影响骨质疏松症老年人的微量元素及膳食因素探讨

目的分析探讨骨质疏松症老年人微量元素含量变化。方法选取2014年7月—2015年6月到佛山市第一人民医院就诊的老年患者200例为研究对象,男性53例,女性147例,根据BMD分组为正常组、骨量低下组与骨质疏松组,对比分析男性与女性,不同BMD分组之间的微量元素含量。结果女性腰椎和股骨颈骨密度均明显低于同年龄的男性(P0.05),且绝经后女性更容易发生骨质疏松。男性微量元素Fe、Zn、Cd含量显著高于女性(P0.05);而Cu含量则显著低于女性(P0.05)。男性组中,骨质疏松组血清Fe、血清Cd含量均显著高于骨量正常组(P0.05)。女性组中,骨质疏松组血清Se、血清Pb含量显著高于正常组(P0.01)。结论老年骨质疏松症的发生与老年人机体内微量元素含量降低、营养代谢能力减弱等因素存在较大关系,故积极探究影响骨质疏松症老年人的微量元素及膳食因素具有重要意义。     

基于MRI的绝经后女性腰椎退行性病变程度与骨质疏松的相关性研究

本研究探讨基于磁共振成像(MRI)的绝经后女性腰椎退行性病变程度与骨质疏松的关系。选取经骨密度检查确诊的骨质疏松绝经后女性患者50例为骨质疏松组、非骨质疏松症绝经后妇女50例作为对照组,两组妇女均接受MRI检查。结果显示,骨质疏松组的L1/L2、L2/L3、L3/L4、L4/L5、L1~S1椎间盘Pfirrmann分级评分均高于对照组,差异均具有统计学意义(P<0.05);骨质疏松组患者的腰椎L1/L2、L2/L3、L3/L4、L4/L5、L1~S1之间的BMD与椎间盘Pfirrmann分级评分呈显著的正相关关系(P<0.05);多元线性回归模型结果显示:绝经时间、年龄、腰椎BMD值与患者椎间盘Pfirrmann分级评分呈显著的正相关关系(P<0.05)。绝经后女性采用MRI检查评估的腰椎退行性病变程度Pfirrmann分级评分与骨质疏松程度有关,同时与患者的年龄、绝经时间长度有关。     

A Study on the Effect of Environmental and Genetic Factors on Postmenopausal Osteoporosis in Wenzhou Women

为探讨温州地区绝经后女性骨质疏松症( Postmenopausal osteoporosis,PMOP)与雌激素受体基因( Estrogen receptor,ERa)多态性及相关因素的关联性,将203例观察对象按骨质疏松症诊断标准分为骨量正常组、骨量减少组与PMOP组,分别检测各组观察对象的腰椎L1-4正位骨密度、Pvu Ⅱ、Xba Ⅰ基因型并调查其膳食行为与运动习惯等项目.结果显示:(1)年龄越大、文化程度越低、身材矮小及BMI低者、妊娠次数越多、产次越多者易罹患PMOP;经常饮用牛奶、豆浆、茶,经常食用水产品、豆类、肉类、蛋类、水果、坚果及每月运动次数较多者与高骨密度有关;在校正年龄、文化程度、BMI等干扰因素之后,饮茶、食用水果、坚果类的次数与BMD呈正相关.(2)该研究未发现Pvu Ⅱ与Xba Ⅰ基因型与PMOP间有关联.提示该地区膳食行为、环境因素与PMOP关系密切,但雌激素受体α多态性与骨密度间关系尚不明确,其对骨质疏松的预测价值尚待深入研究.     

Micro-CT参数对骨质疏松性椎体压缩性骨折术后复发的预测价值

本研究探讨Micro-CT参数对骨质疏松性椎体压缩性骨折(OVCF)患者术后复发的预测价值。选取OVCF患者127例,根据术后6个月骨折复发情况分为复发组(n=41)与未复发组(n=86)。患者均接受Micro-CT检查,对比两组Micro-CT参数,即骨体积分数(BV/TV)、骨小梁厚度(Tb.Th)、骨小梁间隙(Tb.Sp)、结构模型指数(SMI),以及骨密度(BMD)、骨矿含量(BMC),分析各参数与BMD、BMC及术后复发相关性,并评价各参数对术后复发的预测价值。结果显示,复发组骨体积分数(BV/TV)、骨小梁厚度(Tb.Th)低于未复发组,骨小梁间隙(Tb.Sp)、结构模型指数(SMI)高于未复发组(P<0.05);BV/TV、Tb.Th与骨密度(BMD)、骨矿含量(BMC)呈正相关,Tb.Sp、SMI与BMD、BMC呈负相关(P<0.05);将年龄、BMD、BMC等其他因素控制后,BV/TV、Tb.Sp、Tb.Th、SMI与OVCF术后骨折复发显著相关(P<0.05);BV/TV、Tb.Sp、Tb.Th、SMI联合预测OVCF术后骨折复发的曲线下面积(AUC)最大,为0.888(P<0.05)。提示Micro-CT参数在OVCF患者中呈异常表达,采用Micro-CT检查可为临床预测OVCF术后骨折复发提供科学指导。     

