proteins,BGP)及骨特异性碱性磷酸酶(bone alkaline phosphotase,BAP),尿羟脯氨酸/尿肌酐(urinary hydroxyproline/creatinine,HYP/Cr)及尿脱氧吡啶啉/尿肌酐(urinary deoxypyridinoline/ereatinine,DPD/Cr)的动态变化规律,以及骨代谢指标、骨折风险、骨密度之间的相关性.[方法]采用WHO骨折危险性评估工具FRAX软件和亚洲人骨质疏松自我筛查工具(OSTA指数)2种方法评估骨折风险;检测晨起血清BGP、BAP,尿HYP/Cr、DPD/Cr;双能X线骨密度仪检测绝经后妇女常见骨折部位骨密度(bone mineral density,BMD).[结果](1)随着年龄增长,绝经后妇女骨折风险呈升高趋势,L2-4、L-FN、Ward's三角、L-distal forearm等4个部位的BMD呈降低趋势;BGP、BAP在51 ～ 55岁阶段有明显上升,随后呈下降趋势;(2)骨代谢指标与骨折风险相关性:BGP与2种骨折风险评估结果均呈负相关(P＜0.01),BAP、HYP/Cr、DPD/Cr与2种骨折风险评估结果均呈正相关(P＜0.01);(3)骨代谢指标与BMD相关性:BGP与4个部位的骨密度呈负相关(P＜0.01),以L2-4最为显著(r值=-0.739).BAP、HYP/Cr、DPD/Cr与4个部位骨密度均呈正相关(P＜0.01),其中BAP与Ward's三角BMD高度相关(r值=0.729),HYP/Cr、DPD/Cr与L2-4部位BMD高度相关(r值分别为0.536、0.751);(4)骨密度与骨折风险相关性:4个部位的骨密度与2种方法评估的骨折风险呈正相关(P＜0.01),L-FN、L2-4的BMD与FRAX、OSTA指数风险分级均有显著相关性.[结论]绝经后妇女的四项骨代谢指标与FRAX评估结果、OSTA指数、骨密度均有相关性,监测BGP、BAP、HYP/Cr、DPD/Cr等指标对此人群骨质疏松症的早期防治具有一定意义.     

阿仑膦酸钠对绝经后骨质疏松症患者骨代谢指标的影响

目的观察抗骨吸收药物双膦酸盐对绝经后骨质疏松症患者骨代谢状态的影响。方法本研究为回顾性研究,共收集在我院骨质疏松门诊数据库中临床资料完整的女性绝经后骨质疏松症患者152例,其中阿仑膦酸钠治疗组93例(A组),每周给予阿仑膦酸钠70 mg,一次口服;未服用阿仑膦酸钠对照组59例(B组)。分别观察治疗前和治疗后3、6、12个月骨转换生化指标:骨特异性碱性磷酸酶(BAP)、抗酒石酸酸性磷酸酶(TRAP-5b)及25羟维生素D(25(OH)VD)的变化。结果 A组患者经阿仑膦酸钠治疗3个月后BAP和TRAP-5b水平分别较治疗前下降30.60%和32.95%(P0.001)治疗6个月时完全降至女性绝经前水平,并一直维持在此水平至治疗后12个月。B组患者治疗前后BAP和TRAP-5b水平差异无统计学意义。结论绝经后骨质疏松症患者骨代谢处于高转换状态,其BAP及TRAP-5b水平较绝经前明显升高;经阿仑膦酸钠治疗3个月后高转换状态可以明显改善,骨转换指标BAP和TRAP-5b水平回落到绝经前水平。     

