DCE-MRI参数联合IFIT1基因对腰椎间盘突出患者椎间盘退变程度的评估价值

探讨DCE-MRI参数及IFIT1基因对腰椎间盘突出症(LDH)患者椎间盘退变(IDD)程度的评估价值。随机选取确诊的66例LDH患者作为研究对象,根据改良Pfirrmann分级法将患者分为2组:轻中度IDD(Ⅰ~Ⅲ级)组(46例)和重度IDD(Ⅳ~Ⅴ级)组20例。通过DCE-MRI检查考察患者的K-trans值,采用日本骨科学会评分(JOA)评估腰椎功能,采用视觉模拟评分法(VAS)评估腰部疼痛,采用RT-PCR检测外周血单个核细胞(PBMC)中IFIT1的mRNA表达。轻中度IDD组的K-trans值显著低于重度IDD组。轻中度IDD组患者PBMC中的IFIT1 mRNA相对表达量显著低于重度IDD组。K-trans值与PBMC中的IFIT1 mRNA水平和VAS评分正相关,与JOA评分负相关(P<0.05)。PBMC中的IFIT1 mRNA水平与VAS评分正相关,与JOA评分负相关(P<0.05)。K-trans值和PBMC中的IFIT1 mRNA水平联合诊断重度IDD的AUC值、敏感性和特异性分别为0.991、91.3%和100.0%,AUC值和特异性均高于单独诊断。DCE-MRI检查中的K-trans值联合PBMC中的IFIT1 mRNA水平可用于LDH患者IDD程度的诊断。     

腰椎CT矢状面屈曲角、终板屈曲深度和双侧腰大肌横断面积差值诊断腰椎间盘突出症(LDH)的价值及与退变程度的关系

本研究的目的是探讨腰椎矢状面屈曲角、终板屈曲深度和双侧腰大肌横断面积差值诊断腰椎间盘突出症(LDH)的价值及与椎间盘退变程度的关系。选取LDH患者120例作为观察组,同时选取体检健康者100例作为对照组,均给予腰椎CT检查。实验结果显示,观察组L_3～S_1平均终板屈曲深度、平均矢状面屈曲角、平均腰大肌横断面积与对照组比较,差异有统计学意义(P0.05);观察组Pfirrmann分级Ⅳ～Ⅴ级的患者L_3～S_1平均终板屈曲深度、平均矢状面屈曲角、平均腰大肌横断面积差值与Ⅱ～Ⅲ级患者比较,差异有统计学意义(P0.05);L_3～S_1平均终板屈曲深度、矢状面屈曲角、腰大肌横断面积差值诊断Pfirrmann分级Ⅳ～Ⅴ级的ROC曲线下面积分别为0.601、0.890和0.771。本研究证实矢状面屈曲角、终板屈曲深度、双侧腰大肌横断面积差值与LDH患者椎间盘退变程度有一定关系,诊断椎间盘退变程度有一定价值。     

氢质子MR波谱及双回波同反相位成像评价腰椎骨质疏松的研究

为探究氢质子MR波谱(MRS)的脂肪分数(FF)、脂水比(LWR)及双回波同反相位信号比值(SIR)与腰椎定量CT(QCT)骨矿物质密度(BMD)的相关性,并评估MRS、双回波同反相位成像对腰椎骨质减低及骨质疏松的诊断价值,本研究对因腰腿痛就诊的120名患者资料进行了回顾性分析,根据QCT分类标准将患者分为正常组、骨量减少组和骨质疏松组。所行MRI检查包括MRS和双回波同反相位成像,测量腰2~4椎体FF、LWR及双回波同反相位SIR。结果发现,FF、LWR、SIR与BMD呈负相关;FF、LWR与SIR呈正相关。FF、LWR、SIR、BMD在骨量正常组、骨量减少组和骨质疏松组任意两组间差异均有显著性(P<0.001)。本研究表明MRS及双回波同反相位成像可通过无创无辐射检测骨髓脂肪组织而间接反映骨代谢情况。     

