云克调节绝经后骨质疏松骨代谢调节作用
云克注射液联合锶89治疗骨转移癌骨痛的疗效及对患者血清钙磷指标的影响
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云克注射液联合锶89治疗骨转移癌骨痛的疗效及对患者血清钙磷指标的影响孙莲华【期刊名称】《《中国合理用药探索》》【年(卷),期】2019(000)008【总页数】4页(P19134-19136)【关键词】云克注射液; 锶89; 骨转移癌; 骨痛【作者】孙莲华【作者单位】[1]信阳市中心医院核医学科河南信阳464000【正文语种】中文【中图分类】R730.5随着国内医疗技术水平的提高,恶性肿瘤诊断和治疗效果显著提升,患者的生存期明显延长[1]。
但调查研究显示,骨转移癌的发病率随之升高,并发骨痛者所占比例也较高,严重影响患者的生存质量[2]。
目前临床上对于骨转移癌骨痛的临床治疗手段主要包括激素疗法、化疗以及外科手术等,效果有限,副反应较为明显,且镇痛效果欠佳。
专家指出,采取放射性核素内照射治疗能够提高广泛骨转移的治疗效果,且止痛作用较明显[3]。
我院采用云克注射液联合锶89治疗骨转移癌骨痛,效果较理想,现分析其临床优势,以期为该病的治疗提供参考,报道如下。
1 资料与方法1.1 一般资料将2015年1月—2017年12月我院收治的60例骨转移癌骨痛患者纳入本研究。
按照随机数字表法分为观察组和对照组,各30例,观察组男18例,女12例;年龄35~74岁,平均年龄(59.26±6.31)岁;肿瘤类型:乳腺癌10例、肺癌12例、前列腺癌4例、肠癌2例、其他2例;转移灶数量:1个3例、2个7例、2个以上20例。
对照组男17例,女13例;年龄35~75岁,平均年龄(59.29±6.35)岁;肿瘤类型:乳腺癌11例、肺癌11例、前列腺癌 3例、肠癌2例、其他3例;转移灶数量:1个2例、2个8例、2个以上20例。
两组患者性别、年龄等基线资料比较,差异无统计学意义(P>0.05),具有可比性。
1.2 纳入和排除标准纳入标准:患者经常规影像学检查结合病理活检确诊为骨转移癌,存在明显骨痛症状;预计生存期超过3个月;符合本研究用药指征;签署知情同意书。
绝经后妇女骨代谢生化指标的临床观察及应用
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绝经后妇女骨代谢生化指标的临床观察及应用
荣墨克
【期刊名称】《中国老年学杂志》
【年(卷),期】2003(023)012
【摘要】目的研究早期绝经后妇女4种骨生成和骨吸收生化指标的变化及与骨密度(BMD)的关系.方法将107例绝经后妇女分为对照组和治疗组(钙剂组,钙剂+利维爱组).分别于治疗前和治疗后测定碱性磷酸酶(ALP)、骨钙素(OC)、抗酒石酸酸性磷酸酶(TrACP)、Ⅰ型胶原羧基端端肽(CTx).并与骨密度测定方法比较.结果对照组骨吸收生化指标1年后出现降低,治疗组于治疗后1个月和3个月出现不同程度的骨代谢生化指标的改变,TrACP和CTx改变早且显著.骨密度在治疗后3个月未见改变,1年后出现骨密度增加.结论骨密度测定对于早期监测骨质疏松症的治疗效果没有意义,TrACP和CTx可作为敏感的早期监测骨代谢变化生化指标.
【总页数】2页(P826-827)
【作者】荣墨克
【作者单位】吉林大学中日联谊医院检验科,吉林,长春,130031
【正文语种】中文
【中图分类】R446.1
【相关文献】
1.雷洛昔芬对绝经后妇女骨密度、骨代谢生化指标和血脂的影响 [J], 程娜;吴毅明
2.绝经后妇女骨代谢生化指标与骨密度相关性研究 [J], 李玉琴;段凤梅;周亚丽
3.健康绝经后妇女应用盐酸雷洛昔芬1年后骨代谢生化指标的变化 [J], 张颖;张忠兰;刘建立
4.异黄酮补充疗法对绝经后妇女骨密度及骨代谢生化指标的影响 [J], 于青琳
5.苯卓昔芬对健康绝经后妇女骨代谢生化指标的影响 [J], 徐苓;吴宜勇;刘建立;王淑玉;黄琪仁;林金芳
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云克治疗骨质疏松患者的护理体会
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云克治疗骨质疏松患者的护理体会摘要】目的:探究骨质疏松患者采用云克治疗的方法和效果。
方法:选取2014年4月~2015年6月收治的113例骨质疏松患者进行护理,随机分组,实验组60例选择综合护理,对照组53例患者选择常规护理,比较患者的护理效果。
结果:实验组患者护理总有效率为90.91%,对照组患者护理总有效率为75.0%。
实验组患者得到更加显著的护理效果,有统计学意义(P<0.05)。
结论:骨质疏松患者接受云克治疗的同时接受综合护理措施,能够提高治疗效果,缓解患者的骨痛,安全性高,操作简单,值得推荐。
【关键词】骨质疏松;云克治疗;综合护理【中图分类号】R473.6 【文献标识码】A 【文章编号】1007-8231(2016)01-0021-02Nursing Yunke treatment of patients with osteoporosis Guoai Xia, Li Zhaoxia, Cheng Chao, Zhou Shengkui.Qingdao City Hospital Department of Nuclear Medicine,Qingdao City, Shandong Province 266071【Abstract】Objective To explore the osteoporosis patient using the method and effects of MDP treatment. Methods From april 2014 to June 2015 were treated 113 cases of patients with osteoporosis care, randomized, experimental group of 60 patients comprehensive care to select the control group of 53 patients choose routine care, more patient care results. Results The total effective patient care in the experimental group was 90.91%, the total effective patient care in the control group was 75.0%. Experimental group patients receive care more significant effect was statistically significant (P <0.05). Conclusion Osteoporosis patients receiving treatmentat the same cloud gram comprehensive care measures can improve the therapeutic effect, relieve the patient's pain, safe, easy to operate, is recommended.【Key words】Osteoporosis; Yunke treatment; Comprehensive care骨质疏松属于全身性的骨骼疾病,骨组织出现微循环的破坏或者患骨量减少,从而降低骨强度,增加骨脆性,容易出现骨折,该疾病有继发性和原发性两种。
云克联合低频脉冲电磁场强化治疗老年骨质疏松的疗效
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3讨论 在老年恶性肿瘤中,DTC 被认为是预后较好的一种恶性肿
瘤,但因老年人的生理特点及老年 DTC 的侵袭性、隐匿性,部 分老年 DTC 预后较差。老年 DTC 与青中年 DTC 相比有明显的 不同。老年 DTC 的病史长,发现晚,病情较重。老年患者又常 合并一些基础疾病,如冠心病、高血压、糖尿病、呼吸系统疾病, 延误最佳手术时机,部分手术难以根治,残余癌灶较多,肺、骨 转移相对发病率较高。DTC 具有易发生淋巴结转移的特点,但 老年 DTC 较青壮年发生颈部淋巴结转移较晚。有研究〔2〕表明 甲状腺原发肿瘤大小相等条件下,年龄与颈部淋巴结转移数目 之间存在显著的负相关。还有学者〔3〕认为无淋巴结转移、无远 处转移是增加清甲成功率的关键因素。Lundgren 等〔4〕的研究 发现,患者初诊时若存在远处转移灶,虽然采用同样的治疗方 案,但是其死亡率是初诊时仅有局部淋巴结转移灶患者的 7 倍。因此,老年 DTC 术后 1 ~ 2 个月及时行131 I 清甲或清灶治疗 疗效显著。目前,国际上公认的 DTC 治疗为甲状腺癌根治术 和 / 或颈部淋巴结清扫术 + 131 I 内照射治疗 + 甲状腺激素抑制 治疗,Paolo Zanotti-Fregonara 等〔5〕认为对 DTC 患者早期诊断并 行131 I 治疗,可有效地控制已明确的转移灶,还可以抑制癌组织 潜在的转移性。DTC 肿瘤组织分化程度较高,具有甲状腺组织 的生物学行为,可以摄取131 I,故可以将术中未能切除的甲状腺 组织功能去除,并对于微小转移灶或因侵犯动脉、食管、气管而
3
Hale Waihona Puke 1 96. 81)表 1 四组患者治疗后疼痛改善效果( n = 31,n)
绝经后骨质疏松性腰椎骨折骨代谢指标的转变
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绝经后骨质疏松性腰椎骨折骨代谢指标的转变李保林,谭建伟,利云峰,庾伟中,杨冰【摘要】目的了解雌二醇和白细胞介素6等骨代谢指标在骨质疏松症发病中的作用。
方式选择女性腰椎骨折患者120 例,绝经后有骨质疏松者60 例(OP组),绝经后无骨质疏松者30 例(NOP组),另外选择绝经前妇女30 例为对照组。
对120名妇女雌二醇、骨密度、白细胞介素六、血清总碱性磷酸酶、骨钙素、尿羟脯氨酸肌酐比值、尿钙肌酐比值等指标进行了测定。
结果绝经后妇女骨形成指标骨钙素及碱性磷酸酶明显高于对照组妇女,其中碱性磷酸酶在OP组和NOP 组间有不同,而骨钙素在OP组和NOP组间无不同;绝经后妇女骨吸收指标尿羟脯氨酸肌酐比值及尿钙肌酐比值明显高于对照组妇女,OP组又明显高于NOP组;绝经后妇女的血清雌二醇的含量明显低于对照组(绝经前妇女),OP组又明显低于NOP组;绝经后妇女血清白细胞介素6的含量明显高于对照组妇女,而OP组又明显高于NOP组。
结论雌二醇、白细胞介素6等骨代谢指标与骨质疏松关系紧密。
这充分说明雌激素水平的下降,IL6分泌增多,致使骨吸收加速。
