加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症临床研究

目的:观察加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症(PMOP)的临床疗效。方法:选取150例肾阳亏虚型PMOP患者,按随机数字表法分为对照组和观察组各75例。对照组给予口服阿仑膦酸钠片治疗,观察组在对照组基础上加服加味温经汤,2组均治疗6个月。对比2组总体疗效、治疗前后碱性磷酸酶(ALP),血钙(Ca)、磷(P),雌二醇(E2),促卵泡雌素(FSH),促黄体生成素(LH)水平,记录治疗过程中不良反应发生情况。结果:观察组总有效率96.0%,对照组总有效率80.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组ALP水平均较治疗前降低(P<0.05),血Ca含量均较治疗前增加(P<0.05);观察组ALP水平低于对照组(P<0.05),血Ca含量高于对照组(P<0.05)。治疗后,2组E2水平均较治疗前升高,FSH及LH水平均较治疗前降低,差异均有统计学意义(P<0.05);观察组E2水平高于对照组,差异有统计学意义(P<0.05)。2组血常规异常、肝肾功能异常、消化道症状、皮肤过敏发生率比较,差异均无统计学意义(P>0.05)。结论:加味温经汤治疗肾阳亏虚型PMOP,能有效改善患者的临床症状和性激素水平,用药安全性高。     

Screening for Metabolic Bone Disease of prematurity

Metabolic bone disease (MBD) of prematurity remains a significant comorbid condition in preterm, low birth weight infants. As the majority of in utero calcium (Ca) and phosphorus (Phos) accretion occurs during the third trimester, many of these children have inadequate mineral stores and are at risk for deficiencies of Ca and Phos. While fortification of formula has allowed for increased mineral delivery to premature infants, intestinal immaturity prevents optimal absorption. This is compounded by immobilization, delayed establishment of enteral feeds, long term parenteral nutrition and medications that may alter mineral levels. Over time, biochemical changes occur and accompany MBD, with poor bone mineralization during this period increasing the risk for complications such as osteopenia, rickets and fractures. Screening is largely based on risk factors, but despite the 2013 AAP Consensus Statement, there remains significant variation in screening practices across institutions. A combination of laboratory and radiologic testing is often used to diagnose and manage MBD of prematurity, but there exists a lack of consensus on which screening tests and thresholds to use. This is in part related to a lack of normative data and clinical trials for preterm infants, and a result, a lack of evidence-based guidelines on the diagnosis and timing of potential treatment. Biochemical markers, such as serum Phos, alkaline phosphatase (ALP) and parathyroid hormone (PTH), have shown some benefit in the diagnosis of MBD in some studies, but have not always been reproducible. Radiographs may identify different degrees of skeletal changes, but these changes may not be detected until later in MBD development. Other modalities, such as DXA and ultrasound, have also been used, but these may be limited by lack of standards in preterm infants or lack of availability in some centers. Further research, more specifically clinical trials, are needed to determine which combination of tests can detect MBD at its earliest, in order to promote early treatment and prevent short- and long-term complications of MBD.     

化学镀法制备32P放射性支架预防再狭窄的实验研究

目的 :评价3 2 P放射性支架对兔髂动脉狭窄的预防作用。方法 :以化学镀法制备3 2 P放射支架 ,与非放射支架配对后 ,随机置入兔双侧髂动脉 ,术前、术后即刻及术后 30d造影观察动脉狭窄程度 ,并进行病理组织学观察内膜面积及管腔内径的变化。结果 :术后 30d ,两种支架置入后的动脉最小腔径 (MLD)均比术后即刻显著减小 ;放射支架侧的MLD显著大于对照侧 (P <0 .0 1) ,而其后期丢失、丢失指数、狭窄程度等 3项指标则显著小于对照侧 (P <0 .0 1)。两种支架置入均使血管内膜增生 ;放射支架侧血管管腔面积显著大于对照侧 (P <0 .0 5 ) ,而其新生内膜面积显著小于对照侧 (P <0 .0 1)。未发现两种支架置入后对支架边缘部位的影响。结论 :化学镀法制备的放射性3 2 P支架安全有效 ,较低的放射活度即可有效防止支架内狭窄 ;以短球囊扩张支架可能会避免边缘部位狭窄的发生     

