骨质疏松诊断方法综述

随着近代生物化学、分子生物学、免疫学和放射影像学的迅速发展，近年来在代谢性骨病，尤其是骨质疏松的诊断方面有了很大进步。新的实验技术和特殊检查为骨质疏松的临床早期诊断和病因鉴别提供了较特异而敏感的依据。但是，和其他疾病一样，     

应用定量CT诊断骨质疏松的研究及临床意义

骨质疏松是一种主要影响中年人群和老年人群的新陈代谢性骨骼疾病，它的特征是骨矿物质(主要是钙的含量)的过量丢失和除头颅外的任何部位的骨骼易发生骨折，已知骨组织的强度有75%~85%与骨密度(BoneMineralDensity，BMD)有关，随着年龄的增大，人的周身骨骼的BMD均呈逐渐下降的趋势，BMD下降到一定程度，易发生骨折。本研究的目的是利用定量CT(QuantitativeCT，QCT)能对松质骨和皮质骨的BMD进行分别测定以达到对BMD进行准确的测定的特点，通过应用QCT对胸椎或腰椎进行横断面薄层三维检查，从而对骨矿物质进行定量测定来测定出B…     

药源性骨质疏松

药源性骨质疏松（DIO）是因为长期应用影响骨代谢的药物,导致骨量减少、骨强度下降、骨微结构破坏、骨脆性增加且易于骨折的全身代谢性骨病。其中以糖皮质激素性骨质疏松症最为常见。此外,DIO的可能原因还包括：芳香化酶抑制剂治疗女性乳腺癌,抗雄激素疗法治疗男性前列腺癌,绝经后妇女服用高剂量的甲状腺素,噻唑烷二酮类药物治疗2型糖尿病,以及各种靶向免疫抑制剂药物的应用等。对于临床中使用上述对骨代谢有影响的药物,在治疗原发病的同时,需高度关注药物对骨健康的影响,临床医生应遵循标准的骨质疏松症诊疗的建议和指导方针,制定基于个体化的DIO治疗模式。     

降钙素及甲状旁腺激素在骨质疏松中的诊断价值探讨

目的：探讨降钙素和甲状旁腺激素在骨质疏松中的诊断价值。方法：选择96例骨质疏松患者为观察组,另选85例非骨质疏松患者为对照组,检测血液中的降钙素和甲状旁腺激素浓度,并与前臂远端、第四腰椎、股骨大转子的骨密度水平比较分析,探讨降钙素和甲状旁腺激素在骨质疏松中的诊断价值。结果：观察组血液中降钙素和甲状旁腺激素浓度分别为（13.71±1.49）pmol/mL、（22.63±6.172）pg/mL,前臂远端骨、第四腰椎、股骨大转子的骨密度水平分别为（0.53±0.65）g/cm2、（0.76±0.19）g/cm2、（0.73±0.18）g/cm2,与对照组比较,降钙素浓度水平低于对照组（P<0.05）,甲状旁腺激素浓度水平则明显高于对照组（P<0.01）。结论：老年骨质疏松症患者血液中的降钙素和甲状旁腺激素浓度变化比较明显,在骨质疏松的诊断中有较大的意义。     

骨密度正常为何被诊断为骨质疏松？

除皮肤病外，在临床上有许多疾病会引起皮肤瘙痒。贫血皮肤瘙痒往往是其先兆。由于体内红细胞和血红蛋白减少，皮肤组织出现营养障碍，上皮细胞功能降低，导致皮肤干燥、皱褶、萎缩。     

嘉兴市骨质疏松流行病学调查分析

目的:了解人群的骨质情况,为骨质疏松的筛查、预防提供科学依据。方法:采用病例搜索的方式,在足跟部采用韩国Osteo Sys超声骨密度仪SONOST₃000进行全干式测量。根据WHO的骨质疏松诊断金标准（骨质疏松:T值≤-2.5;骨量减少:-2.544岁,年龄与T值有一定相关性（P=0.039）。女性以55岁为界,界前各组间差异没有统计学意义（P=0.742）,界后各组测定值较界前明显下降,其差异有统计学意义（P=0.000）。结论:年龄和性别都能影响骨质疏松的发生,总体来看,年龄≥45岁均出现不同程度的骨质疏松,女性多于男性,女性年龄≥55岁骨质疏松率明显增高,可根据检查结果适当补钙,同时加强体育活动,并给予健康指导。     

骨质疏松不“疏松”

情景再现 骨质疏松症是一个世界范围的、越来越引起人们重视的健康问题。目前全世界约2亿人患有骨质疏松,其发病率已跃居常见病、多发病的第七位。我国约有骨质疏松症患者6000-8000万。作为中     