【关键词】骨质疏松症;腰椎骨折;骨代谢Study on Parameter of the Bone Metabolism Changes in Lumbar Vertebrae Fracture Patient of Postmenopausal OsteoporosisAbstract: Objective To explore the role of parameter of the bone metabolism in onset of osteoporosis. Methods We chose 120 women with lumbar vertebrae fracture(90 cases postmenopausal and 30 premenopausal). These women were divided into the three groups: osteoporosis group(OP,60 cases) and nonosteoporosis group(NOP,30 cases). 30 normal premenopausal women were chose as the control group. The BMD,the serum levels of E2,Alkaline phosphatase(ALP),Osteocalcin(bone γcarboxyglutamic acid containing protein, BGP) and the Urinary hydroxyproline(U Hyp)/creatinine(Cr,Urinary Ca(U Ca)/Cr were measured. Results The level of BGP,ALP, IL 6 in postmenopausal women was significantly higher than that in the the control group(P<0.01), the level of the U Hyp/Cr and U Ca/Cr was significantly higher than in the the control group too(P<0.01),whereas the BMD and the level of E2 in postmenopausal women was significantly lower than that in the control group. (P<0.01). There was significantly difference in BMD, E2, IL6, ALP, U Hyp/Cr and U Ca/Cr between OPand NOP group. Conclusion There is some relationship between the decreased expression of E2 and the increased expression of IL 6, the decreased expression of E2 may activate the cells producing IL6, which leads to the increased expression of IL 6; the increased expression of IL 6 enhances the bone resorption, which leads to the increase of U Hyp/Cr,UCa/Cr and decrease of BMD, and this is one of possible important reasons for osteoporosis.Key words: osteoporosis; lumbar vertebrae fracture;bone metabolism骨质疏松是以骨量减少、骨组织显微结构退化(松质骨骨小梁变细、断裂、数量减少,皮质骨多孔、变薄)为特点,以致骨的脆性增高及骨折危险性增加的一种全身性骨病。
云克疗效
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目的探讨锝亚甲基二磷酸盐针剂联合碳酸钙D3片、骨化三醇胶丸治疗绝经后2型糖尿病并骨质疏松症患者的疗效。
方法诊断明确的绝经后2型糖尿病并骨质疏松症患者31例为治疗组,其中汉族19例,维吾尔族12例。
予以每日静脉滴注锝亚甲基二膦酸盐针剂15日,联合口服碳酸钙D3片、骨化三醇胶丸,持续6月。
同时选取绝经后2型糖尿病并骨质疏松症患者28例为对照组,其中汉族14例,维吾尔族14例,年龄、糖尿病病程及绝经年限均与治疗组匹配,常规口服碳酸钙D3片、骨化三醇胶丸,疗程均为6月。
测定两组治疗前后的骨密度、血清碱性磷酸酶、肝功、肾功及骨代谢指标,并进行组间对比。
结果治疗组6个月后临床症状改善,云克治疗组疗效明显优于对照组,总有效率%;与对照组的各部位平均骨密度值比较差异有统计学意义(P<。
左前臂桡尺骨远端1/3交界处、腰椎及股骨颈骨密度(BMD)增幅分别达%、%,%。
与治疗前相比血清碱性磷酸酶降低,差异有统计学意义。
治疗前后血清肝肾功无明显变化。
结论云克联合钙尔奇D片、盖三淳胶丸治疗绝经后女性2型糖尿病并骨质疏松症有效且安全。
22-0011-01类风湿关节炎(RA)是一种常见的以关节慢性炎症为主要表现的系统性风湿性疾病,病因不明,致残率高,严重影响患者生活质量。
我科于2006年2月至2009年3月间,对来院诊治的80例RA患者的治疗中,采用按序抽样和统一治疗方案进行治疗,并开展疗效和血沉、C反应蛋白的综合临床研究,现将结果报告如下:1 资料和方法病例及分组 80例患者中男性11例,女性69例,年龄22~68岁,平均年龄为42±8,病程为3月~8年,平均病程月为50±8。
按入院先后顺序编号,将80例患者分成2组,单号入治疗组(40例),双号入对照组(40例)。
病例诊断标准全部病例诊断均符合1987年美国风湿病学院关于RA的诊断标准[1]。
所选病例均表现为活动期:关节肿痛指数≥3个,加下例两项或两项以上指标:a.血沉≥25mm/h或C反应蛋白≥10mg/L;b.晨僵≥1h;关节指数>9。
云克与钙剂_维生素D_3联合治疗原发性骨质疏松症的探讨
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论著云克与钙剂、维生素D3联合治疗原发性骨质疏松症的探讨林 勇,王 雄 ,肖 石(成都铁路中心医院,四川成都610081)摘要 目的 探讨云克与钙剂、维生素联合治疗原发性骨质疏松症的临床疗效。
方法 选择70例经双能量X线骨密度仪(DEXA)检查证实存在原发性骨质疏松症的患者,其骨密度值(BMD值)<峰值2SD,随机分为治疗组和对照组,治疗组(云克组)35例,治疗方案采用云克5 5mg缓慢静脉推注,1次/d,20d。
间隔1周后开始下一疗程。
共4个疗程。
同时口服钙尔奇D(成分:碳酸钙1 5g,可提供元素钙600mg,维生素D3125IU),1片/d,持续应用半年。
对照组35例,应用钙尔奇D,1片/d。
治疗前和治疗后6个月分别测定尺桡骨值及BGP、PYD检测。
结果 用药6个月后治疗组患尺桡骨BMD均有明显增加。
结论 云克与钙剂、维生素D3联合治疗半年以上可以提高骨质疏松患者质量,从而降低骨折危险度。
关键词 99锝 亚甲基二膦酸盐;钙;维生素D3;骨质疏松;治疗中图分类号 R591 1 文献标识码 A 文章编号 1004 0501(2008)09 1183 03Combination therapy of Yunke,calcium and vitamin D3on primary osteoporosis.LIN Yon g,WANG Xiong,XIAO Shi.Chengdu Railway Center Hospital,Chen gdu,Sichuan610081,ChinaAbstract Objective To explore the clinical effect of combinaton therapy of Yunke(99technetium methylenediphosphonate,99Tc MDP),calciu m and vitamin D3on primary osteoporosis.Methods Seventy patients suffered from primary osteoporosis with bone mineral densi ty(BMD)2SD lower than peak value measured by dual energy X ray absorptiometry were randomized in to treatment group and control group.Treatment group contained35cases were treated with treatment protocols included Yunke(5.5mg of Yunke was injected slowly through vein everyday for twenty times and subsequently with an intermission for one week,repeated four ti mes),calcium carbonate (1.5g,once daily)and vitamin D3(125u,once daily)for six month.Control group contained35cases were treated with calcium carbonate (1.5g,once daily)and vitamin D3(125u,once daily)for six month.The ulna and radius B MD,seru m bone gla protein and urine pyridinoline between the two groups were compared.Results The ulna and radi us B MD of treatment group was improved significantly after si x month of combinati on therapy of Yunke,calci um and vi tamin D3.C onclusion Six month of combination therapy of Yunke,calcium and vitain D3can i mprove the B MD and lower the ri sk of puncture of patients with primary osteoporosis.Key w ords 99technetium methylenediphosphonate;calciu m;vitamin D3;pri mary osteoporosis;therapy骨质疏松症是一种以骨量减少和骨组织显微结构退化为特征的全身性进展性骨骼疾病。
云克对骨质疏松症患者成骨功能影响的研究
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678中国骨质疏松杂志 2021年5月第27卷第5期 Chin J Osteoporos , May 2021 , Vol 27 , No. 5Published online doi : 10. 3969/j.issn.1006-7108. 2021. 05. 011云克对骨质疏松症患者成骨功能影响的研究陈洁1周锡平1何成松1何跃2*基金项目:四川省卫生和计划生育委员会科研课题( 150078)* 通信作者:何跃,Email :hylyfy@ 1. 西南医科大学附属医院风湿免疫科,四川泸州6460002. 西南医科大学附属医院眼科,四川泸州646000中图分类号:R589. 5;R965 文献标识码:A文章编号:1006-7108(2021) 05-0678-05摘要:目的观察云克对骨质疏松症患者成骨功能的影响。
