骨质疏松症的诊断

骨质疏松症是一种骨重建异常的代谢性骨病,不仅骨量丢失,且骨质结构改变,骨质量下降。骨折是骨质疏松症的严重并发症。双能X线骨密度仪测量脊柱前后位L1~L4和髋部股骨颈、大粗隆、全髋骨密度为骨质疏松症诊断的“金标准”,T值<-2.5个标准差诊断为骨质疏松症;常规拍摄腰椎、股骨上端和跟骨等X线照片,观察骨密度和结构改变;并参考骨转换标记物测定和有关临床症状综合判断。骨质量评估技术的应用将对更全面地诊断骨质疏松症起到明显推动作用。     

电离辐射致股骨头坏死早期病理特点和机制的研究

Objective To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was re-estabhshed to detect the pathological changes of capillaries after irradiation. Result The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence(6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %)(P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries.     

高纯度破骨细胞分离培养与功能表达

目的：获得足量高纯度活性破骨细胞进行破骨细胞生化学和分子生物学研究。方法;利用破骨细胞与I型胶原基质的高亲合力,先用pronase和EDTA作用除去不贴附的造血细胞及结合较疏松的间质细胞,继而用0.01%胶原酶作用进一步除去残留的间质细胞,最后用0.1%胶原酶作用得到高纯度破骨细胞悬液。分离细胞用抗酒石酸酸性磷酸酶（TRAP）染色,荧光标记显示细胞骨架,RT-PCR方法检测破骨细胞标志酶基因。结果：胶原基质培养结合酶消化可大大提高破骨细胞纯度,破骨细胞对降钙素反应,并表达MT1-MMP,MMP-9,组织蛋白酶K和TRAP基因mRNA,可产生吸收陷窝。结论：利用兔破骨细胞与I型胶原的亲合力,可获得多量高纯度破骨细胞;并表达特征性基因。     

骨折愈合刺激素对体外培养成骨细胞的影响

目的　观察骨折愈合刺激素对体外培养成骨细胞的作用。方法　在新生SD大鼠头颅骨次代成骨细胞 (OB2 )培养液中分别加入不同浓度 (2× 10 2 U/L～ 2× 10 4U/L)骨折愈合刺激素 ,观察OB2的增殖功能 (用波长 5 70nm处OD值表示 ) ,取药物敏感浓度 (2× 10 2 U/L)分别观察分化功能〔用碱性磷酸酶 (ALP)活性表示〕和矿化功能 (用矿化结节数量 /视野表示 )。结果　OB2 增殖功能 (OD值 )实验组为 0 336± 0 0 73～ 0 35 9± 0 0 5 1,对照组为 0 347± 0 0 35 ;OB2 分化功能〔ALP(U/g蛋白质 )活性〕实验组为 83± 9,对照组为 81± 4 ;OB2 矿化结节数量 /视野 (个 )实验组为 6 0± 1 82 6 ,对照组为1 5± 1 0。结论　骨折愈合刺激素各浓度对OB2 的增殖和分化功能均无明显作用 (P >0 0 5 ) ,而对其矿化功能具有明显的刺激作用 (P <0 0 1)。     

电离辐射致股骨头坏死早期病理特点和机制的研究

Objective To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was re-estabhshed to detect the pathological changes of capillaries after irradiation. Result The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence(6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %)(P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries.     

骨吸收机制

骨吸收是破骨细胞 ( Osteoclast,OC)在成骨细胞( Osteoblast,OB)参与下侵蚀骨质的生物学功能 ,是 OC发生、激活和与骨基质相互作用的吸收过程。影响因素包括由 OC的产生和凋亡速度决定的细胞数量和功能状态。正常情况下 ,OC的骨吸收作用在维持稳定的血钙水平和骨重建中负有重要责任 ,而骨吸收过分活跃则是高转换型骨质疏松症的重要原因 ,因而阐明骨吸收机制对认识骨质疏松症的病理机制和推进防治骨质疏松药物的研究具有重要意义。目前有关骨吸收机制的研究主要涉及成骨细胞因素、破骨细胞因素和骨基质因素三个方面。1.成骨细胞因素成骨…     

