骨代谢指标BAP、BGP、CTX-I、TRACP5b等变化对老年髋部骨折后骨密度的影响及在二次骨折中的风险预测

目的探究老年髋部骨折后骨代谢指标BAP、BGP、CTX-I、TRACP5b的变化对骨密度的影响,为二次骨折风险预测提供理论依据。方法选择我院2015年1月至2016年12月骨科收治入院的36例60岁以上老年髋部骨折患者作为观察组,42例健康老年人作为对照组。制定随访标准,观察组于骨折后1天、1个月、3个月、6个月、12个月进行骨代谢指标骨碱性磷酸酶(BAP)、骨γ-羧基谷氨酸蛋白(骨钙素,BGP)、Ⅰ型胶原羧基C端交联肽(CTX-Ⅰ)、清抗酒石酸酸性磷酸酶5b(TRACP5b)的测定,同时检测患者髋部骨密度。对照组健康老年人也监测上述各项数据指标作为对照分析。采用SPSS21.0软件对最后数据进行统计学分析。结果观察组髋部骨折患者骨折至愈合6个月,骨代谢指标BAP、BGP、CTXI、TRACP5b水平分别为11.11±1.21μg/L、7.38±0.82μg/L、0.44±0. 8μg/L和5.13±0. 42μg/L,显著高于对照组,髋部骨密度T值为-3.57±0.06,明显低于对照组-1.05±0.06,差异有统计学意义(P<0.05)。12个月BAP、BGP水平分别为11.16±1.18μg/L和6.89±0.59μg/L,与对照组比较,差异仍有统计学意义,且与骨密度变化显著相关。结论老年髋部骨折愈合后骨密度较正常人明显降低,发生二次骨折的风险大大增加。可通过监测患者血清BAP、BGP水平,可快速准确地判断骨密度变化,以降低罹患二次骨折的风险。

Is osteoporosis risk in anorexia nervosa underestimated? A case report series

Introduction: Anorexia nervosa (AN) is a mental disorder whose features are deliberate weight loss, disordered body image, and intrusive overvalued fears of gaining weight. Long-term consequences of AN include endocrine dysfunctions leading to secondary amenorrhea, bone loss and/or osteoporosis with an increased risk of bone fracture. Therefore young women with AN may develop a risk for bone fractures comparable to that of postmenopausal women. Methods: In this case report series Bone Mineral Density (BMD) was examined by Dual energy X-ray Absorptiometry (DXA) in 19 hospitalized patients with diagnosis of AN and prolonged amenorrhea. Results: All patients showed a lumbar/femoral bone loss or osteoporosis, with an increased fracture risk comparable to that of postmenopausal women. Conclusions: Our observation suggests that DXA evaluation of anorexic patients with prolonged amenorrhea would be helpful to prevent fracture risk in this population of patients. However, although DXA is almost routinely recommended in women over 65, it is not in young AN patients with prolonged amenorrhea.

动态冲击下泡沫能量吸收对头盔防护性能的影响

为摩托车头盔的安全性设计,需要研究在冲击载荷下内衬泡沫的能量吸收能力对摩托车头盔防护性能的影响。该文建立了有限元数值分析头盔模型,依据欧洲经济委员会(ECE)的法规ECE R22.05的动态测试方法,验证该模型的有效性。改变头盔不同测试点下的泡沫密度,进行了12个跌落的仿真试验。结果表明:在头盔的前部、冠部和后部测试点区泡沫密度由40 kg/m3增加到80 kg/m^3时,泡沫的能量吸收能力逐渐增大,头部冲击能量衰减得更快,导致3个测试点头部颅骨骨折的风险从25%、55%、39%分别增大至53%、96%、96%。头盔右侧部测试点区域下的泡沫密度与颅骨骨折风险没有显著的关系。因而,头盔的安全性设计应同时兼顾内衬泡沫密度与尺寸。