方法取骨质疏松症患者骨组织,酶消化法培养成骨细胞,给予不同浓度云克予以干预,CCK-8法检测细胞增殖功能、流式细胞仪检测细胞周期、对硝基苯磷酸盐法检测碱性磷酸酶(ALP ) 活性、茜素红染色计数矿化结节的变化、Real-time RT-PCR 检测骨钙素和骨形成蛋白(BMP )-2基因的表达。
结果 在10-9 moVL-10-5mol/L 浓度条件下云克对成骨细胞均有促进增殖的作用(P<0.05);在10-8mo^L 浓度云克作用下,成骨细胞S 期细胞均明显增多(P<0.05),G0/Gl 期细胞明显减少(P <0.05),细胞增殖指数(PI )明显增高(P <0.05);在10-9mol/L- 10-5 mo^L 组浓度条件下云克对成骨细胞ALP 活性均有促进作用(P<0. 05);在10-8mol/L 浓度云克作用下,成骨细胞形成矿化结 节数量增多(P<0.05),BMP-2 mRNA 表达明显增高(P <0.05),骨钙素mRNA 表达稍有增高,但差异无统计学意义(P >0.05)o 结论 在一定浓度条件下云克具有促进骨质疏松症患者成骨功能的作用。
云克治疗绝经后骨质疏松症的临床疗效观察
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21 . 降压疗效 8 周治疗后对照组和治疗组收缩压和舒 张压均显 著下降 , 差异 有统计学 意义(< . ) P O 5。对照组降压 总有效率 7. 治疗组降压 总有效 率 0 9 %, 4 9 . 治疗组优于对照组 , 1 %, 2 两组 比较差异有统计学意义( , . ) B 0 5 。见表 1 0 。
医学信息 2 l 年 1 月第 2 卷第 l 期 M d aIf Tt nD c21. o 2. o 1 01 2 4 2 ei 1n na . e.0 1V1 4 N .2 c 0 li o .
不全 、 型糖尿病患者 、 2 同时服用其他影 响血压 的药物患者 。随机分为对 照组
重2 治疗前后两组患者心率变 化情况( /_ 次mn )
表 1 治 疗 前 后 两 组 患 者 的 降 压 疗 效 ( s mmHg) 。
氯噻嗪为基础 的降压治疗方案 。 酸氨氯地平还能较有效地控制血压晨峰 , 苯磺 对糖、 、 脂 尿酸代谢 和电解质均无影响。以苯磺酸氨氯地平 为基础的联合降压 治疗模式 , 具有重要的临床意义口 。 瑞典老 高血压 试验( T P 和英 国医学研究 委员会治疗老 年高血压试 { SO ) 验( R ) M c 发现应 用小剂量噻 嗪类 利尿剂 比大剂 量更明显降 低脑卒 中和冠肪 、 电解质代谢无影响 。近期发表的 抗 高血压 和降脂 治疗预防心脏病发作试验 ( L H T 再 次证实价格低廉的利 A LA ) 尿剂作为高血压病一线治疗药物的地位 。 本研究结果显示 ,国产氨氯地平联合氢氯噻 嗪治疗轻 中度老年高血压具 有协 同降压作用 , 总有效率达 9. 优于单用氨氯地平治疗 。国产氨氯地平 1 %, 2 联合氢氯噻嗪治疗轻中度老年高血压取得较理想降压效果的同时 ,对心率无 明显影响 , 价格相对低廉 , 是基层较为理想 的联合治疗方案之一 , 值得推荐。
云克的功效及临床运用
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云克的药理作用是利用微量元素价态的变化,来消除人体内的自由基,保护超氧化物歧化酶SOD的活性;它还能抑制前列腺素的产生,并通过螯合金属离子而降低若干基质金属蛋白酶包括胶原酶的活性,从而发挥消炎、镇痛的作用;对骨的生成区和具有炎症的骨关节部位具有明显的靶向性,能明显的抑制破骨细胞活性,抑制骨吸收,因而能修复破坏的软骨组织,恢复关节功能;有研究表明, RA 患者因自由基增多而引起SOD 系统的紊乱,导致炎性组织损伤加重, 锝99TC能增强人体抗类风湿疾病的能力,避免自由基促进炎症的发展和损伤组织;AS强直性脊柱炎的治疗是一个长期的、慢性的过程,比较棘手也无特异性的药物或方法;云克的主要成分是99mTc和亚甲基二磷酸盐MDP,前者是一种化学性质活泼的稳定同位素,是一种人工微量元素,化合价态为+4价时,很容易得到或失去一个电子成为+3或+5价态,而得失电子和价态变化可以消除人体内的自由基,保护人体内超氧化物岐化酶SOD的活力,调节人体自身免疫功能,增强人体抗风湿性疾病的能力;MDP具有非甾体类药物和皮质激素两种作用,通过抑制前列腺素的产生,抑制组织胺的释放等,具有较强的抗炎、镇痛作用;且MDP是一种盐类化合物,对金属离子有很强的鳌合能力,通过鳌合金属离子可降低若干金属蛋白酶的活性,因此对组织的破坏有抑制作用,对破坏的软组织和软骨有修复作用;云克作为一种新的抗风湿药,具有标本兼治、毒副作用少、消炎镇痛效果好的特点,值得进一步推广应用;骨关节炎OA又称增生性关节炎,病因迄今尚未阐明;它主要累及滑膜关节,伴有关节间隙狭窄或边缘骨赘形成,是力学和生物学等多因素共同作用下导致软骨细胞、细胞外基质、软骨下骨质三者降解和合成失衡的结果;在50岁以上人群中, OA发病率仅次于心脏病,高居第二位;双氯芬酸钠为非甾体抗炎药NSAID,对前列腺素合成酶、环氧化酶cyclooxygenase,简称COX有抑制作用,可导致前列腺素生成减少,从而达到缓解症状的目的;但非甾体抗炎药同时存在起效缓慢、作用较弱、损伤消化道粘膜等缺点,每年由这类药物引发的不良反应或并发症高达20万例,病死率>20%;云克为微量元素锝和亚甲基二磷酸盐组成,亚甲基二磷酸盐能抑制金属蛋白酶,阻止对关节软骨组织的分解破坏作用;锝通过得失电子清除自由基,防止其对组织的破坏;锝与亚甲基二磷酸盐鳌和后有免疫抑制作用,在人体内半衰期长,是一种长效自由基清除剂;云克对骨关节部位具有显着的靶向性,明显抑制破骨细胞的活性,能修复破坏的软骨组织,使病理改变逆转,进而修复关节功能;由于其积蓄在骨的生成区和骨关节部位,无须血药浓度,体内半衰期1~10年,长期发挥疗效;亚甲基二磷酸盐还具有类似非甾体抗炎药和肾上腺皮质激素的作用,通过抑制前列腺素的产生,抑制血胺释放等,具有较强的抗炎、镇痛作用而没有类似的毒副反应;近年来对骨关节炎的研究进入了分子水平,细胞因子的作用越来越受到关注;基础研究发现白细胞介素-1 IL-1和肿瘤坏死因子αTNF-α是骨关节炎病理过程中促进软骨基质降解和关节软骨破坏的两种最重要的细胞因子;研究表明云克还可明显降低IL-1β、TNF-α的水平,其治疗作用可能与此直接相关;目前OA治疗的目的在与缓解症状,改善功能,避免或减少畸形,减少病情进展的风险性及有利于受损关节的修复;在本临床对照观察试验中,我们应用云克与对照组非甾体抗炎药进行了随机分组对照研究,结果表明治疗组各项指标均显着优于对照组;综上所述,我们认为云克通过多种不同药理作用的联合,治疗膝关节OA具有很好的疗效;经临床验证病人用药后从未发生过不良反应,其安全性极好,对人体无毒副作用,作为一种新的治疗骨关节的药物,值得临床推广和进一步研究;股骨头缺血性坏死ANFH 常见于大量饮酒,外伤、长期服用激素类药物等原因造成供应股骨头的血管发生形态或结构的改变,引起股骨头供血不足,使股骨头骨质代谢出现异常,成骨与破骨的平衡失凋,导致骨质疏松、破坏,由于其病变部位的特殊性,严重影响患者的正常生活;在各种治疗中内科药物疗效不显着,外科手术置换人工股骨头费用昂贵,且耐用时间短,使 ANFH 成为临床上较为难治的顽症;新药“云克”由微量元素锝Tc和亚基二磷酸盐MDP螫合而成,由于MDP 的趋骨性,该药有较长的骨停留时间,致使Tc 的体内半衰期大大延长,成了长效的自由基清除剂;它可以通过调节人体自身免疫功能,保护超氧化物歧化酶SOD的活力,避免自由基促进炎症发展和损伤组织;“云克”还是一种盐类化合物,可通过螫合金属离子降低若干金属蛋白酶的活性,降低胶原酶对骨滑膜组织的破坏作用,抑制破骨细胞,增强成骨细胞,促进新骨形成,从而恢复受损关节,使病情逆转;同时“云克”还能抑制前列腺素的合成和抑制组织胺的释放作用,从而发挥抗炎和镇痛作用,螯合后其治疗机理使这两种有效成分产生协同作用,这是其他药物无法替代的,本品临床使用推荐剂量未发现明显毒副作用;本文42 例ANFH 患者经云克治疗后,治愈率为52%,总有效率为93%;完全有效者 4 例10%、疗效显着者 18 例43%、好转者17 例40%;对16 例Ⅱ期和较早Ⅲ期 ANFH 患者的治疗后,髋关节功能完全恢复,疼痛消失,取得显着疗效;17 例晚Ⅲ期、Ⅳ期患者疼痛症状减轻,运动功能改善,达到了很好的近期止痛效果;本文病例的治愈率及总有效率都是比较理想的,经检索2005~2008年与ANFH相关的医学期刊,治愈率为%~%,总有效率为%~%,虽然总有效率相近,但治愈率却明显高出相关报道;“云克”作为治疗骨科疾病的新型药物,具有治疗方法简单、操作方便、安全有效以及毒副作用小等特点,对I、Ⅱ期和较早Ⅲ期ANFH 患者是一种积极的治疗方法,对Ⅳ期患者能减轻疼痛症状,延迟部分患者人工髋关节置换的时间,具有重要的临床价值;骨转移癌是许多恶性肿瘤常见的并发症之一,它常常引起顽固性疼痛,令病人痛不欲生,单纯的三阶梯止痛药物,由于随剂量增加而增加的严重胃肠道反应,以及骨髓毒性反应,使其在临床实际应用中受到一定的局限;我院经过2年多的临床统计分析,恶性肿瘤骨转移经放疗、化疗后或者单纯放疗后再作“云克”治疗,%的患者骨痛平均在3±d就得到不同程度的缓解,持续时间较长1个疗程后可维持1个月左右,显效率72%;云克99Tc-MDP,其中MDP属二膦酸盐,具有趋骨性,有较长的骨贮留性能,是同类药品中结构最简单的;便于吸收且毒性很小,能抑制破骨细胞活性和抑制骨吸收作用,而不影响骨形成骨吸收的降低也是由于破骨细胞数目的降低所致,因为破骨细胞前体进入多核细胞库的补充过程被抑制之故;使骨代谢恢复平衡,修复破骨,它不仅具有消炎镇痛作用,同时也是一种免疫增强剂,使癌骨病灶缩小、减少或消失缓解骨痛,防止病理性骨折;我们认为该方法值得在临床推广;。
甲状腺功能亢进患者131碘治疗前后骨密度的变化
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甲状腺功能亢进患者131碘治疗前后骨密度的变化王勇;丁勇;邢家骝;张友仁;管美超【摘要】目的:探讨甲状腺功能亢进患者131碘(131 I)治疗前后骨密度的变化特点及131 I 治疗甲状腺功能亢进的价值。
方法通过对我科甲状腺功能亢进患者按照治疗前后、性别及年龄(女性绝经后及男性>50岁设定为高龄组,女性未绝经及男性≤50岁设为青年组)等因素进行分组,通过对131 I 治疗前[经过抗甲状腺药物(antithyroid drugs, ATD)治疗后]的骨密度及131 I 治疗后18个月的骨密度测定值进行分析;另选取同期健康体检者140例作为对照组。
结果本组甲状腺功能亢进患者131 I 治疗前(ATD 治疗后)的骨密度较健康对照组减低,但同组经131 I 治疗后各部位骨密度较治疗前明显好转(P <0.05)。
131 I 治疗前及治疗后不同性别、不同年龄组骨密度均有差异,且治疗后女性骨密度的变化值与男性组比较差异有统计学意义,青年组骨密度的变化值与高龄组差异有统计学意义(P <0.05)。
男女高龄组骨密度的变化值差异亦有统计学意义(P <0.05)。
