肱骨近端骨密度的测量及其与年龄和体质量指数的相关性研究

目的 建立一种肱骨近端骨密度(BMD)的测量方法,研究肱骨近端BMD与年龄和体质量指数(BMI)的关系,探讨肱骨近端BMD在预报骨质疏松症的敏感性.方法 选择绝经后健康女性志愿者,使用Hologie DELPHI-A双能X射线骨密度仪及本研究设计的肩部定位器和前臂定位器测虽肱骨近端BMD.研究第一部分包括30名忐愿者,每人连续测量右侧肱骨近端BMD 2次,根据测量结果计算短期精密度RMS SD和RMS CV;第二部分包括92名志愿者,记录其年龄、身高、体重,测量右侧肱骨近端BMD,分析肱骨近端BMD与年龄和BMl的相关性.结果 本研究肱骨近端BMD测量方法的短期精密度:RMS SD=0.011 g/cm2,RMS CV=2.4%.本研究92名志愿者平均(60.2±6.4)岁,平均身高(159.5±5.4)cm,平均体质晕(59.4±7.5)kg,平均BMI 23.3±2.7,平均肱骨近端BMD(0.543±0.083)g/cm2,肱骨近端BMD 同年龄呈负相关,同BMI无显著相关.结论 本研究建立了一种测苗肱骨近端BMD的方法;年龄越人肱骨近端BMD越低;由于BMI对BMD的影响会掩盖骨质的丢失,而非负重区域即肱骨近端会最大程度地减少BMI对BMD的影响程度.     

The use of multiple sites for the diagnosis of osteoporosis

Introduction It has been suggested that bone mineral density (BMD) measurements should be made at multiple sites, and that the lowest T–score should be taken for the purpose of diagnosing osteoporosis. Purpose The aim of this study was to examine the use of BMD measurements at the femoral neck and lumbar spine alone and in combination for fracture prediction. Methods We studied 19,071 individuals (68% women) from six prospective population-based cohorts in whom BMD was measured at both sites and fracture outcomes documented over 73,499 patient years. BMD values were converted to Z-scores, and the gradient of risk for any osteoporotic fracture and for hip fracture was examined by using a Poisson model in each cohort and each gender separately. Results of the different studies were merged using weighted β-coefficients. Results The gradients of risk for osteoporotic fracture and for hip fracture were similar in men and women. In men and women combined, the risk of any osteoporotic fracture increased by 1.51 [95% confidence interval (CI)=1.42–1.61] per standard deviation (SD) decrease in femoral-neck BMD. For measurements made at the lumbar spine, the gradient of risk was 1.47 (95% CI=1.38–1.56). Where the minimum of the two values was used, the gradient of risk was similar (1.55; 95% CI=1.45–1.64). Higher gradients of risk were observed for hip fracture outcomes: with BMD at the femoral neck, the gradient of risk was 2.45 (95% CI=2.10–2.87), with lumbar BMD was 1.57 (95% CI=1.36–1.82), and with the minimum value of either femoral neck and lumbar spine was 2.11 (95% CI=1.81–2.45). Thus, selecting the lowest value for BMD at either the femoral neck or lumbar spine did not increase the predictive ability of BMD tests. By contrast, the sensitivity increased so that more individuals were identified but at the expense of specificity. Thus, the same effect could be achieved by using a less stringent T–score for the diagnosis of osteoporosis. Conclusions Since taking the minimum value of the two measurements does not improve predictive ability, its clinical utility for the diagnosis of osteoporosis is low.     