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。     

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。     

腰椎CT定量参数诊断LDH的价值及与退变程度的关系

回顾性分析130例腰椎间盘突出症(LDH)患者(观察组)的腰椎CT影像学资料,选取同期其他原因行腰椎CT检查的130例患者作为对照组,比较发现,观察组L_4上终板和下终板、L_5上终板和下终板、S_1上终板屈曲角、L_(4～5)和L_5～S_1双侧腰大肌横断面积差值均大于对照组,且与LDH改良Pfirrmann分级呈正相关(P0.05);观察组L_4上终板和下终板、L_5上终板和下终板、S_1上终板的终板屈曲深度均低于对照组,且与LDH改良Pfirrmann分级呈负相关(P0.05);经ROC分析获取各参数截断值敏感度均70%。因此,笔者认为腰椎CT矢状面屈曲角、终板屈曲深度、双侧腰大肌横断面积差值可为LDH诊断及退变程度判断提供有效参考价值。     

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。     

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。     

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。     

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.     

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.     

Association of Paraoxonase 1 (PON1) polymorphisms with osteoporotic fracture risk in postmenopausal Korean women

There is increasing evidence of a biochemical link between lipid oxidation and bone metabolism. Paraoxonase 1 (PON1) prevents the oxidation of low-density lipoprotein (LDL) and metabolizes biologically active phospholipids in oxidized LDLs. Here, we performed association analyses of genetic variation in PON1 to ascertain its contribution to osteoporotic fractures (OFs) and bone mineral density (BMD). We directly sequenced the PON1 gene in 24 Korean individuals and identified 26 sequence variants. A large population of Korean postmenopausal women (n=1,329) was then genotyped for eight selected PON1 polymorphisms. BMD at the lumbar spine and femoral neck was 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 (i.e., wrist, hip, forearm, humerus, rib, and pelvis) was examined using self-reported data. Multivariate analyses showed that none of the polymorphisms was associated with BMD at either site. However, +5989A>G and +26080T>C polymorphisms were significantly associated with non-vertebral and vertebral fractures, respectively, after adjustment for covariates. Specifically, the minor allele of +5989A>G exerted a highly protective effect against non-vertebral fractures (OR=0.59, P=0.036), whereas the minor allele of +26080T>C was associated with increased susceptibility to vertebral fractures (OR=1.73, P=0.020). When the risk for any OFs (i.e., vertebral or non-vertebral) was considered, the statistical significance of both polymorphisms persisted (P=0.002-0.010). These results suggest that PON1 polymorphisms could be one of useful genetic markers for OF risk in postmenopausal women.     

Bone mineral density of lumbar spine and proximal femur in healthy males

The aim of this study was to investigate the relationship between BMD and age at lumbar spine and proximal femur in Turkish males. Two hundred ninety healthy males (aged 20-59 years) were investigated. BMD of the lumbar spine had its peak at ages 30-39, however, the peak for the proximal femur was between the ages of 20 and 29. There was a significant decrease in BMD at proximal femur after these peak values with increasing age. In conclusion, there was a significant correlation between age and the proximal femoral BMD in males and age has a strong predictive power on proximal femur BMD score. This revised version was published online in August 2006 with corrections to the Cover Date.     

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.     

Methionine synthase reductase polymorphisms are associated with serum osteocalcin levels in postmenopausal women

Homocysteine (Hcy) is thought to play an important role in the development of osteoporosis and fracture. Methionine synthase reductase (MTRR) is an enzyme involved in the conversion of Hcy to methionine. We hypothesized that certain genetic polymorphisms of MTRR leading to reduced enzyme activity may cause hyperhomocysteinemia and affect bone metabolism. We therefore examined the associations of the A66G and C524T polymorphisms of the MTRR gene with bone mineral density (BMD) and serum osteocalcin levels in postmenopausal women. Although we did not detect any significant associations between MTRR polymorphisms and BMD or serum osteocalcin levels, we found that the 66G/524C haplotype, which has reduced enzyme activity, was significantly associated with serum osteocalcin levels in a gene-dose dependent manner (P = 0.002). That is, the highest osteocalcin levels (34.5 +/- 16.8 ng/ml) were observed in subjects bearing two copies, intermediate osteocalcin levels (32.6 +/- 14.4 ng/ml) were observed in subjects bearing one copy, and the lowest levels of osteocalcin (28.8 +/- 10.9 ng/ml) were observed in subjects bearing no copies. These results suggest that the 66G/524C haplotype of the MTRR gene affect bone turn over rate.