Factors affecting urinary pyridinoline and deoxypyridinoline excretion in the growing lamb

Changes in urinary pyridinium crosslink excretion and plasma osteocalcin and growth hormone levels were measured at 3–5 week intervals in lambs from 2–22 weeks of age, in relation to changes in metatarsal length. There were close correlations between pyridinium crosslink excretion and plasma growth hormone levels and live weight gain, but no direct relationship was seen between the rates of excretion of the pyridinium crosslinks and linear bone growth. Plasma osteocalcin levels were correlated with linear bone growth rate up to about 12 weeks of age but, thereafter, showed no correlation despite a continued decline in bone growth rate. In the young lamb, daily pyridinium crosslink excretion represented 1.3–2.9% of that in the body, declining to 0.06% of pool size in adult sheep.     

Circadian rhythm of the urinary crosslinks pyridinoline and deoxypyridinoline in normal human and involutional osteoporosis

Urinary pyridinoline (Pyr) and deoxypyridinoline (Dpyr) are collagen crosslinks found in bone and cartilage and are sensitive bone resorption markers. In this study, values of urinary Pyr and Dpyr during 24-h periods in 6 normal men, 10 normal women, and 10 osteoporotic patients were measured. In these three groups, urinary Pyr and Dpyr showed significant circadian variations only in normal men. Neither urinary Pyr nor Dpyr showed significant circadian variations in normal women or osteoporotic subjects, although they had the same trend as the diurnal changes of urinary crosslinks in normal men. Comparing the values of urinary crosslinks in the daytime (11:00–20:00 h) and at night (20:00–11:00 h), the latter were significantly higher than the former in both normal and osteoporotic subjects. Furthermore, the nighttime and daytime difference of urinary Pyr in osteoporotic subjects was significantly larger than those in normal subjects. Urinary Pyr and Dpyr were 22.6% and 10.7% higher, respectively, at night compared to during the day in normal women, while in osteoporotic patients, the values were 51.2% and 25.5% higher at night than during the day, respectively. In conclusion, the acceleration of bone resorption at night may be one of the etiologies of involutional osteoporosis.     

Diagnostic performance of the urinary deoxypyridinoline in spinal tuberculosis

This study investigated the diagnostic significance of urinary deoxypyridinoline measurement as a screening tool for spinal tuberculosis in patients with pulmonary tuberculosis.Urinary deoxypyridinoline levels were measured by automated chemiluminescence immunoassay and automated chemistry methods in patients with spinal (n=33) and pulmonary tuberculosis (n=33) and in healthy controls (n=30). Urinary deoxypyridinoline was divided by urinary creatine to exclude the factors of body mass index and urine dilution. The results underwent validity analysis. The measurements of urinary deoxypyridinoline in the spinal tuberculosis, pulmonary tuberculosis, and control groups were 14.9 ± 9.8, 6.4 ± 2.6, and 6.3 ± 2.0 μmol/molCr, respectively. Compared with the other 2 groups, the urinary deoxypyridinoline level in the spinal tuberculosis group was significantly increased (P=.001 and P=.000, respectively). However, urinary deoxypyridinoline levels were not significantly different between the pulmonary tuberculosis and control groups (P=.751). The receiver operating characteristic curve in the spinal tuberculosis group was 0.83. For deoxypyridinoline, the sensitivity (88%) and specificity (95%) were seen at the cutoff level of 8.0 μmol/molCr. The false positive and false negative were 12% and 5%, respectively. Diagnostic validity of the method was 93%.Bone metabolism alteration occurs during the progression of spinal tuberculosis, which can be reflected by the sensitivity and specificity of urinary deoxypyridinoline. The detection of urinary deoxypyridinoline is a benefit of screening patients with pulmonary tuberculosis for spinal tuberculosis.     

尿脱氧吡啶啉排泄率在绝经后骨质疏松症中的临床监测意义

目的　观察尿脱氧吡啶啉 (DPD)排泄率在鲑鱼降钙素治疗绝经后骨质疏松症中的变化。方法　 5 0例绝经后骨质疏松症患者 ,分为两组 :鲑鱼降钙素加钙剂治疗组 30例 ,肌注鲑鱼降钙素 5 0IU ,每日一次 ,2周后改为每周 2次 ,同时每日服钙尔奇D 1片 (元素钙 6 0 0mg) ;单纯服钙剂对照组 2 0例 ,每日口服钙尔奇D 1片 ,疗程 6个月。结果　鲑鱼降钙素加钙剂治疗组 ,患者尿DPD排泄率在治疗 3个月、6个月时较治疗前明显下降 (- 2 3 3%± 14 5 %和 - 2 4 2 %± 16 8% ,P值均 <0 0 0 1) ,腰椎 1～ 4骨密度较治疗前升高 (3 4 %± 7 3%和 5 0 %± 7 5 % ,P <0 0 1)。对照组用药前后比较无明显改变。结论　尿DPD排泄率能够反映绝经后骨质疏松症骨吸收状况 ,是监测骨质疏松症治疗的敏感性生化指标     