儿童急性白血病骨髓浸润的MRI与MRS分析

目的 研究儿童急性白血病在发病初期、化疗缓解期及复发期骨髓MRI及MRS成像。方法 研究大连市妇女儿童医疗中心2015年2月至2016年8月间30例儿童(2~16岁)急性白血病患者的MRI平扫及MRS成像特征。急性淋巴细胞白血病25例,急性非淋巴细胞白血病5例;早期组24例,化疗缓解组21例,复发组2例,17例分别在发病初期、化疗缓解期或复发期行MRI检查。对照组为30例同年龄段正常儿童志愿者。结果 急淋初始发病时骨髓在T1信号减低,STIR示骨髓信号较均匀增高;MRS显示发病初期组脂峰消失或地平,水峰高耸。化疗缓解组骨髓腔信号在T1较初发组信号增高;STIR示骨髓信号减低;MRS脂峰复现。早期组与化疗缓解组比较、早期组与对照组之间骨髓FF%有显著性差异(P0.05),而化疗缓解组与对照组比较,无显著性差异(P0.05)。结论 骨髓MRI及MRS作为一种无创性的检查工具,对儿童急性白血病骨髓状态及评价预后具有价值。     

环境及遗传因素对温州地区绝经女性骨质疏松影响的研究

为探讨温州地区绝经后女性骨质疏松症（Postmenopausal osteoporosis,PMOP）与雌激素受体基因（Estrogen receptor,ERa）多态性及相关因素的关联性,将203例观察对象按骨质疏松症诊断标准分为骨量正常组、骨量减少组与PMOP组,分别检测各组观察对象的腰椎L1~4正位骨密度、PvuⅡ、XbaⅠ基因型并调查其膳食行为与运动习惯等项目。结果显示：（1）年龄越大、文化程度越低、身材矮小及BMI低者、妊娠次数越多、产次越多者易罹患PMOP;经常饮用牛奶、豆浆、茶,经常食用水产品、豆类、肉类、蛋类、水果、坚果及每月运动次数较多者与高骨密度有关;在校正年龄、文化程度、BMI等干扰因素之后,饮茶、食用水果、坚果类的次数与BMD呈正相关。（2）该研究未发现PvuⅡ与XbaⅠ基因型与PMOP间有关联。提示该地区膳食行为、环境因素与PMOP关系密切,但雌激素受体α多态性与骨密度间关系尚不明确,其对骨质疏松的预测价值尚待深入研究。     

DSA、CTA联合MR影像评估AIS患者脑支循环及预后性关系

探讨数字减影血管成像(DSA)、计算机断层扫描血管成像(CTA)联合磁共振(MR)影像评估急性缺血性卒中(AIS)患者脑支循环及预后性关系。选取60例大脑中动脉M1段急性闭塞所致AIS患者为研究对象,根据DSA、CTA与MR影像对其脑侧支循环评估,比较患者基线资料、结局指标等,并分析预后性。结果发现:基于DSA、CTA与MR影像对AIS患者脑侧支循环评估结果一致性良好;3种影像模式下脑侧支循环良好组与不良组结局资料差异显著(P<0.05);多因素分析显示,FVH-ASPECTS评分、rLMC评分、ASITN/SIR分级量表均为AIS患者神经功能预后的独立影响因素。总之,DSA、CTA、MR影像对AIS患者脑侧支循环评估具有一致性,且FVH-ASPECTS评分、rLMC评分、ASITN/SIR分级量表均为AIS患者神经功能预后的独立影响因素。     

血清外泌体的蛋白质组分析及其在骨质疏松中的应用

外泌体是细胞分泌的微小具膜囊泡，作为重要媒介参与细胞间的信号传递，已在疾病的诊断和治疗中发挥独特作用。骨质疏松症是全身性骨代谢疾病，容易引起骨密度减少并导致骨折，在老年人群中发病率很高，目前急需发展特异性体液诊断技术。本论文采用超速离心的方法，对血清中的外泌体进行了分离富集和表征，并采用液相色谱-质谱进行了外泌体蛋白质组学分析，共鉴定到了179个外泌体蛋白质，主要参与防御响应和免疫应答等生物过程。针对来自正常对照组、骨量减少组和骨质疏松组的血清样本，分离富集其中的外泌体，通过免标记定量蛋白质组学分析，分别鉴定到188、224和185个蛋白质。定量分析显示17个蛋白质的表达量在骨质疏松组和骨量减少组有显著改变（p<0.05），包括Integrin β 3、Integrin α 2 β 1、Talin 1和Gelsolin等，说明人体骨质在衰变过程中发生了系统性变化，并体现在血清外泌体中。该研究可为骨质疏松研究提供潜在的分子标志物，有助于阐明其病变机制。     

