妊娠哺乳相关骨质疏松症的诊治进展

妊娠哺乳相关骨质疏松症(pregnancy and lactation associated osteoporosis,PLO)是一种罕见的疾病,主要发生在妊娠晚期和产后早期妇女,常在第一次妊娠时发病,以胸腰椎多发压缩性骨折最常见,主要表现为腰背疼痛、身高变矮、活动受限。其发病机制目前尚不清楚,可能与妊娠、哺乳状态、遗传因素等相关。在怀孕期间,通过肠道钙吸收的加倍以满足胎儿及母体对钙的需求,但如果母亲摄入的钙不足,不能满足母亲和胎儿的综合需求,母亲的骨骼会通过PTHrP(parathyroid hormone-related peptide,PTHrP)刺激骨骼吸收。哺乳期,在高水平PTHrP的主导作用和低雌激素的共同作用下,促进骨吸收动员骨钙入血。目前PLO尚无统一的诊断标准,防治措施尚无定论。现有研究表明大多数PLO患者在断奶后骨量逐渐增加,因此对PLO患者建议停止哺乳并补充充足钙剂及维生素D。有报道双膦酸盐、迪诺赛麦、特立帕肽等抗骨质疏松药物治疗PLO,但其存在或潜在的不良反应,使用受到限制;椎体成形术和后凸成形术等用于治疗产后椎体骨折整体疗效尚不明确,一般不推荐使用。对PLO患者需充分评估患者情况慎重选择治疗方案。     

妊娠哺乳相关骨质疏松症1例分析及文献回顾

目的探讨妊娠哺乳相关骨质疏松症(PLO)的临床特点及诊治。方法围绕1例妊娠哺乳相关骨质疏松症的临床资料进行回顾性分析。结果本例患者在妊娠哺乳期出现骨痛、活动受限、胸腰椎多椎体压缩性骨折、骨密度明显降低等骨质疏松症表现。并在确诊前进行了充分的代谢性骨病的鉴别诊断。停止哺乳,予以钙剂、活性维生素D疗效良好。结论 PLO可能具备多种易患因素,在妊娠哺乳期出现的腰背痛应考虑本病可能,需引起临床医生的重视,但充分的鉴别诊断是确诊该病的前提。     

妊娠哺乳相关性骨质疏松症的临床应对

目的 妊娠哺乳相关性骨质疏松症(PLO)是一种罕见的明显致残性疾病,通过个案分析和文献回顾以提高对本病的认识和临床应对能力.方法 回顾性分析一例PLO患者的临床特点和诊疗经过并进行相关文献复习.结果 该患者为青年女性,平素月经规律,哺乳早期出现腰痛及活动障碍,生化检查基本正常,影像学检查示椎体多发亚急性压缩性骨折,骨密...     

妊娠和哺乳相关骨质疏松症的研究进展

妊娠和哺乳相关骨质疏松症是一种罕见的继发性骨质疏松症,通常发生在妊娠晚期和哺乳早期,由于发病率较低及发病时间特殊,相对诊断工具有限,并且大多数文献报道也属个案或对疾病状态的一般描述,因此对其管理与诊断尚未形成指南与共识。由于妊娠和哺乳相关骨质疏松症具有自限性,一部分病人在妊娠和哺乳完成后,骨密度会自发改善,因此如何治疗该病的确凿建议也未明确提出。降钙素、双膦酸盐、地舒单抗和特立帕肽均已用于个体患者,但是治疗效果褒贬不一,也没有大量的客观数据反馈长远治疗效果,因此,对于妊娠和哺乳相关骨质疏松症的探索仍然有待继续,有望在未来形成共识并开发出更安全的药物进行治疗。     