采用羟基磷灰石涂层股骨柄假体行全髋置换术的早期疗效

目的总结采用羟基磷灰石(HA)涂层股骨柄假体行全髋关节置换术的早期疗效。方法2000年2月～2003年10月,采用钛合金HA涂层股骨柄假体行无骨水泥全髋关节置换术65例(70髋)。术前诊断:股骨颈骨折30例,骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿性髋关节炎2例,髋关节融合1例。分别于术后1周、3个月、6个月,以后每年一次行髋关节功能和X线片检查,其中44例接受双能X线骨密度仪(DEXA)的骨密度(BMD)检查。结果术后X线片提示股骨柄假体的初始固定均符合优良标准。随访2～5.5年,平均3年。髋关节功能从术前Harris平均评分32分(25～52分)恢复至最后随访时的平均96分(85～100分),至今无一髋表现股区痛或需行翻修手术。术后1年内的X线片测量显示:<1.5mm下沉者7髋,其余均无假体下沉。至今无一例显示股骨近端或髓内骨溶解,也无一例显示假体松动。DEXA检查显示BMD在术后下降,然后迅速恢复,3～6个月后可达到正常或接近正常水平,其中Ⅱ、Ⅵ区的BMD增加速度最快,有时甚至高于对照侧。按Engh标准评定,全部患者均获骨性固定。结论近段HA涂层能增强股骨柄假体的初始固定,促进早期骨长入和骨性生物学固定,阻止聚乙烯磨屑的髓内移行和骨溶解,故用于无骨水泥全髋置换术的早期疗效满意。     

Vitamin K supplementation does not significantly impact bone mineral density and biochemical markers of bone in pre- and perimenopausal women

Because of its role in osteoblastic metabolism, vitamin K has been studied with respect to bone. However, there has been limited research examining the influence of long-term vitamin K supplementation on bone mineral density (BMD). Therefore, the purpose of this study was to assess the impact of 6 months of vitamin K supplementation on BMD and biomarkers of bone in pre- and perimenopausal women. Based on previous work, we hypothesized that vitamin K would improve BMD and biochemical markers of bone formation. A double-blind, placebo-controlled, randomized trial is an effective way to study the impact of long-term supplementation. Thus, 14 pre- and perimenopausal women, 25 to 50 years of age, were randomly assigned to an experimental group (E) that received 600 μg/d of vitamin K in the form of phylloquinone (K₁) or a control group (C) that received identical-looking placebo tablets. Regional BMD and percent body fat, measured by dual-energy x-ray absorptiometry, and serum osteocalcin and urinary N-telopeptide levels were all assessed at 0, 3, and 6 months. When BMD was measured across time, C had a significant increase (P = .011) in greater trochanter BMD compared to E. The E group had a nonsignificant increase (P = .067) in shaft BMD compared to the C group. There was no significant difference between E and C in serum osteocalcin concentrations over time. Urinary N-telopeptide levels increased significantly over time in E compared to C (P = .008). Six months of 600 μg/d vitamin K₁ supplementation did not improve regional BMD in this group of pre- and perimenopausal women.     

β-隐黄质对糖尿病大鼠骨质影响的研究

目的:研究β-隐黄质对小剂量多次腹腔注射链脲佐菌素所致糖尿病大鼠骨质的影响。方法:用链脲佐菌素以30 mg/kg注射Wister雄性大鼠6周,建立糖尿病模型;测定并比较正常对照组、糖尿病模型组、β-隐黄质组和胰岛素治疗组的骨常规参数。结果:糖尿病模型组骨密度、骨结构力学参数、生物力学参数、骨矿物质及羟脯氨酸含量均比正常对照组有显著降低(P<0.01),而骨磷含量、骨和血清碱性磷酸转移酶均比正常对照组显著升高(P<0.01);β-隐黄质组在上述参数指标方面均与糖尿病模型组呈现显著性差异(P<0.01),与胰岛素治疗组呈现相同作用趋势,但效果不如后者。结论:长期摄入β-隐黄质可减少小剂量多次腹腔注射链脲佐菌素大鼠糖尿病的发病率,进而影响糖尿病大鼠骨质变化的发生。     