慢性乙型肝炎患者在阿德福韦酯治疗期间的肌酐和血磷水平变化

阿德福韦酯(ADV)在上市前的临床试验中已经被发现具有潜在的肾毒性,但由于其用于治疗慢性乙型肝炎(CHB)的剂量较小(10 mg/d),肾毒性轻微,常被临床医生忽视.本研究对CHB患者在使用ADV治疗期间的肌酐和血磷变化进行回顾性观察,以供临床医生参考. 一、资料与方法 1.病例来源:2006年1月1日至2011年12月31日,本院门诊及ADVⅢ期临床试验[1]中,服用ADV(购自葛兰素史克公司)单药或联合治疗的CHB及其并发症患者,经门诊登记及医院HIS系统查询,符合以下条件者:(1)服用ADV 10 mg/d单药或联合治疗≥2年:(2)治疗依从性好,有门诊就诊记录或医院HIS系统记录,随访间隔≤6个月;(3)定期监测肾功能和血磷水平.排除标准:(1)依从性差,间断服药或自行停药者;(2)治疗中途有换用其他抗病毒药物者;(3)门诊及检测记录不完全者;(4)在我院门诊就诊但由外院检测者;(5)仅有服药记录而无检测记录者,或仅有检测记录而无服药记录者;(6)服用其他公司生产昀ADV者.     

款冬花氮磷钾吸收特性研究

目的：研究款冬花氮磷钾吸收特性。方法：测定不同生育时期的款冬花各器官的氮磷钾含量,结合干物质积累规律进行分析。结果：60～80d是叶片生长旺盛时期,80～100d是根茎部位生长旺盛时期,两者养分的累积速率都是氮〉钾〉磷;100～160d是植株养分需求的高峰时期,氮磷钾累积量均在全生育期的60％左右;180～220d之间,花蕾氮磷钾累积速率最大;整个生育期养分总累积量为钾〉氮〉磷,氮：磷：钾为4．00：1：4．29,需要氮41．693kg／667m^2,P20510．414kg／667m^2,K2044．709kg／667m^2,即每生产1kg干花,需消耗氮0．836kg,P2050．209kg,K200．897kg。结论：6月上旬和7月下旬应追肥一次以满足植株营养形态建成需求。9月中下旬宜追肥一次,以提高花的产量。每次追肥都应该氮磷钾兼施,尤其应保证钾肥的供应。     

Osteomalacia and altered magnesium metabolism in the X-linked hypophosphatemic mouse

Summary A new genetic mutant in mice,Hyp, has been proposed as a model for the human disease X-linked hypophosphatemia (the most common form of vitamin D-resistant rickets). The gene is X-linked, dominant, and produces reduced renal tubular reabsorption of phosphate, hypophosphatemia, and dwarfism. Our goal was to evaluate the skeletal changes histologically and to measure chemically the prominant blood and bone minerals to judge the suitability of this mutant as a model for the human disease. Thirteen-week-old hemizygousHyp male mice were compared with their normal littermate controls. TheHyp mice were hypocalcemic, hypophosphatemic, hypermagnesemic, and had elevated plasma alkaline phosphatase. The femur ash weighed less than half the normal ash weight but had a normal Ca:P ratio. The ash composition was high in %Na and K but low in %Mg. The mandibular incisor ash was also low in %Mg. Histologically the femur showed wide osteoid borders and wide epiphyseal plate. Microradiography revealed reduced bone density and enlarged osteocyte lacunae. Skeletal muscle samples, although smaller in theHyp mice, showed no striking alternations in inorganic or total phosphate content, dry weight (as % wet weight), or extracellular fluid space. TheHyp gene in mice seems to produce a condition similar to that of X-linked hypophosphatemia in humans.     

不同腹膜转运特性对血钙、血磷及PTH的影响

目的研究无尿持续非卧床腹膜透析（CAPD）患者腹膜转运功能对骨矿物质代谢的影响。方法选择159例无尿CAPD患者,根据腹膜平衡试验将患者分为2组：低转运特性组87例,高转运特性组72例。检测两组患者血钙、血磷、甲状旁腺激素等生化指标,测定腹膜尿素清除指数（KT／V）及肌酐清除率（CCr）。结果与低转运特性患者相比,高转运特性患者血钙、血磷和甲状旁腺激素水平明显偏低,而KT／V、CCr偏高,差异有统计学意义（P〈0．05）。多元逐步回归分析显示,CCr与血钙、血磷呈负相关（P〈0．05）,Kt／V与血钙呈负相关关系（P〈0．05）,而D／Pcr与血钙、血磷、甲状旁腺激素无明显相关性。结论低腹膜转运特性患者易出现高磷血症和高甲状旁腺激素;腹摸转运特性能影响血钙、血磷、甲状旁腺激素水平,但之间未见显著相关性。     

