雌激素受体和骨钙素基因多态性位点联合PXh单倍型对绝经后妇女骨密度的影响

目的 探讨雌激素受体(ER)基因(Xba Ⅰ、Pvu Ⅱ)、骨钙素基因(Hind Ⅲ)多态性位点联合型与绝经后妇女骨密度的相关性.方法 采用双能X线(DXA)骨密度仪检测307例绝经后妇女腰椎和左侧股骨上端骨密度,聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测ER基因Xba Ⅰ、PvuⅡ和Hind Ⅲ多态性.结果 (1)XX型大转子骨密度C(O.600±0.104)g/cm2]低于xx型[(0.653±0.119)g/cm2],P<0.05;Xx型、有X等位基因组的股骨颈[分别为(0.695±0.087)g/cm2和(0.697±0.088)g/cm2]、大转子[(0.592±0.106)g/cm2和(0.594±0.105)g/cm2]、Ward's三角[分别为(0.500±0.115)g/cm2和(0.505±0.123)g/cm2]骨密度低于xx型[分别为(0.737±0.108)g/cm2、(0.653±0.119)g/cm2、(0.554±0.130)g/cm2]、无X等位基因组[分别为(0.737±0.108)g/cm2、(0.653士0.119)g/cm2、(0.554±0.130)g/cm2],均P<0.05.(2)PP型、有P等位基因组Ward's三角骨密度分别低于pp型、无P等位基因组(P<0.05).(3)hh型、有h等位基因组的股骨颈、大转子、Ward's三角骨密度低于HH型,无h等位基因组骨密度低于HH型(均P<0.05).(4)含有PX、PXh单倍型组股骨颈、大转子、Ward's三角骨密度分别低于元PX、无PXh单倍型组(均P<0.05).结论 ER基因Xba Ⅰ、骨钙素基因Hind Ⅲ多态性与绝经后妇女骨密度相关,X、h等位基因对骨密度有不利影响,PXh单倍型可作为福州地区绝经后妇女骨质疏松的遗传标记物.     

绝经妇女雌激素受体基因PvuⅡ酶切位点多态性与骨密度的关系

目的 从分子生物水平探讨绝经后健康妇女雌激素受体（ER）基因PvuⅡ酶切位点多态性与骨密度的关系。方法 选择绝经后健康无亲缘关系妇女237例,运用双能X线吸收骨密度仪及聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法分析ER基因PvuⅡ酶切位点多态性与骨密度的关系。结果 237例绝经后健康妇女PP、Pp及pp基因型频率分别为19.8%、44.3%及35.9%。ANOVA分析显示,Troch部位骨密度与ER基因PvuⅡ酶切位点多态性显著相关（P=0.0106）;多元逐步回归分析发现,ER基因多态性与腰椎及Troch部位的骨密度变化相关性无统计学显著性意义,P值分别为0.0998、0.0548。结论 中国上海地区绝经后健康妇女ER基因多态性与股骨Troch部位的骨密度显著相关,p等位基因具有一定的骨量保护作用。     

雌激素替代治疗预防绝经后骨质疏松

绝经后骨质疏松的防治是目前老年医学领域研究的一个重要课题。本文就雌激素替代治疗预防绝经后骨质疏松的作用、作用机制、实施方法、安全性等问题进行了阐述。认为在绝经后3年内甚至围绝经期即开始长期雌激素替代治疗,能安全、有效地预防骨质疏松。     