去势法兔骨质疏松模型建立的探讨

目的探讨采用去势法建立免骨质疏松症模型的可行性。方法将20只5月龄新西兰雌兔随机分成手术组(OVX)与假手术组(SHAM),手术组行双侧卵巢切除。两组分别于术前、术后 4、8、12、24 w进行全身骨密度(BMD)检测;术前、术后12 w和术后24 w行骨代谢指标检测: 骨特异性碱性磷酸酶(BALP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶-5b(TRAP-5b);于术后 12w和24w各处死10只兔,取其右侧股骨行生物力学测定及取腰椎,制成不脱钙的骨切片,行骨组织形态计量学分析。结果去势6 m后,OVX组全身BMD明显低于SHAM(P<0．01):在骨代谢指标TRAP-5b、BALP及BGP,OVX组均明显高于SHAM组(P<0．01):生物力学检测中的弯曲强度、比例载荷、最大挠度和弯曲破坏载荷OVX组均较SHAM组明显下降(P<0．01)。骨组织形态计量学显示,OVX组的骨质丢失明显增加(BV／TV％下降,Tb．N减少,Tb．Sp变宽),骨小梁形成明显减少(OS／BS及MAR均增多),骨吸收明显升高(ES／BS、Oc．No／Tb．Pm 升高),这些指标与SHAM组比较有明显性差异(P<0．01)。结论去势法建立兔骨质疏松症模型切实可行,5月龄雌兔,造模6月。本模型为探明原发性骨质疏松发病机理、评价药物疗效及临床骨质疏松性假体松动研究提供重要的基础。     

血碱性磷酸酶与血液透析患者认知功能的相关性研究

目的:观察血碱性磷酸酶(ALP)与血液透析(HD)患者认知功能的相关性。方法:选择2019年01月—2020年01月于济宁医学院附属医院行HD患者85例，其中发生认知功能障碍(蒙特利尔认知评估量表评分<26分)51例，认知功能正常34例。收集相关临床资料，采用多因素Logistics回归分析影响HD患者认知功能障碍的独立危险因素；绘制受试者工作特征(ROC)曲线，评估ALP诊断HD患者发生认知功能障碍的效能。结果:认知功能障碍患者糖尿病比例、低血压事件发生率、RDW和ALP明显高于认知功能正常患者[49.02%(25/51)比26.47%(9/34)、58.82%(30/51)比35.29%(12/34)、(14.40,15.10)比(13.40,14.20)和162.27±130.56比98.11±49.51],差异有统计学意义(P<0.05)。Spearman相关性分析显示，ALP与RDW(r=0.278,P<0.05)、认知功能障碍(r=0.298,P<0.05)和糖尿病(r=0.885,P<0.05)呈正相关。多因素Logistics回归分析结果显...     

鹿瓜多肽注射液治疗原发性骨质疏松症疗效观察

目的观察鹿瓜多肽注射液对原发性骨质疏松症治疗作用。方法临床随机选择60例,32例给予鹿瓜多肽注射液静脉滴注;28例为对照组,予物理治疗,口服罗钙全片和钙尔奇D片。统计患者腰背痛及全身骨痛改善情况,检测治疗前后骨源性碱性磷酸酶(BAP)及尿脱氧吡啶啉变化情况。结果治疗组腰背痛及全身骨痛有效率为93.8%,对照组有效率为53.6%,两组间总有效率差异显著;治疗组BAP及尿DPD/cr于治疗后6个月时均显著降低,对照组在治疗前后无明显变化。治疗组骨密度测定(BMD)6个月后有一定升高,与治疗前差异显著,对照组BMD无明显改变。结论鹿瓜多肽注射液对治疗原发性骨质疏松症具有治疗作用。     

