多层螺旋CT两种重建方式检测冠状动脉钙化斑块的比较与评价

目的选择和建立多层螺旋CT检测冠状动脉钙化斑块的最佳重建技术。方法采用16层CT螺旋扫描回顾性心电门控技术对55例患者行冠状动脉钙化积分检查,每一病例原始数据进行两种不同模式的薄层重建：2mm层厚组（层厚2mm,层间隔1mm）和3mm层厚组（层厚3mm,层间隔1．5mm）;计算每组图像钙化斑块的Agatston积分（agatston score,AS）,容积积分（volume score,VS）,质量积分（mass score,MS）,比较两种重建方式在冠状动脉钙化斑块检出及计算钙化积分的差别。结果2mm层厚组检出的钙化斑块较3mm层厚组多38个,其中多为小钙化斑块;全部钙化斑块的钙化积分VS、MS、AS 2mm层厚组较3mm层厚组高（P〈0．05）。结论在探测冠状动脉钙化灶时2mm层厚的图像较普遍应用的3mm重建方式能发现更多、更小的钙化斑块,对于临床冠状动脉钙化斑块早期发现,冠心病的早期预防及早期治疗有重要意义。     

男性杓状软骨钙化对喉接触性肉芽肿治疗效果的影响

研究杓状软骨钙化对喉接触性肉芽肿治疗效果的影响。方法对临床资料完整的 115 例喉接触性肉芽肿男性患者进行回顾性分析,统计患侧杓状软骨钙化对治疗效果的影响。结果115 例男性喉接触性肉芽肿患者,年龄22~68岁,平均年龄45.82 岁。其中单侧肉芽肿 110（110/115,95.65 %）,双侧肉芽肿 5 例（5/115.35%）;病因中有反流病史 67 例（67/115,58.26%）,插管诱发 5 例（5/115,4.35%）,其余患者无明显原因。115例男性患者 CT 显示杓状软骨伴钙化 102例（102/115,88.70%）,杓状软骨无钙化13 例（13/115;11.30%）。其中杓状软骨伴钙化患者治愈时间＞3个月 68 例,治愈时间≤3 个月 34 例;杓状软骨无钙化治愈时间＞3个月患者 4 例,治愈时间≤3个月 9 例。通过 Chi square 检验分析显示患者杓状软骨伴钙化的治愈时间＞3个月的百分数明显多于不伴钙化组（χ2=4.906,P=0.027）。结论喉接触性肉芽肿患者,杓状软骨钙化的患者治疗时间较长,可能是由于这类患者长期慢性炎性刺激引起杓状软骨钙化,病程相对较长,治疗困难。     

骨形态发生蛋白4与血管钙化的相关性

骨形态发生蛋白4(BMP-4)是转化生长因子β(TGF-β)超家族成员之一,属于多功能生长因子,在胚胎发育、血管生成、细胞增殖、分化、骨骼形成、异位成骨、骨折修复等方面具有重要作用。血管钙化(VC)是一个与骨发育相似的可调控的复杂的生物学过程,其中心环节是血管平滑肌细胞(VSMC)向成骨样细胞转化。近年的研究发现,BMP-4可能参与血管钙化的发生和发展,但具体机制尚未清楚,文章就其相关关系的研究进展作一综述。     

Role of bone mineral density in the inverse relationship between body size and aortic calcification: Results from the Baltimore Longitudinal Study of Aging

Objective

There is a J-shaped relationship between body mass index (BMI) and cardiovascular outcomes in elderly patients (obesity paradox). Whether low BMI correlates with aortic calcification (AC) and whether this association is accounted for by bone demineralization is uncertain.

Methods

Presence of AC was evaluated in 687 community-dwelling individuals (49% male, mean age 67 ± 13 years) using CT images of the thoracic, upper and lower abdominal aorta, and scored from 0 to 3 according to number of sites that showed any calcification. Whole-body bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry. Predictors of AC were assessed by logistic regression, and the role of BMD using mediation analysis.

Results

Age and cardiovascular risk factors were positively associated while both BMI (r = −0.11, p < 0.01) and BMD (r = −0.17, p < 0.0001) were negatively associated with AC severity. In multivariate models, lower BMI (OR 0.96, 95%CI 0.92–0.99, p = 0.01), older age, higher systolic blood pressure, use of lipid-lowering drugs and smoking were independent predictors of AC. A nonlinear relationship between BMI and AC was noticed (p = 0.03), with decreased AC severity among overweight participants. After adjusting for BMD, the coefficient relating BMI to AC was reduced by 14% and was no longer significant, whereas BMD remained negatively associated with AC (OR 0.82, 95%CI 0.069–0.96, p = 0.01), with a trend for a stronger relationship in older participants.

Conclusion

Low BMI is associated with increased AC, possibly through calcium mobilization from bone, resulting in low BMD. Prevention of weight loss and bone demineralization with aging may help reducing AC.     