雄激素受体基因(CAG)n多态性与绝经后骨质疏松关系的研究

目的 探讨雄激素受体(AR)基因第1外显子三核苷酸胞嘧啶-腺嘌呤-鸟嘌呤基因重复序列[(CAG)n]多态性在绝经后骨质疏松(PMO)发生中的作用.方法 采用美国NORLAND公司的XR-46系列双能X线骨密度仪测量股骨颈及腰椎2～4(L2～4)骨密度,根据股骨颈和L2～4骨密度诊断为PMO分别为78例和108例(PMO组),非PMO分别为73例和60例(对照组).采用基因扫描及DNA测序技术检测AR基因(CAG),重复次数和基因型,探讨(CAG)n多态性与PMO的关系.结果 检测到(GAG)n多态性的18、20、21、23、24、25、26、27、28、29及30次重复11个等位基因及16种基因型.基因型和等位基因频率分布在根据股骨颈骨密度诊断的PMO组(SS:25.6%,SL:39.7%,LL:34.6%;S:45.5%,L:54.5%)与对照组(SS:23.3%,SL:45.2%,LL:31.5%;S:45.9%,L:54.1%)比较,差异无统计学意义(均为P＞0.05);SL基因型(OR=0.798,95%CI:0.335～1.797)、LL基因型(OR=0.998,95% CI:0.425～2.341)或SL+LL基因型(OR=0.880,95%CI:0.419～1.852)者与SS型者比较,患PMO风险差异无统计学意义(均为P＞0.05).L2～4骨密度诊断的PMO组的基因型和等位基因频率分布(SS:18.5%,SL:49.1%,LL:32.4%;S:43.1%,L:56.9%)与对照组(SS:21.7%,SL:45.0%,LL:33.3%;S:44.2%,L:55.8%)比较,差异无统计学意义(均为P＞0.05);SL基因型(OR=1.276,95%CI:0.552～2.950)、LL基因型(OR=1.137,95%CI:0.468～2.766)或SL+LL基因型(OR=1.217,95%CI:0.556～2.663)者与SS型者比较,患PMO风险差异亦无统计学意义(均为P＞0.05).调整年龄、绝经时间、绝经年龄及体质指数后,Logistic回归分析显示,(CAG)n多态性与股骨颈及L2～4骨密度诊断的PMO均无相关性(P＞0.05).结论 AR基因(CAG)n多态性可能与PMO的发生无关.     

雌激素与绝经后的骨质疏松

绝经后骨质疏松的防治是目前老年医学领域研究的一个重要课题。本文就雌激素与骨质疏松的关系，尤其就雌激素的代谢调节作用，雌激素预防治疗骨质疏松作用机制，实施方法和安全性等问题进行阐述。     

绝经后2型糖尿病患者骨密度的影响因素和骨质疏松患病率

目的探讨绝经后2型糖尿病(T2DM)患者骨密度(BMD)的影响因素及其与糖尿病微血管并发症的相关性.方法 对符合纳入标准的197例绝经后T2DM患者的住院资料进行回顾性分析.结果 ①多元逐步回归分析示,体重指数、年龄和绝经年限是影响腰椎和髋部BMD的主要因素.②低体重组的BMD低于正常体重组、超重组和肥胖组(P＜0.05或P＜0.01),其骨质疏松(OP)患病率为100%,显著高于肥胖组(69%)(P＜0.0).③绝经年限≥6年组的BMD明显低于绝经年限＜6年组的BMD(P＜0.01),其OP患病率为88%,也显著高于绝经年限＜6年组(55%)(P＜0.0).④随着尿白蛋白排泄量的增加,BMD逐渐下降,但组间BMD和OP患病率无统计学差异.⑤并发视网膜病变组其髋部BMD明显低于未并发视网膜病变组(P＜0.05),前者OP患病率为91%,显著高于后者(75%)(P＜0.0).结论 绝经年限长、体重低、并发糖尿病微血管病变或高龄的绝经后T2DM妇女BMD低,易发生OP.     

绝经后女性雌激素水平与骨质疏松症和动脉粥样硬化风险相关性研究

目的探讨绝经后女性雌激素水平与骨质疏松症和动脉粥样硬化的关系。方法选择沈阳市健康汉族女性216例,根据月经史分为4组,绝经前组57例,绝经1~10年组69例,绝经11~20年组36例及绝经>20年组54例。采用ELISA法检测血清雌激素水平。采用骨矿物质密度(BMD)与腰椎、髋部T值评价骨代谢情况。动脉粥样硬化评估指标包括踝肱指数(ABI)、肱踝脉搏波传导速度(baPWV)及颈动脉内膜中层厚度(CIMT)。结果与绝经前组比较,绝经后各组baPWV及CIMT明显升高,髋部和腰椎BMD明显降低,绝经>20年组ABI显著降低(P<0.01)。绝经后女性平均雌激素水平与绝经时间呈负相关(r=-0.423,P<0.01)。雌激素水平与腰椎、髋部BMD和腰椎、髋部T值呈正相关(r=0.556,P<0.01;r=0.490,P<0.01;r=0.620,P<0.01;r=0.523,P<0.01)。雌激素水平与ABI呈正相关,与baPWV和CIMT呈负相关(r=0.228,P<0.01;r=-0.250,P<0.01;r=-0.203,P<0.05)。结论绝经后女性雌激素水平与骨质疏松症和动脉粥样硬化风险密切相关。     