尿脱氧吡啶啉对评价肾病综合征患儿泼尼松治疗后骨吸收异常的价值及肾康灵的干预作用

目的：（1）通过观察肾病综合征（NS）患儿尿脱氧吡啶啉（DPD）排泄率的变化,探讨用尿脱氧吡啶啉来评价泼尼松治疗肾病综合征患儿骨吸收异常的价值。（2）观察肾病综合征患儿肾康灵治疗前后DPD排泄率的变化,探讨肾康灵治疗激素性骨质疏松的疗效。方法：（1）以30例NS患儿为研究对象,在足量泼尼松治疗前及治疗后6周分别留取尿标本检测尿DPD排泄率。（2）30例患儿在泼尼松足量治疗后6周随机分为治疗组、对照组。对照组继续足量泼尼松治疗,治疗组在对照组的基础上加用中药复方肾康灵冲剂口服治疗,2周后留取尿标本检测尿DPD排泄率。结果：泼尼松足量治疗6周后尿DPD排泄率明显高于激素治疗前（P〈0.01）。（2）泼尼松足量治疗8周后治疗组与对照组相比较,尿DPD排泄率明显降低,两者比较有统计学差异（P〈0.05）。结论：（1）泼尼松治疗肾病综合征的患儿尿DPD排泄增加,支持了激素可导致骨吸收增加的观点。（2）肾康灵能显著降低肾病综合征的患儿尿DPD的排泄,提示其治疗激素性骨质疏松有一定益处,其抗骨质疏松作用可能通过多个途径而实现。     

Urinary deoxypyridinoline excretion for the evaluation of bone turnover in chronic renal failure

BACKGROUND: The urinary excretion of deoxypyridinoline (DPD) was evaluated in predialysis chronic renal failure (CRF), together with intact PTH and several classic markers of bone turnover in order to assess whether urine free and total DPD excretion are equivalent parameters of bone turnover in CRF, and to evaluate the relationship between urine DPD excretion, PTH and the other bone markers. METHODS: The study was carried out in 94 patients with different degrees of renal failure due to various kidney diseases. Besides urinary DPD expressed as free DPD, total DPD, free/total DPD, free DPD/Cr and total DPD/Cr, the following determinations were made: intact PTH, bone alkaline phosphatase (BALP), total alkaline phosphatase (AP), osteocalcin (BGP), serum C-terminal telopeptide of collagen type I (ICTP) and hydroxyproline (OHpro). The patients were divided into 3 groups according to the increasing severity of renal failure (Ccr >40, 40-20, <20 ml/min). RESULTS: The ratio free/total DPD decreased (NS) with advancing renal failure, and was inversely correlated with total DPD excretion. While PTH increased progressively to about four times the values observed in the Ccr >40 group, there was a parallel increase only in BGP and ICTP, parameters retained in the serum with decreasing renal function, while AP, BALP, total DPD and OHpro did not change. However, significant correlations between total DPD/Cr and PTH, BALP, BGP and ICTP were also found. CONCLUSIONS: In CRF free DPD is an unreliable index of bone turnover due to a probable interference in its production from the peptide-bound DPD. Total DPD or total DPD/Cr are better used. In spite of the significant correlations observed in advanced renal failure between PTH and most of the parameters examined, a resistance of bone tissue to PTH action in CRF must be considered.     

Urinary gamma-glutamyltransferase (GGT) as a potential marker of bone resorption

We recently identified γ-glutamyltransferase (GGT) as a novel bone-resorbing factor. The present study was undertaken to determine whether GGT is a marker of bone resorption in two genetic models of hyper- and hypo-function of osteoclasts, as well as in postmenopausal women with accelerated bone resorption, using type I collagen N-telopeptide (NTX) and deoxypyridinoline (DPD) as established biochemical markers. Urinary excretion of GGT, corrected for creatinine, was found to be increased in osteoprotegerin (OPG)-deficient osteoporotic mice as well as in patients with postmenopausal osteoporosis (67–83 years of age); in both cases the urinary level decreased after treatment of patients or mice with alendronate, a selective inhibitor of bone resorption, concomitantly with a reduction in DPD and NTX. Conversely, in osteopetrotic op/op mice, urinary GGT increased in parallel with DPD after induction of osteoclasts with M-CSF injection. Constant infusion of parathyroid hormone (PTH) also increased urinary GGT along with DPD. In a survey of 551 postmenopausal women (50–89 years of age) at their regular health checkup, urinary GGT excretion exhibited a high correlation with DPD (ρ = 0.49, p < 0.0001). The calculated sensitivity and specificity for diagnosing elevated bone resorption, as determined by a DPD value higher than 7.6 nM/mM Cr, were 61% and 92%, respectively, when a cut-off value of 40 IU/g Cr was assigned for urinary GGT. Since GGT activity can be measured inexpensively in large numbers in a very short time, the measurement of urinary level may provide a convenient and useful method for mass screening to identify those with increased bone turnover and hence at increased risk for bone fracture.     