结论甲状腺功能亢进时对骨密度影响较大,与性别、年龄及ATD 的使用关系密切。
ATD 治疗甲状腺功能亢进对骨密度的改善不显著,131 I 治疗后骨密度显著改善,131 I治疗甲状腺功能亢进较 ATD 对骨密度的恢复更具优势。
%ABSTRACT:Objective To investigate the characteristics of bone mineral density in hyperthyroidism patients before and after 131 I treatment and its clinical value for the disease.Methods Hyperthyroidism patients were grouped by the following factors:before and after treatment,gender and age (postmenopausal women and men older than50 years were grouped into elder group;premenopausal women and men younger than 50 years were grouped into youth group).Before 131 Itreatment,patients were treated with antithyroid drug(ATD).Then,the bone mineral density was detected.At 18 months after 131 I treatment,bone mineral density was detected again.140 healthy individuals were enrolled as control group at the same time.Results The bone mineral density of hyperthyroidism patients before 131 I therapy but after ATD treatment was significantly reduced as compared with that of the healthy individuals.After 131 I treatment,bone mineral density of each part improved significantly (P <0.05).Before and after 131 I treatment,bone mineral density was remarkably different between gender or age groups.The change in females bone mineral density was markedly different from that in males after 131 I treatment (P < 0.05).The change in bone mineral density of youth group was also prominently different from that of the elder group (P <0.05).For the elder group,bone mineral density changes were also different between men and women (P <0.05).Conclusion Hyperthyroidism has a great effect on bone mineral density,which is closely corelated with gender,age and the use of ATD.ATD treatment for hyperthyroidism has little effect on bone mineral density,whereas 131 I therapy can significantly improve bone mineral density,indicating that 131 I treatment has better effect on the bone mineral density recovery of hyperthyroidism than ATD treatment.【期刊名称】《临床荟萃》【年(卷),期】2015(000)001【总页数】4页(P74-77)【关键词】甲状腺危象;碘同位素;骨密度;抗甲状腺药【作者】王勇;丁勇;邢家骝;张友仁;管美超【作者单位】解放军第 307 医院核医学科,北京 100071;解放军第 307 医院核医学科,北京 100071;解放军第 307 医院核医学科,北京 100071;解放军第 307 医院核医学科,北京 100071;解放军第 307 医院核医学科,北京 100071【正文语种】中文【中图分类】R581.1甲状腺功能亢进症(甲亢)患者伴随的骨量减少及骨质疏松已受到国内外学者的重视。
云克调节绝后骨质疏松骨代谢调节作用
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云克调节绝经后骨质疏松骨代谢调节作用云克对骨组织有良好的靶向性,进入体内后被骨生成区和带有炎症的骨关节和软骨迅速摄取、蓄积。
云克在血液中半排期为0.52h,血液中的30%~40%迅速分布并最终贮存在骨骼内,半排期可达6~9月,终端骨半排期在1年以上。
对骨代谢调节发挥重要作用。
在骨代谢调节过程中IL-1、IL-6、TNF-α被认为是骨组织微环境中溶骨细胞因子网络中的关键成员,参与骨代谢影响骨重建。
IL-1、IL-6不仅直接刺激骨吸收,还增强其他细胞因子的作用,使骨吸收大大增加。
TNF-α刺激破骨细胞前体细胞增生分化为成熟的破骨细胞,同时改变骨碱性磷酸酶的(BALP)活性。
BALP、BGP在绝经后骨质疏松演变过程中代表由破坏细胞造成骨吸收的、骨形成高转换状态。
云克是一种外源性钙代谢调节物质,进入体内以后吸附于骨组织的羟基磷灰石晶体表面,抑制磷酸酶的降解,不仅延缓磷灰石结晶聚集成大块晶体,同时也抑制磷灰石晶体溶解。
被破骨细胞摄取,可直接抑制破骨细胞活性,达到抑制骨溶解(骨破坏)、降低血钙、缓解骨痛的作用。
云克还通过螯合金属离子降低金属蛋白酶、胶原酶的活性,从而抑制胶原酶对骨组织的破坏。
云克中含有人工合成的锝元素,在低价状态下化学性质活泼,容易得到和失去电子,具有清除体内自由基、抑制病理的复合物产生作用、抑制白细胞介素的产生。
由此可见云克在骨代谢调节中的作用不仅直接抑制破骨细胞活性,而且具有抑制白细胞介素的产生,降低金属蛋白酶、胶原酶活性的作用。
本研究跟踪随访的113例绝经后骨质疏松患者,统计的治疗前后细胞因子、骨代谢指标及BMD的变化与国内的相关报道一致。
与李茂良等中国专利说明书论述的药物作用相同。
云克的二磷酸盐成分及金属离子锝参与骨代谢,降低IL-1、Il-6、TNF-α、BALP、BGP作用确切,并具有增加BMD 的作用。
其增加BMD 的作用机制是抑制了破骨细胞活性,间接提高了成骨细胞的功能。
The regulation of Yunke in bone metabolism of postmenopausal osteoporosis ZHANG Mengmeng, LIU Zhonghou, WU naibao, et al.Research Lab of Bone Metabolism, No.4 Hospital of Jilin University, Changchun130011, ChinaAbstract: Objective Yunke is a kind of multiple preparation with the bisphonate and microelemengt. To study the regulation of Yunke in bone metabolism by following 113 patients with postmenopausal osteoporosis in 9th month after therapy.Method To observe the effects of Yunke on the serum IL-1, IL-6, TNF-ɑ, BGP, BALP, E2 and bone mineral density(BMD) in 113 patients with postmenopausal osteoporosis. Result Before medication, BMD and the level of serum E2 significantly decreased (P<0.01), And the level of TNF-ɑ was high than that in control group (P<0.05). The levels of serum IL-1, IL-6, TNF-ɑ, BGP, BALP decreased rapidly in the 9th month after therapy. There was no change on the level of serum E2. Conclusion Yunke plays on obvious the activity of osteoclast and the loss of bone, and increase BMD.Key words: postmenopausal osteoporosis; Yunke; Bosorption; Bone metabolism;Bone formationYunke is a chelate composed of methylenediphosphonate and technetium got from which sodium pertechnetate reduced by stannous chloride and methylenediphosphonate. YunKe has the stable P-C-P bond. It can been ingested quickly by bone and the effect is lasting. Besides, its blood clearance rate is high.This paper reported the regulation of YunKe in Bone Metabolism by observing the changes on the level of serum BMD,BALP,BGP,TNF-ɑ,IL-1,IL-6,E2of 113 patients with postmenopausal osteoporosis after therapy.1. Material and method1.1 The treatment observation objectAccording to the case history, sign, bone density measurement and X-ray examination, the 113 patients