骨质疏松胶囊对大鼠骨质疏松症骨密度的影响

目的观察骨质疏松胶囊对实验性骨质疏松大鼠骨密度的影响。方法摘除大鼠双侧卵巢,术后4周,制造骨质疏松症模型,以骨质疏松胶囊1.0、2.0、4.0 g/kg 3个剂量灌胃去卵巢骨质疏松大鼠,连续12周,观察本品对去卵巢骨质疏松大鼠骨密度、血液生化指标的影响。结果骨质疏松胶囊明显改善去卵巢骨质疏松大鼠一般状况:中、高剂量骨质疏松胶囊显著降低骨质疏松大鼠体质量(P<0.05);明显增加骨质疏松大鼠骨密度(P<0.05);降低骨质疏松大鼠血清抗酒石酸酸性度酶5b及血清骨碱性磷酸酶活性(P<0.05,P<0.01)。结论骨质疏松胶囊具有增加去卵巢骨质疏松大鼠骨密度;抑制骨吸收、促进骨形成的作用。     

2型糖尿病患者骨质疏松相关因素分析

目的:探讨2型糖尿病患者骨密度变化与身高、体重、体重指数、血糖、胰岛素等相关因素的关系。方法:采用双能X线骨密度仪进行腰椎2～4及左股骨近端骨密度测定并比较结果。结果:2型糖尿病患者的骨密度改变与血糖、糖化血红蛋白呈负相关,与胰岛细胞功能、体重、身高、体重指数呈正相关。结论:2型糖尿病患者合并骨质疏松症的发病率明显高于对照组,低体重是发生骨折的危险因素之一。对2型糖尿病患者应严格控制血糖,定期进行骨密度测定,防治骨质疏松症的发生,降低骨折的危险性。     

骨质疏松性骨科并发症及药物治疗

探讨骨质疏松伴骨科并发症的骨密度变化及其机理，了解骨代谢情况及相关因素，推测两者之间可能存在的关系，建立合理的药物治疗方案。     

Overview of the diagnosis of cytomegalovirus infection

Cytomegalovirus (CMV) is recognized as the most common congenital viral infection in humans and an important cause of morbidity and mortality in immunocompromised hosts. This recognition of the clinical importance of invasive CMV disease in the setting of immunodeficiency and in children with congenital CMV infection has led to the development of new diagnostic procedures for the rapid identification of CMV. Diagnosis of acute maternal CMV infection by the presence of immunoglobulin (Ig)M and low-avidity IgG requires confirmation of fetal infection, which is typically performed using polymerase chain reaction (PCR) assays for CMV on amniotic fluid. Viral culture of the urine and saliva obtained within the first two weeks of life continues to be the gold standard for diagnosis of congenitally-infected infants. PCR assays of dried blood spots from newborns have been shown to lack sufficient sensitivity for the identification of most neonates with congenital CMV infection for universal screening purposes. However, saliva PCR assays are currently being assessed as a useful screening method for congenital CMV infection. In the immunocompromised host, newer rapid diagnostic assays, such as phosphoprotein 65 antigenemia and CMV real-time PCR of blood or plasma have allowed for preemptive treatment, reducing morbidity and mortality. However, lack of standardized real-time PCR protocols hinders the comparison of data from different centers and the development of uniform guidelines for the management of invasive CMV infections in immunocompromised individuals.     

髋关节一过性骨质疏松症的磁共振成像诊断

目的探讨磁共振成像(MRI)在髋关节一过性骨质疏松症(TOH)中的诊断价值。方法对9例髋关节一过性骨质疏松症患者的临床和影像学资料进行回顾性分析。结果 9例患者均在患侧髋关节骨质内出现骨髓水肿区,5例患者出现股骨头、颈部骨质信号异常,其余4例信号异常区除股骨头、颈部外,还包括股骨粗隆间骨质。3例患者股骨头关节面下骨质内可见局限性骨质损伤区,其症状持续时间较无骨质损伤的患者明显延长(P<0.05)。同时,骨髓水肿区范围与症状持续时间、有无股骨头关节面下骨质损伤与骨髓水肿区范围之间差异均无统计学意义(P>0.05)。结论 MRI是TOH各种检查技术中最敏感、最可靠的检测方法,能反映出TOH病理变化过程。     

定量CT在骨质疏松症诊断中的应用

目的 探讨定量CT（QCT）测定椎体骨密度（BMD）在诊断骨质疏松症中的临床价值.方法 对604例中老年患者进行椎体BMD测定.结果 中老年骨密度值50～59岁和60～69岁两组之间两性差异均有统计学意义,女性更为显著.随着年龄增长在两性不同年龄段骨密度值均下降,女性较男性下降比率速度更明显.女性以60～69岁为骨折高发期,男性于70岁以后为骨折高发期.结论 QCT能为骨质疏松提供具体的BMD数值,有助于骨质疏松症的诊断.     

定量CT在骨质疏松症诊断中的应用

Objective To explore the clinical signiticance of quantitative computed tomography(QCT) adjust bone mineral density measurement in diagnosis of osteoporosis. Methods The vertebral BMD of 604 elderly patients were measured. Results BMD between 50 ～ 59 years group and 60 ～ 69 years group was significantly different, and women even more prominent. With age increasing, BMD of women decreased more rapidly than that of men. Females in 60 ～ 65 years had high incidence of fractures, while man was more than 70 years. Conclusion QCT could provide specific osteoporosis BMD values and contribute to the diagnosis of osteoporosis.     

Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis

Quantitative ultrasound (QUS) is of increasing interest for evaluation of osteoporosis because, compared with dual-energy X-ray absorptiometry (DXA), it is portable, less expensive, and radiation-free. The aim of our study was to determine the sensitivity, specificity, and cut-off values of quantitative ultrasound parameters in identifying patients with osteoporosis compared to the World Health Organization (WHO) standard definition. We performed a cross-sectional investigational study of 73 subjects, and determined total hip and lumbar spine T-scores by dual-energy X-ray absorptiometry (DXA) (Prodigy Advance Lunar-GE). The QUS parameters (broadband ultrasound attenuation [BUA], speed of sound, bone mineral density, the stiffness index, and QUS T-score) were determined with Sahara Hologic equipment. The AUC was 0.81 (95% CI 0.67–0.95, p<0.05) for speed of sound (SOS) and 0.76 (95% CI 0.62–0.90, p<0.05) for BUA for the patients with DXA T-scores ≥ −1 DS; the cut-off values were 1542.2 meters per second for SOS and 63.3 dB/MHz for BUA. In patients with DXA T-scores ≤ − 2.5 DS, AUC was 0.80 (95% CI 0.70–0.90, p<0.05) for SOS, and 0.76 (95% CI 0.65–0.87, p<0.05) for BUA. The cut-off values were 1504.95 meters per second for SOS and 49.5 dB/MHz for BUA. Pearson correlation coefficients were positive and statistically significant (> 50%) for all QUS parameters in both groups, (2-tailed, p<0.05). QUS parameters correctly identified normal patients (false negative 34.21% and false positive 2.53%) and those with osteoporosis (false negative 8.55% and false positive 7.82%). The patients with QUS parameters between the cut-off values corresponding to DXA T-scores of −1 SD and − 2.5 SD should be further evaluated by DXA.     

磁共振扩散加权成像在骨质疏松诊断中的应用

探讨磁共振扩散加权成像（diffusion weighted imaging,DWI）在骨质疏松诊断中的应用价值。根据受检者年龄分为40～50岁组、51～60岁组、61～70岁组,每组各50例受试者,采用GE1.5T磁共振扫描仪对150例不同年龄组的受试者进行DWI扫描,比较不同年龄、性别骨髓表观扩散系数（ADC）值的差异。采用组间t检验对不同年龄组间ADC值差异进行统计学分析。40～50岁组、51～60岁组的ADC值明显高于61～70岁组（P＜0.05）,40～50岁组的ADC值高于51～60岁组（P＜0.05）,40～50岁组、51～60岁组、61～70岁组女性骨骼平均ADC值均高于男性（P＜0.01）。DWI可以无创性了解骨质疏松症患者骨髓的生理变化,ADC值能够尽早、及时且较为敏感地反映骨骼骨质量的减少,为提早预防骨质疏松提供较为可行的诊断、监测手段。     

更新知识，规范诊疗——应对骨质疏松症的高患病率

2001年，美国国立卫生研究院（NIH）提出的骨质疏松症定义是：以骨强度下降、骨折风险增加为特征的骨骼系统疾病。NIH的骨质疏松定义强调了骨强度的重要性，在一般情况下，骨强度由骨矿密度和骨质量两个主要参数反映。但是，     

结核性脑膜炎诊疗概况

结核性脑膜炎常见于中枢神经系统感染性疾病,是肺外结核中病情最重、危害最大、破坏力最强的结核病。早期确诊、及时合理的治疗是改善预后和降低致死率及致残率的关键。本文就近年来关于结核性脑膜炎的早期诊断与治疗进展进行综述。     

药师参与糖皮质激素性骨质疏松患者的诊治分析

糖皮质激素性骨质疏松(GIOP)是继发性骨质疏松的常见原因之一。本文通过临床药师参与4例GIOP患者的诊疗过程,进行药学问诊,分析如何根据患者伴发疾病的情况选择抗GIOP的药物,并对患者进行用药教育。对GIOP的发生机制、特点及各类抗GIOP的药物进行简单阐述,通过实践,使GIOP患者得到了个体化的治疗方案,并取得了良好的治疗效果,促进临床合理用药。     

Overview of lipophilic yeast Malassezia: the current status of the molecular diagnosis

The lipophilic yeast, genus Malassezia is a part of the normal cutaneous microflora of human and warm-blooded vertebrates. Species of the genera were re-classified to seven species; M. pachydermatis, M. globosa, M. furfur, M. obtusa, M. restricta, M. slooffiae and M. sympodialis. However, the means of species identification in conventional clinical laboratories have not been reported and the clinical significance of each species is not clearly understood. Species identifications of genus Malassezia which depend on the morphological, physiological characters are difficult and time-consuming. Recently, many molecular techniques have been developed for identification or typing of Malassezia. PCR-mediated methods, PCR-direct sequencing and nested-PCR using specific primers, are useful to identify the spices. The basic information obtained from these approaches have been contributing to the understanding of these pathogenic yeasts and related diseases.