Changes of basic bone turnover parameters in short-term and long-term patients with spinal cord injury

The bone mineral density (BMD), the cross- links (PYD, DPD and NTx) and the bone specific alcaline phosphatase (BAP) was investigated in a cross-sectional study in 62 male patients with spinal cord injury (SCI), n = 28 short-term (0–1 year after SCI) and n = 34 long-term SCI patients (> 5 years after SCI). Knowledge about this parameters are necessary to find an adequate therapy for this special kind of osteoporosis. Immobilisation osteoporosis in SCI patients is a well-known problem that may lead to pathological fractures. Little is known regarding the extend of the osteoporosis as well as the causative factors. Measurements of the BMD in the proximal femur and the lumbar spine were performed with dual-energy-X-ray-absorptiometry (DEXA), of the osteoblast marker BAP (bone specific alkaline phosphatase) from serum and the osteoclast markers PYD (pyridinoline), DPD (desoxy-pyridinoline) and NTx (N-telopeptide of collagen type I) from urine. We found a significant decrease of BMD in the proximal femur and no relevant change in the lumbar spine compared to an age- and sex correlated control group (Z-score) in short-term and long-term SCI patients. There was a significant bone loss at the proximal femur between short and long-term SCI patients, whereas at the lumbar spine the BMD even slightly increases. Bone resorption (cross-links) was increased in both groups, though in long-term SCI patients it is significantly decreased compared to short-term SCI patients (DPD from 211.7 u/g creatinine to 118.1 u/g creatinine; NTx from 215.1 nmol/mmol creatinine to 83,6 nmol/mmol creatinine). The bone formation marker BAP is slightly below normal range in both groups (12.3 U/l in short-term, 9.7 U/l in long- term SCI patients). Only the proximal femur is affected by the immobilisation osteoporosis of SCI patients, therefore the BMD measurements in these patients should be performed at the lower limb. The problem of the immobilisation osteoporosis in SCI patients is the striking increase of bone resorption and the missing reaction of the bone formation.     

Effect of dietary-induced metabolic acidosis and ovariectomy on bone mineral density and markers of bone turnover

Dietary-induced metabolic acidosis (DIMA) has been implicated as a significant confounder in the development of osteoporosis. Twenty-four mature ewes were randomly assigned to four groups of six sheep. Group 1 consumed a control diet (ND); group 2 consumed a normal diet (ND) and had ovariectomy (OVX), group 3 consumed a diet that induced metabolic acidosis (MA), without OVX, and group 4 consumed a diet that induced MA, with OVX. The study was conducted over 180 days and the sheep were maintained on the assigned diet throughout. Sheep were weighed and bone mineral density (BMD) was measured, using dual-energy X-ray absorptiometry (DEXA), on days 0 and 180. Serum bone alkaline phosphatase (BAP), urine deoxypyridinoline (DPD), and fractional excretions (FE) of Ca and P were determined on days 0, 90, and 180. Arterial blood pH was determined on day 180. Analysis consisted of a two-way analysis of variance for repeated measures with significance set at P 0.05. Body weights, serum BAP, and urine DPD were not influenced by either diet or OVX status. DIMA did significantly increase urinary FE of Ca and P and significantly decreased lumbar BMD and arterial pH. Arterial pH remained within physiologic normal limits. DIMA was a more potent cause of calcium wasting than OVX over the time frame of this study. Sheep appear to be sensitive to DIMA and will therefore be a useful animal model to study the influence of diet on the development of osteoporosis. The specific mechanisms through which DIMA exerts its influence are still unknown and are the subject of ongoing studies.     