原发性闭经患者骨代谢及其骨调节因素水平的观察

目的　了解低雌激素性原发闭经患者骨代谢及其骨调节因素水平与正常同龄妇女之差异。方法　对 １０ 例原发性闭经患者进行桡骨骨矿含量（ＢＭＣ）和血清降钙素（ＣＴ）、甲状旁腺激素（ＰＴＨ）、雌二醇（Ｅ２）、碱性磷酸酶（ＡＬＰ）以及空腹尿钙与肌酐（Ｃａ／Ｃｒ）、羟脯氨酸与肌酐（ＯＨＰｒ／Ｃｒ）比值的测定。结果　原发性闭经组妇女ＢＭＣ的水平低于正常对照组,血清ＰＴＨ 的水平高于对照组,但均未见显著性差异（Ｐ＞ ０．０５）,空腹尿（Ｃａ／Ｃｒ）、ＯＨＰｒ／Ｃｒ 比值和ＡＬＰ的水平高于对照组、血清Ｅ２ 和ＣＴ 的水平低于对照组,并均有显著性差异（Ｐ＜ ０．０５、Ｐ＜ ０．０１ 或Ｐ＜ ０．００１）。结论　低雌激素性原发闭经患者骨矿含量的水平较正常同龄妇女降低。其骨代谢已呈高转换失钙状态,显示严重的骨质疏松易患倾向,故应及时予以防治。     

增龄对大鼠血清卵磷脂胆固醇酰基转移酶活性的影响

本文采用比色法对不同月龄大鼠血清卵磷脂胆固醇酰基转移酶(LCAT)活性进行了测定。结果表明,20月龄组LCAT活性明显低于4月龄组(P<0.05),表明血清LCAT活性在老年时降低。LCAT活性下降可导致胆固醇酯化和HDL_3向HDL_2转化障碍,影响胆固醇的逆向转运,促进动脉粥样硬化的形成。     

青年人群腰椎骨密度及标准差对骨质疏松检出率的影响:多中心、大样本分析

背景：不同地区骨峰值和标准差不同，对骨质疏松诊断率有较大影响。探讨建立一完整数据库为中国人骨质疏松诊断准确性提供依据。目的：探讨青年人腰椎骨密度和标准差正常参考值影响骨质疏松症检出率的程度。设计、时间及地点：调查分析，于1997—01／1999-12分别在北京、上海、广州、南京、嘉兴和成都市完成。对象：采用前瞻性及回顾性方法对全国6个中心骨密度参考数据库中11418人进行调查统计分析；男3666人，女7752人：年龄20岁～90岁；分别来自北京（2385人）、广州（1178人）、上海（1404人）、南京（2938人）、成都（1425人）、嘉兴（2088人），受试者来源于社区调查、健康体检和健康志愿者。方法：用GE-Lunar公司的DXA仪测量骨密度，调查全国6个中心11418人L2-L4腰椎后前位和髋部骨密度，建立了骨密度参考数据库。6个中心的仪器内部精度0．3％～0．7％，仪器间的精度1．1％。主要观察指标：①6个中心不同年龄组腰椎骨密度分布。②青年人群骨密度及其标准差值对骨质疏松症检出率的影响。结果：中国汉族女性以腰椎进行骨质疏松症诊断的青年人群的骨密度和标准差值，6个中心，最大差值分别为0．098g／cm^2和0．027g／cm^2。用6个中心及总体各自的青年人平均骨密度和标准差值为参考标准，对同一人群计算T-score和获得的骨质疏松症检出率不相同；发现青年人平均骨密度每变化0．01g/cm^2，则骨质疏松症检出率变化1．6％（呈正相关），其标准差值每变化0．01g／cm^2，则骨质疏松症检出率变化4％（呈负相关）。结论：青年人平均骨密度和标准差值不同引起骨质疏松症检出率也不相同。为了让不同中心的骨质疏松症检出率有可比性，建议同一个类型的骨密度仪，同一个种族，同一个地区用一个设计较完善大样本的参考数据库，以其青年人正常参考值计算T-score。