绝经后女性2型糖尿病患者骨密度及维生素D受体的临床研究

目的　观察绝经后女性 2型糖尿病 (T2 - DM)患者骨密度和骨代谢指标以及血清 2 5(OH) VD和血淋巴细胞内维生素 D受体的含量。方法　绝经后女性 2 - DM患者 38例 ,根椐干化学法将其分成正常蛋白尿组 (尿蛋白阴性 ) ,微量蛋白尿组 (30 mg/ dl<尿蛋白≤ 1 0 0 mg/ dl) ,大量蛋白尿组 (尿蛋白 >1 0 0 mg/ dl) ,对照组 30例。使用双能 X线骨密度仪测量受试者的腰椎 (L2 ～ L4 ) ,股骨上端 (Neck、Ward三角、Troch)骨密度 ,以及血清钙 (Ca)、磷 (P)、碱性磷酸酶 (AKP)、血清 2 5(OH) VD、血淋巴细胞内维生素 D受体 (VDR)含量。结果　绝经后 T2 - DM组各部位骨密度值 (BMD)均低于正常对照组。除糖尿病大量蛋白尿组血清 Ca水平高于正常对照组外 ,糖尿病其余各组血清 Ca、P、AKP与正常对照组比较差异无显著性 (P>0 .0 5)。糖尿病各组血清 2 5(OH) VD和血淋巴细胞 VDR含量均低于正常对照组 ,2 5(OH) VD和 VDR与 BMD呈显著正相关。结论　绝经后 T2 - DM为低转换型骨丢失 ,它可引起血清 2 5(OH) VD及 VDR含量下降。     

鲑鱼降钙素鼻喷剂治疗绝经后骨质疏松患者骨密度及骨转换指标的变化

目的 观察鼻喷鲑鱼降钙素(calcitonin)治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMO)患者6个月和12个月后骨密度及骨转换指标的变化.方法 选择PMO患者共67例,给予鼻喷降钙素治疗37例;其余30例PMO患者单纯服用钙剂和维生素D作为对照组.各组分别于用药前和用药后6个月和12个月采用DEXA骨密度仪测定骨密度;定量夹心酶联免疫法(ELISA)测定Ⅰ型胶原N末端肽(NTX)、骨特异性碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRACP-5b)、25-羟维生素D,化学发光法测定骨钙素(BGP).结果 5例患者因医疗费用、拒绝坚持治疗退出试验,鼻喷降钙素组共32例完成试验.鼻喷降钙素治疗6个月后可见患者股骨颈和腰椎骨密度均较前有所增加,但仅在腰椎差异有统计学意义(P＜0.05),而在股骨颈治疗前后骨密度的差异无统计学意义(P＞0.05).治疗12个月时股骨颈和腰椎骨密度较前均明显升高,差异有统计学意义(P＜0.05).对照组在治疗6个月时的腰椎和治疗12个月时的股骨颈和腰椎部位骨密度均较治疗前降低,差异有统计学意义(P＜0.05).鼻喷降钙素治疗6个月和12个月时,股骨颈和腰椎骨密度均较对照组升高(P＜0.05).鼻喷降钙素治疗6个月后,TRACP-5b、NTX/Cr较治疗前降低,差异有统计学意义(P＜0.05);治疗12个月后,除TRACP-5b、NTX/Cr较前降低更加明显以外(P＜0.01),BALP较治疗前有升高,差异有统计学意义(P＜0.05).对照组在治疗12个月时,BALP较前有降低,差异有统计学意义(P＜0.05).25-羟维生素D在各组经治疗后,均明显升高,差异有统计学意义.结论 本研究结果显示鼻喷降钙素治疗6个月有效,12个月效果显著,可预防骨丢失,增加骨量.

Abstract：

Objective To study the changes of bone mineral density(BMD)and bone turnover in postmenopausal osteoporotic patients treated with salmon calcitonin nasal spray. Methods Sixty-seven postmenopausal osteoporotic patients were enrolled in our trial. All of them received calcium and vitamin D; 37patients were treated with salmon calcitonin nasal spray for 12 months and the other 30 patients received calcium and vitamin D only. Dual-energy X-ray absorptiometry(DEXA)and measurements of a series of bone turnover indices were performed before and after medication for 6 and 12 months. Results After treatment with salmon calcitonin nasal spray for6 months, BMD in lumbar spine 2-4 increased but no change occurred in femoral neck. However, after treatment for 12 months, BMD in both lumbar spine 2-4 and femoral neck increased. In the control group, BMD in lumbar spine 2-4 decreased after treatment for 6 and 12 months, but BMD in femoral neck decreased only after 12months. Comparing with the control group, after treatment with salmon calcitonin nasal spray, BMD in lumbar spine 2-4 and femoral neck were increased obviously. The level of TRACP-5b and NTX/Cr decreased after treatment with salmon calcitonin nasal spray for6 months and 12 months, while BALP increased only after treatment for 12 months. In the control group, BALP decreased after treatment for 12 months. The level of 25-(OH)vitamin D increased after treatment for 6 months and 12 months in both groups. Conclusions Long-term treatment with salmon calcitonin nasal spray prevents bone loss and may increase bone mass.     