Urinary γ-glutamyltransferase (GGT) as a potential marker of bone resorption

We recently identified γ-glutamyltransferase (GGT) as a novel bone-resorbing factor. The present study was undertaken to determine whether GGT is a marker of bone resorption in two genetic models of hyper- and hypo-function of osteoclasts, as well as in postmenopausal women with accelerated bone resorption, using type I collagen N-telopeptide (NTX) and deoxypyridinoline (DPD) as established biochemical markers. Urinary excretion of GGT, corrected for creatinine, was found to be increased in osteoprotegerin (OPG)-deficient osteoporotic mice as well as in patients with postmenopausal osteoporosis (67–83 years of age); in both cases the urinary level decreased after treatment of patients or mice with alendronate, a selective inhibitor of bone resorption, concomitantly with a reduction in DPD and NTX. Conversely, in osteopetrotic op/op mice, urinary GGT increased in parallel with DPD after induction of osteoclasts with M-CSF injection. Constant infusion of parathyroid hormone (PTH) also increased urinary GGT along with DPD. In a survey of 551 postmenopausal women (50–89 years of age) at their regular health checkup, urinary GGT excretion exhibited a high correlation with DPD (ρ = 0.49, p < 0.0001). The calculated sensitivity and specificity for diagnosing elevated bone resorption, as determined by a DPD value higher than 7.6 nM/mM Cr, were 61% and 92%, respectively, when a cut-off value of 40 IU/g Cr was assigned for urinary GGT. Since GGT activity can be measured inexpensively in large numbers in a very short time, the measurement of urinary level may provide a convenient and useful method for mass screening to identify those with increased bone turnover and hence at increased risk for bone fracture.     

脊柱骨关节炎与骨质疏松的关系

本研究采用随机区组设计比较了１３８名老年人中脊柱骨关节炎及骨质疏松患者与正常对照组的骨质疏松及骨关节炎程度，结果表明，三组之间的骨质疏松及骨关节炎程度均相差非常显著（Ｐ＜０．０１），其中骨关节炎组的骨关节炎程度明显重于正常对照组和椎体压缩骨折组（Ｐ＜０．０１），而椎体压缩骨折组骨质疏松程度也明显重于正常对照组和骨关节炎组（Ｐ＜０．０１）。本研究结果提示脊柱的骨关节炎与骨质疏松之间存在着十分明显的负相关。     

熟地对去卵巢大鼠骨代谢生化指标及骨密度的影响

目的 研究熟地水煎液对去卵巢大鼠骨代谢生化指标及骨密度的影响，探讨熟地对骨质疏松症大鼠的药理作用。方法 采用去卵巢大鼠模型，每天灌胃1g/kg、2g／kg及4g/kg3种剂量的熟地水煎液，3个月后检测大鼠血清雌二醇、骨钙素、碱性磷酸酶、钙、磷、尿脱氧吡啶啉、钙、磷等生化指标及股骨骨密度的变化，并与模型组、正常对照组、己烯雌酚组比较。结果 与假手术组比较，熟地3个剂量组、己烯雌酚组ALP和BGP均明显升高（P〈0．05），E2含量均低于假手术组（P〉0．05）。与模型组比较，各用药组ALP、BGP、尿DPD／Cr、Ca／Cr含量均低于模型组（P〈0．05）。各用药组大鼠股骨骨密度均较模型组有所升高（P〈0．05）。结论 熟地可抑制骨吸收，延缓去卵巢大鼠骨量丢失，对骨质疏松症有一定的防治作用。     

治痹补骨丹治疗绝经后骨质疏松症47例临床观察

选择４９～６５岁，绝经１～２０年确诊为骨质疏松症的妇女６７例，随机分为治疗组４７例，用中药治痹补骨丹治疗；对照组２０例，用龙牡壮骨冲剂治疗。分别于治疗前后监测骨密度、血清碱性磷酸酶（ＡＫＰ）、尿钙／肌酐（Ｕ－Ｃａ／Ｃｒ）比值、尿羟脯氨酸／肌酐比值（Ｕ－ＨＯＰ／Ｃｒ）、血钙、血磷等。结果显示：治疗组服药后３个月和６个月，临床症状有效率明显优于对照组（Ｐ＜０．０１），并能升高骨密度，提高血ＡＫＰ值。说明该药能活跃骨代谢，并能改善胶原细胞的异常交联。