BMP信号通路在华法林诱导的大鼠血管平滑肌细胞钙化中的作用

目的探讨骨形态发生蛋白(BMP)信号通路在华法林诱导的大鼠血管平滑肌细胞(VSMC)钙化中的作用。方法体外分离培养大鼠胸主动脉VSMC,将其随机分为正常对照组、高磷组、华法林(10μmol/L)干预组及华法林(10μmol/L)+维生素K(10μmol/L)干预组。对细胞进行钙含量和碱性磷酸酶(ALP)活性检测,茜素红染色检测钙结节,Western blot检测细胞中Runx2蛋白的表达变化,RT-PCR检测细胞中骨形态发生蛋白2(BMP-2)、Smad1及Runx2的表达变化。结果茜素红染色结果显示,与正常对照组和高磷组相比,华法林干预组钙化结节明显增多;钙含量测定结果与茜素红染色结果基本一致。与正常对照组和高磷组相比,华法林干预组ALP活性明显增加(P0.05),Runx2 mRNA和蛋白表达水平及BMP-2、Smad1 mRNA表达明显增高(P0.05);与华法林干预组相比,华法林+维生素K干预组细胞钙含量、ALP活性及BMP-2、Smad1、Runx2的表达均明显降低(P0.05)。结论BMP信号通路参与了华法林促进的大鼠VSMC钙化,其可能的作用机制是介导了VSMC的表型转化。     

Immunocytochemical localization of BGP in human bones in various developmental stages and pathological conditions

Summary Bone-carboxyglutamic acid containing protein (BGP) was isolated from human bone and anti-BGP antibody was produced in rabbits. Localization of BGP was investigated immunocytochemically by light and electron microscopy in human bones in various developmental stages and pathological conditions. In the bones of a 12 week fetus, osteoblasts stained strongly in areas of bone formation. However in bones of late fetal stages and in newborns and adults, BGP was localized predominantly in the osteoid and bone matrix in the ossifying front. Osteoblasts and osteocytes also stained positive, but less dominantly than in the early fetus. Electron microscopy showed that BGP was localized in the ER and Golgi cisternae of osteoblasts and osteocytes, and the collagen fibers of the osteoid and bone matrix. The intensity and distribution of staining were not significantly different in osteoporosis and osteoarthritis. These observations indicate that BGP is synthesized by osteoblasts most actively in early fetal life and is then deposited on collagen fibers of the osteoid and bone matrix.     

老年钙化瓣膜病的研究新进展

老年钙化瓣膜病可引起心脏瓣膜的狭窄和关闭不全,临床上以主动脉瓣和二尖瓣及其瓣环最常受累。它是引起老年人充血性心力衰竭、心律失常、晕厥和猝死的重要原因之一,也是老年人最常见的心脏瓣膜病变。该文就老年钙化瓣膜病的发病机制、危险因素等方面予以综述,从探讨中寻找治疗的新进展,如他汀类药物、肾素-血管紧张素系统抑制药物及抗骨质疏松药物的应用,并对经皮主动脉瓣膜置换术的新进展进行相关阐述。     

超声造影对伴有钙化甲状腺结节的诊断价值

目的探讨超声造影在伴有钙化的甲状腺结节诊断中的临床价值。方法对73例甲状腺良性结节和53例甲状腺恶性结节患者分别进二维超声和超声造影检查,比较良恶性结节微钙化、弱增强及不均匀增强的构成比,并比较超声造影时良恶性结节始增时间、达峰时间和峰值强度。结果伴有钙化的甲状腺恶性结节微钙化、弱增强及不均匀增强的构成比均高于良性结节(P0.05);超声造影恶性结节峰值强度低于良性结节(P0.05),良恶性结节始增时间、达峰时间差异无统计学意义(P0.05);超声造影对伴有钙化甲状腺结节良恶性诊断的敏感度、特异度、阳性预测值及阴性预测值均高于二维超声检查(P0.05)。结论超声造影可敏感、动态地观察甲状腺结节的增强特点,对伴有钙化的甲状腺结节的诊断具有较高的临床价值。     

肺部孤立结节钙化征象的HRCT评价

目的：本文旨在评价良恶性孤立结节（ＳＰＮＳ）的钙化征象在高分辨率ＣＴ（ＨＲＣＴ）上的差异。材料和方法：分析一组连续的资料，共５９例，其中４３例经病理学证实，１６例经临床诊断和随访明确。结果：３０例良性中的１２例（４０％），２９例恶性中的４例（１３石的）可见钙化征象（Ｐ＜０．０５）。钙化的形态有三种，１）结节状或斑炔状，２）点状，３）沙粒状。结节状或斑块状钙化是良性的特征。良恶性钙化分布不同，良性多位于中央，恶性则为偏心性的。ＨＲＣＴ所显示的１６例钙化中普通ＣＴ扫描仅显示３例。结论：ＨＲＣＴ上钙化征象多见于良性ＳＰＮＳ．但并非良性病变所特有，钙化对良恶性结节的鉴别有一定的参考价值。在钙化的显示上，ＨＲＣＴ明显优于普通Ｘ线及常规ＣＴ扫描。     

钙化在不伴肿块乳腺肿瘤中的表现特点分析

目的探讨钙化在非肿块型乳腺肿瘤X线诊断中的意义,提高对非肿块型乳腺良、恶性肿瘤的鉴别诊断水平。方法回顾性分析2008年11月至2011年3月期间四川大学华西医院经病理检查证实的X线片未见肿块的90例乳腺肿瘤患者的临床资料,其中乳腺良性肿瘤55例,乳腺癌35例,观察并记录钙化的形态、分布、总数、位置及乳腺局限性不对称致密。结果①乳腺良性疾病钙化形态多粗大(31例),多以散在分布为主(35例),且钙化总数较少,较少伴有乳腺局限性不对称致密影(7例),较少伴有同侧腋窝淋巴结的改变(2例)。②乳腺癌的钙化多以细砂样钙化为主(32例),颗粒细小,但钙化大小不一致,形态各异,其钙化的分布多呈簇样分布(24例),且恶性钙化的总数较多,多伴有乳腺局限性不对称致密影(24例),伴有腋窝淋巴结改变(10例)。两者钙化的形态、分布及总数的差异均有统计学意义(P<0.05)。结论良、恶性乳腺肿瘤的钙化各有特征,在早期乳腺肿瘤的鉴别诊断中有着重要的临床意义。