of 53-75 years old were clearly diagnosed to be postmenopausal osteoporosis and with 5-25 years menopausal histories, while their livers function and kidney function were normal. The 113 patients were all with low back pain, lassitude in the tibia and knee, pain in foot and heel, and 21 patients of them once with fracture history of wrist joint or thoracic vertebrae or lumbar. The control group was 60 patients of 43~51 years old examined to be without disease of heart, liver, kidney and endocrine function.1.2Instruments and examination methodDual Energy X-ray Absorptiometry produced by Osteometer Medi Tech Co.,Ltd, Automatic Microparticle Chemiluminescence Meter produced by Beckman inAmerican, Dual Probe Radioimmunoassay Analyzer produced by Shanghai Nuclear Radiation Institute.The life history, family history, menstrual history, past history, movement quantity, and special medication history of every testee were collected. The serum BMD, BALP, BGP, TNF-ɑ,IL-1,IL-6, E2 were examined separately at the time of before treatment, the 3th month and 9th month after treatment.1.3Method of treatmentPlaced the chelate of preparation A 0.20µg and preparation B 20mg of Yunke at room temperature for 5~10mins, then disluted by adding 250ml of normal saline to chelate adequately, ivgtt. qd, for continuous 15 days as a course of treatment.2ResultsAfter two weeks of treatment, the back pains and knee ache flabbiness on patients obviously relievied .After one month of theatment, bone pains disappered on 80% patients accounted in their own words. After 3mos callback, indicated that no change on the BMD, while the level of IL-1,IL-6 significantly decreased. The level of BALP also decreased after treatment. After 9mos of treatment the level of serum BALP,BGP,TNF-ɑ,IL-1,IL-6 decreased rapidly and no change for the level of serum E2, while BMD increased. Table 1 shows the comparison of serum BALP,BGP,TNF-ɑ,IL-1,IL-6,E2 for patients with postmenopausal osteoporosis, and table 2 shows the comparison of BMD before and after treatment for patients with postmenopausal osteoporosis.Table 1 Comparison of the serum BALP,BGP,TNF-ɑ,IL-1,IL-6,E2between two group (x ± s )Group Subjects BALP(ng/ml)BGP(ng/ml)TNF-ɑ(mg/ml)IL-1(ng/ml)IL-6(ng/ml)E2(ng/ml)Control group 60 5.62±4.015.01±2.011.13±0.970.19±0.0694.90±39.9336.40±20.07OP groupPre treatment 113 17.03±6.316.03±1.382.29±0.830.70±0.18139.76±55.4912.8±9.55Post treatment 113 6.44±5.03*5.26±1.44*1.24±0.76*0.31±0.10*97.78±61.04*11.99±10.01*: comparison with pre-treatment P<0.01Table 2 Comparison of BMD before and after therapyof postmenopausal osteoporosis(x ± s )Group Subjects Left cubitusradio Left cubitusulnaMean BMDControl group 60 0.609±0.103 0.630±0.116 0.619±0.120OP groupPre treatment 113 0.451±0.170 0.458±0.131 0.454±0.150 Post treatment 113 0.523±0.182* 0.359±0.129* 0.531±0.155**: comparison with pre-treatment P<0.013 DiscussionYunke has strong ability of targeting to bone tissues. When entered in blood system, it can be rapidly taken in and accumulated in the inflamed bone joints and synovial tissues. The elimination half-time of Yunke in blood is 0.52h. The 30%~40% Yunke in blood is soon distributed and finally stored in skeletons. The elimination half-time of Yunke in skeletons is 6mo~9mo and even more than 1ys. For regulation of bone metabolism Yunke plays important effect.During the regulation of bone metabolism, IL-1,IL-6 and TNF-αregarded as key members of the cytokine network of the osteolysis in the microenvironment of the bone tissues. IL-1 and IL-6 not only directly stimulate bone resorption, but also strengthen the function of the other cytokine. And so they increase the function of bone resorption. TNF-αstimulate pre-osteoclasts, and then the cellular proliferation and differentiation produce ripe osteclasts. At the same time, they affect the activity of bone alkaline phosphatase (BALP). BALP and BGP show the state of the high bone resorption and formation inversion in the postmenopausal osteoporosis.Yunke as a regulation material of ectogenetic calcium metabolism, when absorbed in bone tissues, it can control the formation of crystal calcium phosphonate, delay the congregate of apatite into large crystal, and at same time postpone the dissolution of crystal calcium phosphonate. When Yunke absorbed by the osteoclasts, it can directly repress the activity of osteoclasts and osteolysis (osteoclasia), depress the hypocalcemia, release osteocopic pain. Yunke has chelate ability to metal ions, and it can cut down the activity of metallaproteases and collagenase, and so it can refrain the bone disorganization of collagenase. Technetium is an artificial element ( technetium is one of the components of Yunke ). Technetium with lower valence is active, easy to gain or lose electrons. It can remove the free radicals in vivo, restrain the creation of the pathological compound and