尿脱氧吡啶啉排泄率在矿工骨质疏松症中临床监测意义

目的观察尿脱氧吡啶啉(DPD)排泄率在井下和井上矿工中的变化。方法对60名矿工, 分两组,井下30人,井上30人,用化学发电免疫法测定尿脱氧吡啶啉的浓度。结果井下井上受检人员不同年龄阶段之间DPD排泄浓度有差异,P<0．05。结论井下工人骨量丢失的早并且丢失量多,应早期预防。     

尿脱氧吡啶啉及骨源性碱性磷酸酶在骨质疏松症中的临床意义

目的探讨骨源性碱性磷酸酶(BAP)及尿脱氧吡啶啉(DPD)排泄率对骨质疏松症患者的诊断价值及两者的相关性。方法对73例骨质疏松症患者在其治疗前后进行血钙(Ca)、血磷(P)、血碱性磷酸酶(ALP)、血BAP、尿DPD、尿Cr及跟骨密度(BMD)测定,并同时测定50例正常健康人作对照。结果骨质疏松症患者BAP比正常对照组(213±8．13U／L 比142±6．69U／L)、DPD排泄率较正常对照组(6．11±2．14nmol／mmolCr比3．24± 1．62nmol／mmolCr)均明显增高(P<0．01),且治疗前后差异有显著性(P<0．01)。两者之间成正相关(r=0．52)。结论 BAP、DPD／Cr是监测骨质疏松症患者的敏感指标。     

Urinary pyridinoline and deoxypyridinoline as bone metabolic markers in predicting therapeutic effects of estrogen and alfacalcidol in women with osteoporosis

The purpose of the present study was to evaluate the clinical usefulness of urinary pyridinoline (Pyr) and deoxypyridinoline (Dpyr) in predicting therapeutic effects of estrogen and alfacalcidol (1α-D₃) in patients with postmenopausal osteoporosis. We measured urinary excretion of Pyr and Dpyr, and determined bone mineral density (BMD) using a dual-energy x-ray absorptiometry in 48 women with osteoporosis (average age, 55.9 ± 8.4 years). Patients were treated with estrogen (HRT, n = 13), 1α-D₃ (n = 20), or calcium alone (n = 15). Baseline mean levels of urinary Pyr and Dpyr were significantly higher in the 48 patients compared to those in the age-matched postmenopausal women. The levels of urinary Pyr and Dpyr were inversely correlated with BMD. After treatment with estrogen or 1α-D₃, a significant decrease of urinary Pyr and Dpyr was observed, and elevated urinary Pyr and Dpyr were reduced to the level in premenopausal women. A significant inverse correlation was found in Pyr and Dpyr at 6 months and in lumbar BMD after 24 months of treatment (r = −0.43 to −0.52; P < 0.01). We concluded that urinary Pyr and Dpyr have clinical utility for predicting response to estrogen and 1α-D₃ therapy of osteoporosis patients. Received: July 28, 1998 / Accepted: Nov. 11, 1998     

脊柱结核病尿脱氧吡啶啉检测及其临床意义

[目的] 通过对脊柱结核(STB)患者骨代谢标志物尿脱氧吡啶啉(DPD)的测定,观察其变化与脊柱结核病的关系;评价其在判定继发于肺结核(PTB)的脊柱结核筛选诊断方面的临床意义.[方法] 采用自动化学发光免疫分析法及自动化学分析法检测脊柱结核组、肺结核组和健康对照组的尿DPD水平,其中尿DPD以尿肌酐(Cr.)来校正(DPD/Cr.),将检测结果进行诊断有效性分析.[结果] 脊柱结核患者、肺结核患者、健康对照组DPD的测定值分别为(14.9±9.8) μmol/mol Cr.、(6.4±2.6) μmol/mol Cr.和(6.3±2.0) μmol/mol Cr.,脊柱结核患者尿DPD较肺结核患者、健康成人对照组显著增高,差异具有显著性意义(P=0.001,P=0.000).肺结核患者与健康对照组相比,尿DPD的检测差异均无显著性意义(P=0.751).所检测的脊柱结核患者尿DPD的接受者工作特性曲线(ROC)下面积为0.83,在ROC曲线下,DPD测定值以8.4 μmol/mol Cr.为截断点时,诊断脊柱结核的敏感性是87%,特异性是73%.[结论] 脊柱结核可以引起骨代谢的改变,尿DPD能敏感地反映脊柱结核骨吸收的状况,尿液DPD检测有助于继发于肺结核的脊柱结核患者的早期筛选.     