Comparison of the effects of alendronate and risedronate on bone mineral density and bone turnover markers in postmenopausal osteoporosis

The aim of the study was to compare the effects of once-weekly alendronate sodium and daily risedronate sodium treatment on bone mineral density (BMD) and bone turnover markers in postmenopausal osteoporotic subjects. For this purpose, 50 patients were included in this study and randomly classified into two groups. Group I (n=25) received risedronate (5 mg/day) and group II (n=25) received alendronate Na (70 mg/week). The study duration was limited to 12 months. The efficacy of the treatment was evaluated by BMD measurements at spine and hip at 6th and 12th months of the treatment, as well as by the measurement of bone turnover markers such as serum osteocalcin (OC), bone-specific alkaline phosphatase (BASP), urine deoxypyridinoline (DPD) and calcium/creatine ratio in 24-h urine at 1st, 3rd, 6th and 12th months. The evaluation of the changes in BMD in all regions revealed a significant increase in BMD in both groups compared to baseline values except for spine (L2–L4) in alendronate group at 6th and 12th month and femoral neck in risedronate group at 6th month. However, the difference in percentage increase in BMD measurements was not statistically significant between the two groups at 6th and 12th months. In both groups, serum OC, BSAP and urine DPD were found to be significantly attenuated at 1st month of the treatment period, and continued to be lowered throughout the 3rd, 6th and 12th months (P<0.05). However, there was no statistically-significant difference between both groups of patients (P>0.05). In conclusion, our results suggest that both treatment protocols provide treatment options of similar efficiencyfor postmenopausal osteoporosis, and have almost-similar effects in enhancing the BMD and in slowing the bone turnover. Risedronate seems to havea more potent effect in the spinal region than that of alendronate, although this potency was not statistically significant.     

老年男性骨质疏松症患者骨密度和生化指标的变化

目的：了解老年男性骨质疏松症患者骨密度和骨代谢生化指标变化的特点。方法：对30例老年男性骨质疏松症患者进行腰椎（L2－4）骨密度（BMD）、骨矿含量（BMC）、血和尿骨代谢生化指标的测定,并与对照组进行比较。结果：骨质疏松（OP）组的BMD和BMC均显著小于对照组,分别比对照组下降21．6％和25％;OP组骨形成指标血清碱性磷酸酸（ALP）和C端骨钙素（BGP）明显高于对照组,分别上升25．4％和222％;骨吸收指标尿羟脯氨酸与肌酐的比值（HOP／Cr)和Ⅰ型胶原N－末端肽与肌酐的比值（INTX／Cr)明显高于对照组,分别上升22．6％和223％。OP组血清T水平明显低于对照组,两组血清25－羟维生素D3（25－OH－D3）均在正常低限或低于正常水平。结论：腰椎（L2－4）BMD和BMC是诊断男性骨质疏松症的主要依据;老年男性骨质疏松症患者一部分人属于骨代谢高转换型;雄激素对老年男性骨量的维持起重要作用;老年男性维生素D缺乏质疏松症发生的重要基础。     

绝经妇女桡骨骨密度变化的多因素分析

目的探讨绝经后骨量丢失的主要危险因素。方法对１５７例绝经后妇女的桡骨骨矿含量与年龄、绝经年龄、身高、体重分别进行简单相关分析和多元线性回归分析。结果桡骨骨矿含量与年龄呈非常显著的负相关（Ｐ＜０．００１），与绝经年龄呈非常显著的正相关（Ｐ＜０．００１），与身高呈显著的正相关（Ｐ＜０．０１），与体重呈显著的正相关（Ｐ＜０．０５）；多元回归中偏回归系数的偏相关系数绝对值的大小依次为：绝经年龄、年龄、身高、体重。结论早绝经是绝经后骨量丢失的主要危险因素     