妊娠哺乳相关性骨质疏松症的研究进展

妊娠哺乳相关性骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)是指发生于妊娠和哺乳期,以低骨量和骨组织微结构破坏为特征,骨质脆性增加和易于骨折的全身性骨代谢性疾病。由于PLO发病率低,医师重视程度不够,常常容易被漏诊或误诊。目前PLO的病理生理机制尚未完全明确,研究报道也多以个案或病例报道为主,尚无统一治疗方案。本文就妊娠哺乳相关性骨质疏松症的发病机制和治疗进展等方面作一综述。     

妊娠和哺乳相关的骨质疏松症病例分享

妊娠和哺乳相关的骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)是一种罕见的临床特殊骨质疏松症,大多数病例出现在初产妇的妊娠晚期或产后早期,但是也会发生于经产妇中。PLO患者主要表现为在妊娠晚期以及产后初期严重的下背部疼痛、身高下降和脆性骨折,尤其是椎骨骨折。迄今为止,全球报道的PLO患者患病率仅有120余例。目前尚缺乏PLO治疗的指南与共识,各报告病例中指出双膦酸盐、钙和维生素D的补充是治疗PLO的一线疗法,此外特立帕肽、雷奈酸锶、地舒单抗也被证明有助于增加骨密度(bone density, BMD)。本文通过回顾分析两例PLO患者的临床资料,并对相关文献进行复习,以提高对PLO疾病的认识。     

妊娠哺乳相关骨质疏松症一例并文献复习

妊娠哺乳相关骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)是一种罕见的骨质疏松,发生在妊娠晚期或哺乳期年轻女性,容易被误诊及漏诊,严重影响妊娠哺乳期妇女身心健康,本文报告一例完整的PLO诊断、治疗以及随访,同时进行相关文献复习。PLO的发病机制目前并不完全清楚,考虑与多途径介导的骨吸收增加和成骨细胞功能障碍有关。治疗上,目前仍然存在争议,可以先停止诱因(妊娠或哺乳),补充基本的钙剂及维生素D,6～12个月再次评估骨密度决定是否进一步应用双膦酸盐等抗骨质疏松治疗。     

妊娠相关乳腺癌5例临床诊治分析

目的 探讨妊娠相关乳腺癌的诊断和治疗。方法 对第二军医大学附属长征医院1990-2006年收治的5例妊娠相关乳腺癌的临床及病理资料进行分析。结果 妊娠期发病3例、哺乳期发病2例。年龄23～37岁。所有病例术前均终止妊娠和哺乳,行乳腺癌根治术或改良根治术。术后病理报告均为浸润性导管癌,伴腋窝淋巴结转移。4例病人Cerb-2过度表达,有3例雌/孕激素受体均阴性。术后病理TMN分期Ⅱ期2例,Ⅲ期2例,Ⅳ期1例。5例病人术后均予化疗。术后随访有1例病人术后10年仍存活,余4例先后出现复发转移死亡。结论 妊娠相关乳腺癌因诊断晚,进展快,其预后较差。     

妊娠相关骨质疏松症一例报告

妊娠相关骨质疏松症是一种少见的疾病,发病机理尚不完全清楚.笔者报道了l例3l岁的女性妊娠相关骨质疏松症患者,症状表现为妊娠第6个月出现双髋疼痛及行走障碍,骨密度测量证实骨质疏松症.通过为期3周钙、维生素D及阿法骨化醇胶丸治疗后症状缓解.尽管该病少见,由于其可能导致脊柱或其他部位的骨折,仍应积极诊断与治疗.     