生物矿化与类风湿性关节炎

生物矿化是新近发现的纳米细菌的特性之一,机体感染后产生的炎症反应是其主要的致病原因.纳米细菌的生物矿化特性受到感染机体体内多种因素的影响,故生物矿化过程表现为时急时缓,感染的病症也相应地表现为反复迁延.临床类风湿性关节炎部分病例的发病或许即由纳米细菌感染所致,然而对这一认识的缺乏使得很多病因研究误入歧途.该文就纳米细菌生物矿化的特性进行综述,为类风湿性关节炎病因学研究提供一种新思路.     

骨质疏松与类风湿关节炎

类风湿关节炎和骨质疏松在我国都属于常见病和多发病,而二者之间又有着非常重要的联系。但是目前临床上还没有一个广泛应用的药物可以同时对两者都产生很好的治疗效果。为了进一步了解骨质疏松和类风湿关节炎的关系,将来能够找到更好的治疗药物,笔者从流行病学、发病机制以及治疗方法等方面分别进行了论述。     

The effect of calcitonin and growth hormone on urinary deoxypyridinoline levels in burned patients

Reduced bone formation and bone loss have been documented in patients following burn injury. Urinary deoxypyridinoline (DPD) is accepted as a marker of collagen breakdown activity. Because calcitonin (CT) diminishes bone resorption and growth hormone (GH) increases bone formation and density in GH-deficient patients, we studied the short-term effects of CT and GH on urinary DPD levels in burned patients. In 30 patients with severe burns, urinary DPD levels were investigated for 3 days following hospitalisation. Then the patients were divided into 3 groups of 10. In the CT group, CT 100U was injected subcutaneously daily for 5 days. In the GH group, GH 0.1mg/kg was injected subcutaneously three times in a week. In the control group, isotonic saline solution 0.1mg/kg was injected subcutaneously three times in a week. In all groups, following the last dose of the agents, urinary DPD levels were investigated for 3 days again. Mean burn size and age were not significantly different between the groups. Urinary DPD level obtained in the early period was 16.5 +/- 3.1nM in the CT group, 10.4 +/- 5.3nM in the GH group and 18.6 +/- 2.7nM in the control group. There were no statistical differences among the groups (P > 0.5, for all). Urinary DPD level obtained in the late period was 4.5 +/- 1.0nM in the CT group, 14.4 +/- 5.9nM in the GH group and 36.6 +/- 2.1nM in the control group. The differences between the CT group and control group, the CT group and GH group and the GH group and control group were statistically significant (P < 0.001, P < 0.01, P < 0.01, respectively). In the comparison of early and late urinary DPD levels, a significant decrease was only obtained in the CT group (P < 0.001, Z:6.5). In the other 2 groups, DPD levels increased in the late period. We concluded that GH is not effective in decreasing urinary DPD levels. On the contrary, CT was found to very effective in decreasing urinary DPD levels. This decrease in urinary DPD levels may be associated with diminished bone loss     

滑膜成纤维细胞与类风湿性关节炎相关研究的进展

类风湿性关节炎（rheumatoid arthritis，RA）是一种慢性起病的自身免疫性疾病，其病程最终转归往往导致关节破坏，其显著特点是由免疫细胞参与的自身免疫调节紊乱。长期以来，一直认为T细胞、巨嗜细胞及其各自的细胞因子在RA病程中起着关键作用，然而这一学说在近年来受到了强力的挑战，相当一部分学者认为在RA长期的病程中成纤维样细胞（fibroblast—like synoviocytes，FLS）起着主导的作用，这种作用甚至在疾病早期就已经体现出来，     

Elderly-onset rheumatoid arthritis

The treatment of elderly-onset rheumatoid arthritis pursues the same objectives as in younger patients: to control the clinical manifestations, to prevent structural damage, to preserve function, and to decrease excess mortality. In the elderly, the presence of co-morbidities and increased rate of drug-related adverse effects raise specific therapeutic challenges. Nonsteroidal anti-inflammatory drugs are associated with cardiovascular, gastrointestinal, and renal adverse events. The role for corticosteroid therapy remains controversial. Although glucocorticoids provide a short-term decrease in clinical activity and probably a medium-term decrease in structural damage, these benefits are offset by numerous adverse effects. Methotrexate was effective in clinical trials and observational studies and did not produce a higher adverse event rate compared to younger patients, provided renal function was normal. Data on the efficacy of TNFα antagonists in therapeutic trials are available only for etanercept. Disease activity decreased and function improved. The adverse event rate was higher in older patients, but this was also true of the conventional drugs used as comparators. Registry data confirm that TNFα antagonist therapy is effective in RA. An increased rate of infections was found only in some registries. To combat the 2-fold cardiovascular risk increase associated with RA, disease activity should be stringently controlled and all cardiovascular risk factors managed aggressively.