interleukin. From the on, Yunke can not only directly repress the activity of osteoclasts, but also refrain the creation of interleukin, and cut down the activity metallaproteases and collagenase.The research followed up 113 patients of postmenopausal osteoporosis. The changes of cytokine and the marker of bone metabolism and the BMD are same as the domestic relevant report. All of these researches like Li mao-liang` patent specification. Methylenediphosphonate and the metalion technetium, the main active components of Yunke participate bone metabolism, and cut down the action of the IL-1,Il-6,TNF-α,BALP,BGP, and at the same time increase the action of BMD. The mechanism of the increasing action of BMD, the reason is that Yunke refrain theactivities of osteoclasts and indirectly improve the functions of osteoblasts.。
云克联合钙剂活血化瘀药治疗骨质疏松的观察与护理安娜
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Abstract: Objective: The observe and care of osteoporosis treated by MDP calcium and traditional Chinese medicine. Method: From October 2005 to December 2010,128 cases of patients with osteoporosis were admitted to our department. They were treated with MDP calcium and traditional Chinese medicine. A course of treatment is continuous infusion of 15 days . Each treatment interval was 4 -6 weeks. The general treatment continues at least three courses. Result: 120 patients adhere to treatment for 3 courses. After 3 courses,bone mineral density of 106 cases ( 83. 30% ) patients improved. Bone mineral density of 50 cases ( 41. 67% ) patients improved significantly ( T value increased by 0. 5 or more) ,while 14 cases ( 16. 7% ) without improvement. Conclusion: The clinical efficacy of osteoporosis treated by MDP calcium and traditional Chinese medicine is good,quick,good security. It can significantly improve the patient's pain and bone mineral density. The operation is simple. It can maximize the drug effects to improve the therapeutic effect and reduce the suffering of the patients.
成骨细胞G1期调节蛋白与绝经后骨质疏松症关系及中药干预作用的实验研究
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成骨细胞G1期调整蛋白与绝经后骨质疏松症干系及中药干预作用的试验探究blot和Real-time PCR技术检测G1期调整蛋白的表达状况;接受小鼠模型观察中药对骨质疏松症的干预效果。
结果:绝经后骨质疏松症患者成骨细胞中G1期调整蛋白表达水平显著降低。
丹参、红花、骨碎补等中草药可通过调整G1期调整蛋白的表达,提高成骨细胞功能,预防骨质疏松症的发生。
结论:成骨细胞G1期调整蛋白在绝经后骨质疏松症中起重要作用,并且中药可以通过干预该蛋白的表达来预防和治疗骨质疏松症。
关键词:成骨细胞;G1期调整蛋白;绝经后骨质疏松症;中药干预。
Introduction:骨质疏松症是一种常见的骨骼疾病,其主要特征是骨量缩减、骨质疏松、骨骼易碎,容易发生骨折。
绝经后女性是骨质疏松症的高危人群之一,其发病率明显高于男性。
成骨细胞是骨质疏松症发生进步过程中的关键细胞类型,其分化和功能异常与骨质疏松症的发生密切相关。
G1期调整蛋白是成骨细胞生长发育和凋亡过程中一个重要的调整因子。
Method:本试验利用绝经后骨质疏松症患者的成骨细胞和小鼠模型,通过Western blot和Real-time PCR技术分别检测成骨细胞G1期调整蛋白的表达状况,评估其在骨质疏松症发生进步中的作用。
同时,本试验接受丹参、红花、骨碎补等中草药进行干预,观察中药对成骨细胞功能的影响,并评估其对骨质疏松症的干预效果。
Result:与健康比较组相比,绝经后骨质疏松症患者成骨细胞中G1期调整蛋白表达水平显著降低。
丹参、红花、骨碎补等中草药可通过调整G1期调整蛋白的表达,增进成骨细胞的活化、增殖和分化,提高成骨细胞功能,预防骨质疏松症的发生。
小鼠模型试验结果也表明,中药具有显著的骨保卫作用。
Conclusion:成骨细胞G1期调整蛋白在绝经后骨质疏松症中起重要作用,中药可以通过干预该蛋白的表达,预防和治疗骨质疏松症。
此探究为探究骨质疏松症的病理机制和中药干预提供了试验依据,有望为骨质疏松症的临床治疗和预防提供新思路骨质疏松症是一种以骨密度降低、骨微结构变化和骨强度减退为特征的疾病。
云克在治疗老年重度骨质疏松症患者中的疗效观察及护理
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云克在治疗老年重度骨质疏松症患者中的疗效观察及护理发表时间:2011-11-01T09:39:55.877Z 来源:《中外健康文摘》2011年第22期供稿作者:张红英马晓萍[导读] 骨质疏松症是老年人的常见病,随年龄增加,其发病率递增。
张红英马晓萍 (新疆昌吉州人民医院 831100)【中图分类号】R473.6【文献标识码】B【文章编号】1672-5085(2011)22-0421-02【摘要】目的探讨云克在治疗老年重度骨质疏松症的疗效和护理。
方法诊断明确的重度骨质疏松症,年龄≥70岁的患者120例,按入院先后顺序编号,单号为治疗组(60例),双号为对照组(60例),两组常规治疗相同。
治疗组加用云克静点,治疗前后采用双能X线骨密度仪(DEX-A)监测患者右前臂尺桡骨骨密度、血肝、肾功能并全程实施护理配合。
结果 6个月后治疗组临床疗效明显高于对照组,总有效率90%,与对照组的平均骨密度值比较差异有统计学意义(P<0.05),与治疗前肝、肾功能无明显变化。
结论云克治疗老年重度骨质疏松症疗效肯定,副作用小,患者依从性好。
【关键词】老年骨质疏松症云克疗效观察护理骨质疏松症是老年人的常见病,随年龄增加,其发病率递增。
是以骨量减少,骨组织的细微结构破坏,使骨骼强度降低和骨折危险性增加为特征的代谢性骨病[1]。
据不完全统计,我国已有骨质疏松症患者8000多万人,其中58%有腰、背、腿、跟骨的疼痛,全身乏力,睡眠差,20%有发生骨折。
严重损害了老年人的身心健康,如何提高老年患者的生存质量,已成为我国政府即糖尿病、老年性痴呆、又一重点攻克性疾病。
近年来,二磷酸盐类药物已成为最有效的骨吸收抑制剂,开始应用于临床。
我科自2009年6月至2011年3月对收治的年龄≥70岁,骨密度测定(BMDT值≤-4.12-4.6)患者120例,采用按序抽样和统一治疗方案,并开展患者右前臂尺桡骨远端双能X线骨密度测定(DEX-A)[1]、血肝、肾功能的检测和全程实施护理配合,取得了良好的效果,现报告如下:1 一般资料及方法1.1 120例患者均来自于新疆昌吉州人民医院干部病房2009年6月至2011年3月的住院患者,其中男性40例,女性80例,男:女=1:2,年龄70-91岁,平均年龄76.5岁,平均BMDT-Score≤-4.29。
云克对绝经后骨质疏松骨代谢调节的作用
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云克对绝经后骨质疏松骨代谢调节的作用张萌萌;刘忠厚;吴乃宝;郭忠;张彩杰;唐萍【期刊名称】《中国骨质疏松杂志》【年(卷),期】2008(14)9【摘要】目的评价云克对骨代谢调节的作用.方法选择明确诊断的绝经后骨质疏松患者113例,监测云克治疗前及治疗后9个月血清骨特异性碱性磷酸酶(BALP)、骨钙素(BGP)、肿瘤坏死因子(TNF-α)、白细胞介素1(IL-1)、白细胞介素6(IL-6)、雌二醇(E2)及骨密度(BMD)的变化.结果治疗前绝经后骨质疏松患者BMD及E2明显降低(P<0.01).IL-1、IL-6、BALP、BGP明显升高(P<0.01).TNF-α高于正常对照组(P<0.05).治疗后9个月,IL-1、IL-6、BALP、BGP较治疗前明显下降(P<0.01),BMD增加(P<0.05),E2无明显变化.结论云克对骨生成区具有明显的导向性,进入骨组织参与骨代谢调节,具有抑制破骨细胞活性,抑制骨丢失,增加BMD的作用.【总页数】2页(P659-660)【作者】张萌萌;刘忠厚;吴乃宝;郭忠;张彩杰;唐萍【作者单位】130011,长春,吉林大学第四医院骨代谢研究室;130011,长春,吉林大学第四医院骨代谢研究室;130011,长春,吉林大学第四医院骨代谢研究室;130011,长春,吉林大学第四医院骨代谢研究室;130011,长春,吉林大学第四医院骨代谢研究室;130011,长春,吉林大学第四医院骨代谢研究室【正文语种】中文【中图分类】R285.5【相关文献】1.99Tc-MDP联合利维爱对绝经后骨质疏松骨代谢调节的研究 [J], 赵海敏;杨金兰2.中药调节绝经后骨质疏松症骨代谢的研究进展 [J], 方晴;刘继华;董博;李淼;欧国峰;符其飞3.(99)Tc-MDP联合利维爱对绝经后骨质疏松骨代谢调节的研究 [J], 赵海敏;杨金兰4.骨代谢标志物在云克治疗绝经后骨质疏松症中的应用价值 [J], 李彩琴;张斌;靳友芬;刘龙飞;王希林;梁付奎5.骨疏康对绝经后骨质疏松骨代谢的调节作用 [J], 高美霞;陈康;赵志红因版权原因,仅展示原文概要,查看原文内容请购买。