老年性骨质疏松症相关问题研究进展

老年性骨质疏松症是指65岁以上女性和70岁以上男性人群发生的骨质疏松,是一种代谢性骨病,与绝经后妇女骨质疏松症的发病机制不同,发生主要与年龄有关,发病机制复杂,治疗上目前也无确切有效的药物。近年来,老年性骨质疏松发病率逐渐上升,严重影响老年人的生活质量。本文复习相关文献,就老年性骨质疏松症的病因、发病机制及治疗手段等相关问题进行综述,以期引起人们对老年性骨质疏松症的关注。     

Osteoporosis in pregnancy

Osteoporosis has long been described in pregnant women who developed vertebral fractures in the last trimester or shortly after delivery without underlying disorders. However, this condition appears to be relatively rare and the clinical features, associated metabolic abnormalities and a pathological mechanism have not been fully established. This paper reviews available data on osteoporosis and pregnancy and briefly discusses the relationship between pregnancy and bone mass, calcium homeostasis, systemic skeletal hormones and local factors to help explain the pathophysiology of this unique disorder.     

Tramadol in pregnancy and lactation

Tramadol produces analgesic effects through both non-opioid and weak opioid activity and is commonly used to treat mild to moderate pain. It has been in use for over 30 years and has a well-established safety profile in the general population. Since tramadol is not licensed for use in pregnancy and lactation, there is limited clinical research on its use in this patient population. A systematic review was undertaken of articles published in English before June 2011, searching Pubmed, Medline, CINAHL, Embase and Cochrane databases using the terms 'tramadol and pregnancy', 'tramadol and breastfeeding', 'tramadol and lactation', and 'tramadol and neonate'.     

Breast cancer during pregnancy and lactation

Breast cancer is the most frequently seen cancer in pregnancy and lactation, but the incidence is low, the disease being seen in approximately 0.03% of pregnancies. Only 1% to 2% of breast cancer overall is diagnosed during pregnancy or lactation. There is no evidence to implicate pregnancy or lactation in either the etiology or the progression of breast cancer. Careful breast examination early in the pregnancy is very important to find solid masses that require biopsy before breast engorgement hides them. Therapeutic options vary, depending on the stage of disease and the stage of the pregnancy. Operable disease in the first 6 to 7 months of the pregnancy should be treated by mastectomy, as irradiation is contraindicated. Late in the pregnancy, a lumpectomy and axillary dissection can be done, with irradiation being delayed until after delivery. General anesthesia is safe if the usual precautions are taken to compensate for the physiologic changes induced by pregnancy. Unfortunately, delay in diagnosis is common, and 70% to 89% of patients with operable primary lesions have positive axillary lymph nodes. Late stage appears to be the only reason for the generally worse prognosis in these patients, as stage for stage, they have a course similar to that of nonpregnant patients. Adjuvant chemotherapy can be considered late in the pregnancy but should usually be delayed until after delivery. In patients with locally advanced or metastatic cancer diagnosed early in the pregnancy, for whom both chemotherapy and radiation therapy would normally be recommended, consideration must be given to termination of the pregnancy. There is no evidence that termination of pregnancy improves the outlook for the patients, but it does permit standard aggressive therapy in advanced disease.     

Breast cancers in pregnancy and lactation

Four cases of rare coincidence of pregnancy and mammary carcinoma are described in this paper. Tumour growth was at an advanced stage and prognosis thus deteriorated due to delayed diagnosis. The therapeutic concept should be in keeping with the stage of tumour growth and should be formulated with due consideration of the patient's individual peculiarities.     

Carpal tunnel syndrome in pregnancy and lactation

A retrospective study of 40 women with carpal tunnel syndrome developing in pregnancy and 18 women with carpal tunnel syndrome in the puerperium was undertaken. All the cases that developed in pregnancy occurred in the third trimester and resolved within two weeks of delivery. Those cases developing in the puerperium affected women who had breast-fed their infants and their symptoms lasted a mean of 5.8 months. These patients were older and more likely to be primiparous than if the condition occurred in pregnancy. All the pregnant women and none of the lactating women had symptoms of peripheral oedema. Spontaneous resolution with a good response to conservative measures occurred in both groups; only three cases were treated surgically. Residual clinical evidence of median nerve damage was present in 40% of all cases. Carpal tunnel syndrome which develops in pregnancy appears to be a separate clinical entity to that developing in the puerperium.