Calcium, phosphorus, cardiovascular events and all-cause mortality in hemodialysis patients: a single-center retrospective cohort study to reassess the validity of the Japanese Society for Dialysis Therapy guidelines

Mineral and bone disorders frequently cause cardiovascular complications and mortality in hemodialysis patients, but few observational studies of Japanese patients have investigated this matter. A retrospective cohort study of 99 patients (53 males, 46 females; mean age: 65 +/- 12 year; 38% with diabetes mellitus) on maintenance hemodialysis in our dialysis center was conducted. Mean serum Ca, P and intact parathyroid hormone (iPTH) levels were 9.2 +/- 0.9 mg/dL, 6.1 +/- 1.7 mg/dL, and 233 +/- 333 pg/mL, respectively. The cutoff values for each of these three parameter were defined according to the target ranges recommended by the Japanese Society for Dialysis Therapy (JSDT) guidelines (Ca: 8.4-10.0 mg/dL; P: 3.5-6.0 mg/dL; iPTH: 60-180 pg/mL). During a 45-month follow up, patients with all parameters outside the target ranges showed the highest incidence of cardiovascular events and all-cause deaths (16.6 and 29.2 per 1000 person-years, respectively). The relative risks of cardiovascular events and all-cause deaths were analyzed by multivariate Cox regression models. The hazard ratio (HR) for cardiovascular events was significantly lower for patients who achieved serum Ca and P objectives compared with others (HR: 2.12; 95% CI: 1.04-4.34; P < 0.05), and similar differences were observed for all-cause deaths (HR: 3.10; 95% CI: 1.13-8.53; P < 0.05). However, the relationship between iPTH levels and each of the endpoints was less pronounced. The results of this study provide support for the JSDT guidelines, which give priority to the control of serum Ca and P levels over the control of parathyroid function.     

氨基酸鳌合钙联合骨化三醇治疗肾性骨病的临床观察

目的:探讨治疗继发性甲状旁腺功能亢进(SHPT)骨病的方法.方法:对48例长期血液透析的慢性肾功能衰竭患者分别给予骨化三醇及骨化三醇联合钙剂治疗,观察血清钙、磷、钙磷乘积、甲状旁腺激素(PTH)水平变化,并对两种治疗方法的结果进行比较.结果:两种治疗均可显著增加血清钙水平,降低血清磷水平,骨化三醇加钙剂治疗的疗效更为显著(P＜0.01).结论:钙荆加骨化三醇治疗SHPT骨病优于单用骨化三醇.     

Effect of Phosphate Supplementation to Breast Fed Very Low Birthweight Infants on Urinary Calcium Excretion, Serum Immunoreactive Parathyroid Hormon and Plasma 1.25-Dihydroxy-vitamin D Concentration

ABSTRACT. The effect of two doses of Phosphorus (P) supplementation to pooled breast milk (BM): 0.48 and 0.800 mmol/kg/24 h given during the second month of life was evaluated in 22 very low birthweight infants. The concentration of calcium and phosphorus in serum and urine, the serum concentration of immunoreactive parathyroid hormon (iPTH) and the plasma 1,25-dihydroxy-vitamin D concentration (1,25-OH-D) were compared to the values in 19 control infants. The mean ± SD concentrations in control infants and adults are 63 ±18 ulEq/ml for serum iPTH and 85±pmol/l for plasma 1,25-OH-D. With 0.48 P supplementation, urinary Ca (UCa) excretion (median and range) 0.238 mmol/kg/24 h (0.105-0.520) was lower than in the control group 0.288 (0.205-0.679) (p<0.05); the reduction of UCa was larger with 0.8 P supplementation: 0.047 (0.023-0.163) (p<0.01). P supplementation induced no change in serum Ca concentration but a slight and significant increase in serum iPTH was observed only with the 0.8 P supplementation: 55 μl Eq/ml (<25-80) (p<0.05). With 0.8 P supplementation there was no significant change of plasma 1,25-OH-D concentration: 173 μmol/l (106-271) vs. 255 (132-293) in the control group. These data show that with 0.8 P supplementation, the hypercalciuria in BM-fed infant disappears without secondary hyperparathyroidism, but without any change in plasma 1,25-OH-D concentration.