云克联合低频脉冲电磁场强化治疗老年骨质疏松的疗效
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云克联合低频脉冲电磁场强化治疗老年骨质疏松的疗效潘卫民;王身坚;谢权;王超群;颜卫文;周影【期刊名称】《中国老年学杂志》【年(卷),期】2011(31)20【摘要】目的探讨云克联合低频脉冲电磁场(pulsed electromagnetic fields,PEMFs)强化治疗对老年骨质疏松(OP)疼痛症状及提高骨密度(BMD)的临床作用.方法入选的124例原发性OP患者,采用前瞻对照配对分组,每组31例.云克治疗组,给予云克注射液静推;脉冲电磁场治疗组,给予PEMFs治疗;云克治疗+脉冲电磁场治疗组,给予云克+PEMFs治疗;阿仑膦酸钠对照组,给予阿仑膦酸钠(70 mg/片),晨起空腹每周1片口服.前三组均20d1个疗程,行3个疗程治疗.所有入选的病人均摄入适量的钙和维生素D.于治疗前、治疗后2个月及6个月观察患者疼痛症状的改变情况;测定第四腰椎(L4)及股骨颈BMD.结果①四组治疗2个月后疼痛改善效果的有效率分别为67.7%、74.2%、93.5%、35.5%;治疗6个月后疼痛症状缓解的有效率分别为80.6%、77.4%、96.8% 、61.3%.②云克治疗组治疗2个月后L4的BMD与治疗前差异显著,治疗6个月后L4及股骨颈的BMD与治疗前均有显著差异(P<0.05);脉冲治疗组及联合治疗组治疗2个月、6个月后,L4和股骨颈的BMD增加明显,与治疗前差异显著(P<0.05).对照组治疗6个月后,L4的BMD增加,与治疗前差异显著(P<0.05).③联合治疗组治疗2个月、6个月后,L4及股骨颈的BMD增加明显,与云克治疗组、脉冲治疗组、对照组相比,有显著性差异(P<0.05).结论云克联合PEMFs强化治疗老年型骨质疏松能在短期内迅速有效地缓解患者的疼痛症状,提高患者的BMD.【总页数】3页(P3925-3927)【作者】潘卫民;王身坚;谢权;王超群;颜卫文;周影【作者单位】海南医学院附属医院核医学科,海南海口 570102;海南医学院附属医院核医学科,海南海口 570102;海南医学院附属医院核医学科,海南海口 570102;海南医学院附属医院核医学科,海南海口 570102;海南医学院附属医院核医学科,海南海口 570102;海南医学院附属医院核医学科,海南海口 570102【正文语种】中文【中图分类】R68【相关文献】1.伊班膦酸钠联合低频脉冲电磁场治疗老年性骨质疏松的疗效 [J], 李改丽;张汝;王晓湘;王建;王炜;汪丙昂2.甲状旁腺激素联合低频脉冲电磁场治疗老年骨质疏松性股骨粗隆骨折的临床疗效观察 [J], 弓永顺;万超;徐毅3.云克联合低频脉冲电磁场治疗骨质疏松症的临床观察 [J], 潘卫民;王身坚;王超群;颜卫文;谢权;周影4.低频脉冲电磁场联合金天格治疗老年骨质疏松症的疗效 [J], 王冬梅5.低频脉冲电磁场联合双膦酸盐和钙剂治疗老年骨质疏松症的临床研究 [J], 林通; 罗文君; 马菲菲; 张鹏江因版权原因,仅展示原文概要,查看原文内容请购买。
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云克调节绝经后骨质疏松骨代谢调节作用云克对骨组织有良好的靶向性,进入体内后被骨生成区和带有炎症的骨关节和软骨迅速摄取、蓄积。
云克在血液中半排期为0.52h,血液中的30%~40%迅速分布并最终贮存在骨骼内,半排期可达6~9月,终端骨半排期在1年以上。
对骨代谢调节发挥重要作用。
在骨代谢调节过程中IL-1、IL-6、TNF-α被认为是骨组织微环境中溶骨细胞因子网络中的关键成员,参与骨代谢影响骨重建。
IL-1、IL-6不仅直接刺激骨吸收,还增强其他细胞因子的作用,使骨吸收大大增加。
TNF-α刺激破骨细胞前体细胞增生分化为成熟的破骨细胞,同时改变骨碱性磷酸酶的(BALP)活性。
BALP、BGP在绝经后骨质疏松演变过程中代表由破坏细胞造成骨吸收的、骨形成高转换状态。
云克是一种外源性钙代谢调节物质,进入体内以后吸附于骨组织的羟基磷灰石晶体表面,抑制磷酸酶的降解,不仅延缓磷灰石结晶聚集成大块晶体,同时也抑制磷灰石晶体溶解。
被破骨细胞摄取,可直接抑制破骨细胞活性,达到抑制骨溶解(骨破坏)、降低血钙、缓解骨痛的作用。
云克还通过螯合金属离子降低金属蛋白酶、胶原酶的活性,从而抑制胶原酶对骨组织的破坏。
云克中含有人工合成的锝元素,在低价状态下化学性质活泼,容易得到和失去电子,具有清除体内自由基、抑制病理的复合物产生作用、抑制白细胞介素的产生。
由此可见云克在骨代谢调节中的作用不仅直接抑制破骨细胞活性,而且具有抑制白细胞介素的产生,降低金属蛋白酶、胶原酶活性的作用。
本研究跟踪随访的113例绝经后骨质疏松患者,统计的治疗前后细胞因子、骨代谢指标及BMD的变化与国内的相关报道一致。
与李茂良等中国专利说明书论述的药物作用相同。
云克的二磷酸盐成分及金属离子锝参与骨代谢,降低IL-1、Il-6、TNF-α、BALP、BGP作用确切,并具有增加BMD 的作用。
其增加BMD 的作用机制是抑制了破骨细胞活性,间接提高了成骨细胞的功能。
The regulation of Yunke in bone metabolism of postmenopausal osteoporosis ZHANG Mengmeng, LIU Zhonghou, WU naibao, et al.Research Lab of Bone Metabolism, No.4 Hospital of Jilin University, Changchun130011, ChinaAbstract: Objective Yunke is a kind of multiple preparation with the bisphonate and microelemengt. To study the regulation of Yunke in bone metabolism by following 113 patients with postmenopausal osteoporosis in 9th month after therapy.Method To observe the effects of Yunke on the serum IL-1, IL-6, TNF-ɑ, BGP, BALP, E2 and bone mineral density(BMD) in 113 patients with postmenopausal osteoporosis. Result Before medication, BMD and the level of serum E2 significantly decreased (P<0.01), And the level of TNF-ɑ was high than that in control group (P<0.05). The levels of serum IL-1, IL-6, TNF-ɑ, BGP, BALP decreased rapidly in the 9th month after therapy. There was no change on the level of serum E2. Conclusion Yunke plays on obvious the activity of osteoclast and the loss of bone, and increase BMD.Key words: postmenopausal osteoporosis; Yunke; Bosorption; Bone metabolism;Bone formationYunke is a chelate composed of methylenediphosphonate and technetium got from which sodium pertechnetate reduced by stannous chloride and methylenediphosphonate. YunKe has the stable P-C-P bond. It can been ingested quickly by bone and the effect is lasting. Besides, its blood clearance rate is high.This paper reported the regulation of YunKe in Bone Metabolism by observing the changes on the level of serum BMD,BALP,BGP,TNF-ɑ,IL-1,IL-6,E2of 113 patients with postmenopausal osteoporosis after therapy.1. Material and method1.1 The treatment observation objectAccording to the case history, sign, bone density measurement and X-ray examination, the 113 patients of 53-75 years old were clearly diagnosed to be postmenopausal osteoporosis and with 5-25 years menopausal histories, while their livers function and kidney function were normal. The 113 patients were all with low back pain, lassitude in the tibia and knee, pain in foot and heel, and 21 patients of them once with fracture history of wrist joint or thoracic vertebrae or lumbar. The control group was 60 patients of 43~51 years old examined to be without disease of heart, liver, kidney and endocrine function.1.2Instruments and examination methodDual Energy X-ray Absorptiometry produced by Osteometer Medi Tech Co.,Ltd, Automatic Microparticle Chemiluminescence Meter produced by Beckman inAmerican, Dual Probe Radioimmunoassay Analyzer produced by Shanghai Nuclear Radiation Institute.The life history, family