Effects of dairy food supplements on bone mineral density in teenage girls

Summary Background Bone mineral density (BMD) is largely genetically determined and this influence is most powerful in the period of rapid skeletal development in childhood and late adolescence but environmental factors such as exercise and dietary calcium intake may influence up to 20%. Aims of the study The aims of the study were to examine healthy late adolescent females for the effects and benefits of a high calcium intake from dairy product foods on bone mineral density, body composition, lipids and biochemistry. The secondary aim is determine whether a high intake of dairy product foods in the diet is acceptable for this age group long term. Methods Ninety-one teenage girls who participated in a two-year randomised controlled study on the effect of dairy food supplementation on dietary patterns, body composition and bone density in post-pubertal teenage girls were approached one year after the cessation of the study to determine the effects of the cessation of dairy supplements on bone mineral density, dietary habits, biochemical markers, body composition and blood lipids. Bone mineral density and bone mineral content were assessed at the hip, spine and total body. Anthropometric data were collected, and exercise, Tanner, dietary assessment, preference and compliance questionnaires were administered. Lipid profiles, hydroxyproline excretion and urinary calcium and sodium excretion measurements were performed. Results There were no significant differences between the 2 groups for height, weight, lean and fat mass. The supplemented group had significantly higher calcium, phosphorus and protein intake during the supplementation period (p<0.001). No differences were seen between the groups 12 months after supplementation finished. There were no significant differences in exercise level, preference or acceptability of dairy products or in the lipids and bone markers between baseline the end of supplementation and 1 year follow-up. There was a significant increase in trochanter (4.6%), lumbar spine (1.5%) and femoral neck (4.8%) BMD (p<0.05) in the high calcium group at the end of supplementation. There was an increase in bone mineral content at the trochanter (p<0.05) and lumbar spine; however the latter was not statistically significant, in the high calcium group at the end of supplementation. There was no difference in vertebral height or width at any stage of the study, indicating no influence on bone size. Conclusions In this 3 year study (2 years of supplementation, 1 year follow-up), teenage girls, aged 15–18 years, were able to significantly increase their BMD at the trochanter, femoral neck and lumbar spine when supplemented with dairy product foods to a mean calcium intake of 1160 mg/d. There was also an effect seen on the BMC particularly at the trochanter and to a lesser extent at the lumbar spine. The dietary calcium intake achieved did not adversely affect body weight, fat and lean mass or blood lipid profiles. Twelve months after the supplementation finished the girls had returned to their baseline diet, indicating self-selection of a high dairy product diet may be hard to achieve. Received: 5 June 2000, Accepted: 5 September 2000     

X线相干散射CT成像技术

本文概述了一种新型X线成像技术-X线相干散射CT成像技术的原理和在医学中的应用。     

深圳市儿童超声骨密度测定结果

目的:了解深圳地区0～1 5岁儿童少年超声骨密度状况;建立其超声骨密度正常参考值。方法:选择0～1 5岁深圳出生和/或居住的正常儿童少年为检测对象,用定量超声骨密度仪(QUS)测定受检者足跟部骨密度(BMD)值,同时测量受检者体重、身高。结果:0～72个月龄男童与女童之间BMD无差异(P >0.0 5 ) ;6～1 2岁男童与女童之间BMD存在差别(r =0 73.2 ,P <0.0 0 1 ) ,但经体重校正后差异无显著性(P >0 .0 5 ) ,1 3～1 5岁少年BMD与性别有关;0～1 5岁儿童少年BMD值与身高增长快慢有关。结论:胎儿期储备、合理膳食、体重、运动、雌激素对BMD有影响     

辛伐他汀对骨质疏松大鼠血清细胞因子IL-6、IGF-I水平的影响

目的:观察辛伐他汀对去卵巢大鼠血清细胞因子IL-6和IGF-I水平的影响。方法:选择健康雌性Wistar大鼠27只,3月龄,体重(200±30)g,随机分为A、B、C3组,每组9只。A组行开关术,其余两组行双侧卵巢切除术。术后1周A、B两组均灌服生理盐水1.5ml/只/d,C组给予辛伐他汀5mg/kg/d,共10周。双能X线骨密度仪测量股骨和胫骨骨密度(BMD);ELISA定量测定血清细胞因子IL-6、IGF-I水平。结果:B组血清IL-6水平明显高于A、C组(P<0.001)。C组血清IGF-I水平与B组比较差异无显著性(P>0.05);A组血清IGF-I水平明显高于B组(P<0.001)。股骨BMD和胫骨BMD与血清IL-6水平均呈显著负相关(P<0.001),而与血清IGF-I水平均呈显著正相关(P<0.05)。结论:他汀类药物能够下调IL-6的表达水平;但对IGF-I影响作用不大。