Effect of Soybean Isoflavone on Bone Mass and Ultrastructural in Ovariectomized Rat Model of Osteoporosis

为研究大豆异黄酮(SI)对骨质疏松模型大鼠骨量及微观结构的影响,将46只雌性SD大鼠双侧摘除卵巢,术后一周按血清总胆固醇水平随机分为5组,分别给予雌激素,低、中、高剂量SI干预并设正常对照组,实验周期为12周,灌胃给药,每周称质量一次,分别在去卵巢、给药4、8周处死时抽取尾静脉血,实验结束后分别测定血清碱性磷酸酶(AKP)活性及骨密度等指标.结果表明,高剂量SI干预对维持大鼠骨密度的作用与雌激素相似,去卵巢后干预SI可提高碱性磷酸酶(AKP)活性并能缓解因去卵巢造成的骨丢失,全视野下骨形态学以雌激素组、高剂量SI干预组与正常组结构最为接近.提示大豆异黄酮对骨质疏松模型大鼠的骨量及微观结构存在一定影响,中、高剂量干预可使骨质疏松模型大鼠血清AKP酶活性增加、逆转因去势造成的骨密度下降,考虑到植物雌激素与哺乳动物的雌激素受体(ER)结合能力低下,采用SI在临床开展干预的剂量与远期效果尚待进一步论证.     

MRI检查神经根沉降征诊断LSS患者的价值及其危险因素分析

本研究探讨磁共振成像(MRI)检查神经根沉降征(NRS)在腰椎管狭窄症(LSS)患者发生中的相关因素及其诊断学价值。选取接受腰椎MRI检查的262例(511个腰椎节段)患者进行研究,根据MRI结果患者腰椎节段分为狭窄组(172例患者,348个腰椎节段)和非狭窄组(90例患者,163个腰椎节段)。狭窄组硬膜囊面积(CSA)<100 mm²患者占比、椎管正中矢状径(PDA)≤15 mm患者占比、侧隐窝矢状径≤5 mm患者占比、神经根沉降征(NRS)阳性率均显著高于非狭窄组(P<0.05);NRS诊断LSS的曲线下面积(AUC)值为0.714;172例LSS患者,NRS阳性患者108例、NRS阴性患者64例,NRS阳性组的糖尿病率、硬膜囊CSA<100 mm²患者占比、椎管PDA≤15 mm患者占比、侧隐窝矢状径≤5 mm患者占比均高于阴性组患者,差异均具有统计学意义(P<0.05);硬膜囊CSA<100 mm²、椎管PDA≤15 mm、侧隐窝矢状径≤5 mm是LSS患者发生NRS的独立危险因素(P<0.05)。NRS对于诊断LSS具有较高的特异度,但是灵敏度一般,患者椎管狭窄越严重,其NRS发生的风险越高。     

Comparative proteomics analysis of microvesicles in human serum for the evaluation of osteoporosis

Osteoporosis is an emerging health issue worldwide. Due to the decrease of bone mineral density and the deterioration of skeletal microarchitecture, osteoporosis could lead to increased bone fragility and higher fracture risk. Since lack of specific symptoms, novel serum proteomic indicators are urgently needed for the evaluation of osteoporosis. Microvesicles (MVs) are important messengers widely present in body fluids and have emerged as novel targets for the diagnosis of multiple diseases. In this study, MVs were successfully isolated from human serum and comprehensively characterized. Comparative proteomics analysis revealed differential MVs protein profiling in normal subjects, osteopenia patients, and osteoporosis patients. In total, about 200 proteins were identified and quantified from serum MVs, among which 19 proteins were upregulated (fold change >2) and five proteins were downregulated (fold change <0.5) in osteopenia group and osteoporosis group when compared with the normal group. Three protein candidates were selected for initial verification, including Vinculin, Filamin A, and Profilin 1. Profilin 1 was further pre‐validated in an independent sample set, which could differentiate osteoporosis group from osteopenia group and normal group (p < 0.05). Our data collectively demonstrate that serum MVs proteome can be valuable indicators for the evaluation and diagnostics of bone loss disease.     