history, menstrual history, past history, movement quantity, and special medication history of every testee were collected. The serum BMD, BALP, BGP, TNF-ɑ,IL-1,IL-6, E2 were examined separately at the time of before treatment, the 3th month and 9th month after treatment.1.3Method of treatmentPlaced the chelate of preparation A 0.20µg and preparation B 20mg of Yunke at room temperature for 5~10mins, then disluted by adding 250ml of normal saline to chelate adequately, ivgtt. qd, for continuous 15 days as a course of treatment.2ResultsAfter two weeks of treatment, the back pains and knee ache flabbiness on patients obviously relievied .After one month of theatment, bone pains disappered on 80% patients accounted in their own words. After 3mos callback, indicated that no change on the BMD, while the level of IL-1,IL-6 significantly decreased. The level of BALP also decreased after treatment. After 9mos of treatment the level of serum BALP,BGP,TNF-ɑ,IL-1,IL-6 decreased rapidly and no change for the level of serum E2, while BMD increased. Table 1 shows the comparison of serum BALP,BGP,TNF-ɑ,IL-1,IL-6,E2 for patients with postmenopausal osteoporosis, and table 2 shows the comparison of BMD before and after treatment for patients with postmenopausal osteoporosis.Table 1 Comparison of the serum BALP,BGP,TNF-ɑ,IL-1,IL-6,E2between two group (x ± s )Group Subjects BALP(ng/ml)BGP(ng/ml)TNF-ɑ(mg/ml)IL-1(ng/ml)IL-6(ng/ml)E2(ng/ml)Control group 60 5.62±4.015.01±2.011.13±0.970.19±0.0694.90±39.9336.40±20.07OP groupPre treatment 113 17.03±6.316.03±1.382.29±0.830.70±0.18139.76±55.4912.8±9.55Post treatment 113 6.44±5.03*5.26±1.44*1.24±0.76*0.31±0.10*97.78±61.04*11.99±10.01*: comparison with pre-treatment P<0.01Table 2 Comparison of BMD before and after therapyof postmenopausal osteoporosis(x ± s )Group Subjects Left cubitusradio Left cubitusulnaMean BMDControl group 60 0.609±0.103 0.630±0.116 0.619±0.120OP groupPre treatment 113 0.451±0.170 0.458±0.131 0.454±0.150 Post treatment 113 0.523±0.182* 0.359±0.129* 0.531±0.155**: comparison with pre-treatment P<0.013 DiscussionYunke has strong ability of targeting to bone tissues. When entered in blood system, it can be rapidly taken in and accumulated in the inflamed bone joints and synovial tissues. The elimination half-time of Yunke in blood is 0.52h. The 30%~40% Yunke in blood is soon distributed and finally stored in skeletons. The elimination half-time of Yunke in skeletons is 6mo~9mo and even more than 1ys. For regulation of bone metabolism Yunke plays important effect.During the regulation of bone metabolism, IL-1,IL-6 and TNF-αregarded as key members of the cytokine network of the osteolysis in the microenvironment of the bone tissues. IL-1 and IL-6 not only directly stimulate bone resorption, but also strengthen the function of the other cytokine. And so they increase the function of bone resorption. TNF-αstimulate pre-osteoclasts, and then the cellular proliferation and differentiation produce ripe osteclasts. At the same time, they affect the activity of bone alkaline phosphatase (BALP). BALP and BGP show the state of the high bone resorption and formation inversion in the postmenopausal osteoporosis.Yunke as a regulation material of ectogenetic calcium metabolism, when absorbed in bone tissues, it can control the formation of crystal calcium phosphonate, delay the congregate of apatite into large crystal, and at same time postpone the dissolution of crystal calcium phosphonate. When Yunke absorbed by the osteoclasts, it can directly repress the activity of osteoclasts and osteolysis (osteoclasia), depress the hypocalcemia, release osteocopic pain. Yunke has chelate ability to metal ions, and it can cut down the activity of metallaproteases and collagenase, and so it can refrain the bone disorganization of collagenase. Technetium is an artificial element ( technetium is one of the components of Yunke ). Technetium with lower valence is active, easy to gain or lose electrons. It can remove the free radicals in vivo, restrain the creation of the pathological compound and interleukin. From the on, Yunke can not only directly repress the activity of osteoclasts, but also refrain the creation of interleukin, and cut down the activity metallaproteases and collagenase.The research followed up 113 patients of postmenopausal osteoporosis. The changes of cytokine and the marker of bone metabolism and the BMD are same as the domestic relevant report. All of these researches like Li mao-liang` patent specification. Methylenediphosphonate and the metalion technetium, the main active components of Yunke participate bone metabolism, and cut down the action of the IL-1,Il-6,TNF-α,BALP,BGP, and at the same time increase the action of BMD. The mechanism of the increasing action of BMD, the reason is that Yunke refrain theactivities of osteoclasts and indirectly improve the functions of osteoblasts.。