Evaluation of the efficacy of therapeutic ultrasound on bone mineral density in postmenopausal period

Therapeutic ultrasound is a frequently used modality in the practice of physical therapy. However, its effects on osteoporosis (OP) are not clear. We investigate the effect of therapeutic ultrasound on bone mineral density (BMD). We examined retrospectively 1,610 postmenopausal patients’ data and we created two groups. The treatment group consisted of 36 patients who have been applied only the ultrasound treatment and the control group consisted of 38 patients who have never received any kind of physical treatment. Both of two groups have never received OP treatment. The mean values of BMD showed no significant difference between the treatment and control groups. Patients’ BMD values, within the treatment group, were compared according to the treatment application region. There was no significant difference among groups. We determined that the ultrasound application has no effect on BMD. However, we consider that therapeutic ultrasound will help to decrease the skeletal system related complaints of the patients, improve their exercise capacity, and decrease the risk of osteoporosis.     

绝经前妇科手术对绝经后妇女骨量的影响

目的探讨绝经前不同术式切除子宫、卵巢与绝经后妇女骨量的关系。方法对2002年4月至2006年3月绝经20年内的妇女绝经前行一侧卵巢切除术18例、单纯子宫切除术者63例,子宫加单侧卵巢切除术者44例,子宫加双侧卵巢切除术者87例,以及同期自然绝经101例妇女进行骨密度测定,并对各组的骨密度和骨质疏松症的发生率进行比较。骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差。结果自然绝经组与一侧卵巢切除术组平均年龄分别59.8±6.8,56.5±5.5岁;平均绝经年龄分别为49.8±3.2、49.5±3.9,两组在腰椎、股骨颈、大转子、华氏三角区骨密度差异无统计学意义,且两组骨质疏松症发生率分别为61.4%、50%,两组差异无统计学意义（P〉0.05）。单纯子宫切除术组、子宫加单侧卵巢切除术组、子宫加双侧卵巢切除术组腰椎骨密度分别为0.91±0.17、0.88±0.18、0.80±0.14（g/cm^2）,股骨颈骨密度分别为0.75±0.11、0.77±0.14、0.70±0.12（g/cm^2）,大转子骨密度分别为0.60±0.10、0.62±0.12、0.56±0.10（g/cm^2）,华氏三角区骨密度分别为0.56±0.13、0.59±0.16、0.50±0.12（g/cm^2）。子宫加双侧卵巢切除术组骨密度在腰椎、股骨颈、大转子、华氏三角区明显低于单纯子宫切除术组和子宫加单侧卵巢切除术组;后两组组间差异无统计学意义。单纯子宫切除术组、子宫加单侧卵巢切除、子宫加双侧卵巢切除术组骨质疏松症发生率分别为34.9%、38.6%、62.1%。子宫加双侧卵巢切除术组明显高于单纯子宫切除术组、子宫切除术加单侧卵巢切除术组（P〈0.01）,后两组间差异无统计学意义。结论1.绝经前行单侧卵巢切除后不影响绝经后妇女骨量、骨质疏松症的发生率;2.绝经前子宫切除术者尽可能保留单侧或双侧卵巢,以避免远期骨量降低,骨质疏松症发生率增加。     

611例汉族人维生素D受体基因多态性与骨密度关系研究

采用PCR-RFLP分析了611名上海地区汉族人的维生素D受体(VDR)基因型,并测量其骨密度(BMD),统计分析发现男女性VDR基因分布差异存在统计学意义,Bb基因型在男性中的分布频率(26.9%)高于女性(12.7%,P<0.01)。不同基因型的人群BMD差异无统计学意义。     

鲑鱼降钙素对绝经后骨质疏松症的影响

目的观察鲑鱼降钙素对绝经后骨质疏松症的作用。方法鲑鱼降钙素治疗组９２例,隔日肌注５０Ｕ,每日加服元素钙３００ｍｇ,单用钙剂治疗的对照组２３例,每日服元素钙３００ｍｇ。疗程６个月。结果用药组腰２～４椎骨密度分别升高９．３％,１０．６％和８．９％,髋部骨密度无改变,与此同时,血骨钙素明显升高,尿羟脯氨酸／肌酐比值明显降低。对照组用药前后无明显改变。结论鲑鱼降钙素有改善绝经后骨质疏松病人腰椎骨密度作用,其机理与增加骨合成和降低骨吸收有关。