How well does dual photon absorptiometry predict osteoporosis? A comparison between neutron activation analysis and DEXA

The accuracy of dual energy X-ray absorptiometry (DEXA) for measurement of bone mass carried out by quantitative digital radiography (Hologic Inc.) was compared to results with neutron activation analysis (NAA) on 106 subjects. The accuracy with DEXA was further investigated by measurements on aluminium samples of known composition. DEXA measured 4 lumbar vertebrae by spine scan. The central third of the skeleton also was measured by whole body scan to obtain data on the same large part of the skeleton as measured by NAA. Results suggested that DEXA spine scans were more reliable than whole body scans. In addition, the measurement of total mineral content (BMC) was more reliable than the normalization of BMC to bone surface area (BMC/Area) or bone mineral density (BDM). Since the proportion of bone below detection would increase with development of osteoporosis, with osteoporosis the BMC would be increasingly underestimated, but to only a small extent, while the BMD would be more significantly overestimated.     

Generating SNP barcode to evaluate SNP-SNP interaction of disease by particle swarm optimization

Genome-wide association analysis involved many single-nucleotide polymorphisms (SNPs) data is challenging mathematically and computationally. Hence, we propose the odds ratio-based discrete binary particle swarm optimization (OR-DBPSO) method that uses the OR as a new quantitative measure of disease risk among many SNP combinations with genotypes called "SNP barcode". DBPSO are applied to generate SNP barcode, which computes the maximal difference of occurrence between the case and control groups, to predict disease susceptibility such as osteoporosis. Different SNP barcode patterns may occur several times in either low or high bone mineral density (BMD) groups. Our results showed that a DBPSO can effectively identify a specific SNP barcode with an optimized fitness value. SNP barcodes with a low fitness value will naturally be discarded from the population. A representative SNP barcode with a variable number of SNPs is processed to OR analysis to determine the maximum difference between the low and high BMD groups in statistics manner. Therefore, this paper introduces a powerful procedure to analyze disease-associated SNP-SNP interaction in genome-wide genes.     

Total reflection X-ray fluorescence analysis of oral fluids of women affected by osteoporosis and osteopenia

Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures; the early stage of decreased bone density is called osteopenia. More than 200 million people are affected and about 50% of post-menopausic women are expected to develop the disease. Osteoporosis, osteopenia and periodontal disease have in common several risk factors, being hyperthyroidism and smoking habits the most important ones. There is scarce information in the literature about the association between periodontal disease and osteoporosis and/or osteopenia. Some works suggest that osteoporotic women are susceptible to a higher loss of periodontal insertion, alveolar bones, and teeth.     

MRI参数对腰椎间盘突出症患者椎间盘退变程度的评估价值及与JOA、VAS评分相关性

选择腰椎间盘突出症(LDH)患者60例,分为轻度退变组、中度退变组、重度退变组。患者均行MRI检查,比较3组的MRI参数,包括髓核(NP)区、纤维环(AF)区T2值。检测比较发现,3组LDH患者NP区、AF区T2值间存在明显差异,且与腰椎功能评分(JOA)呈正相关,与腰部疼痛评分(VAS)呈负相关(P<0.05)。NP区、AF区T2值联合鉴别轻中度、中重度椎间盘退变程度的AUC大于各指标单一鉴别,具有较高评估效能。因此,MRI参数评估LDH患者椎间盘退变程度方面具有良好价值,可为临床明确患者病情提供重要参考。     

Association of ADIPOR1 polymorphisms with bone mineral density in postmenopausal Korean women

Adiponectin may affect bone through interactions with two known receptors, adiponectin receptors (ADIPOR) 1 and 2. We examined the association between polymorphisms of ADIPOR1 and ADIPOR2 and bone mineral density (BMD) in postmenopausal Korean women. Six polymorphisms in ADIPOR1 and four polymorphisms in ADIPOR2 were selected and genotyped in all study participants (n = 1,329). BMD at the lumbar spine and femur neck were measured using dual-energy X-ray absorptiometry. Lateral thoracolumbar (T4-L4) radiographs were obtained for vertebral fracture assessment and the occurrence of non-vertebral fractures examined using self-reported data. P values were adjusted for multiple testing using Bonferroni correction (P(corr)). ADIPOR1 rs16850799 and rs34010966 polymorphisms were significantly associated with femur neck BMD (P(corr) = 0.036 in the dominant model; P(corr) = 0.024 and P(corr) = 0.006 in the additive and dominant models, respectively). Subjects with the rare allele of each polymorphism had lower BMD, and association of rs34010966 with BMD showed a gene dosage effect. However, ADIPOR2 single nucleotide polymorphisms and haplotypes were not associated with BMD at any site. Our results suggest that ADIPOR1 polymorphisms present a useful genetic marker for BMD in postmenopausal Korean women.