目的探究肺移植后患者骨代谢异常发生现状及其影响因素,为制订护理干预措施提供参考依据。方法回顾性分析2021年6月—2023年8月浙江省某三级甲等综合医院肺移植中心125例肺移植患者的临床资料,使用配对样本t检验比较移植前后骨密度变化趋势,术后骨密度与国内同龄人群骨密度常模比较采用单样本t检验,使用单因素分析和无序多分类Logistic回归分析探究肺移植后骨代谢异常相关影响因素。结果肺移植后骨代谢异常发生率为62.4%,其中,低骨量、骨质疏松症发生率分别为36.8%、25.6%;股骨颈、左侧髋关节骨密度较移植前呈下降趋势(P<0.001);且男性与女性患者骨密度均低于国内同龄人群骨密度常模(P<0.001);Logistic回归分析显示,以骨量正常组为对照,移植前日常生活活动能力评分是肺移植后低骨量的影响因素(OR值为0.957,95%CI为0.928~0.987);女性以及移植前低体重、肥胖、第1秒用力呼气量占用力肺活量百分率(forced expiratory volume in one second/forced vital capacity percentage,FEV1/FVC)、日常生活活动能力评分是骨质疏松症的影响因素,OR值分别为7.181、7.521、15.465、0.960、0.964,95%CI分别为1.287~40.061、2.039~27.738、1.158~206.586、0.937~0.983、0.930~0.999。结论肺移植后患者骨代谢异常现象较为普遍,医护人员应重点关注女性、移植前低体重、肥胖、FEV1/FVC降低以及日常生活活动能力评分偏低的患者,及时采取个性化、多学科干预措施,延缓患者术后骨质流失速率,降低骨代谢异常发生率,提高患者健康相关生活质量。
多囊卵巢综合征与骨质疏松症既是女性内分泌疾病,且两者之间又存在错综复杂的联系。多囊卵巢综合征的特征是雄激素水平升高、胰岛素抵抗和体重增加,历来被认为可以预防骨骼脆性疾病。然而,新兴研究表明,在多囊卵巢综合征中普遍存在的慢性炎症会对骨骼健康产生不利影响。研究表明,多囊卵巢综合征患者的骨密度损失各不相同,其中胰岛素失衡、雄激素及生长激素异常、氧化应激、慢性炎症等关键因素,在PCOS和骨质疏松症之间的复杂相互作用中起着关键作用,影响骨代谢机制,从而导致骨质疏松症。这种错综复杂的骨代谢影响机制,强调了更深入地了解它们相互关系的必要性。因此,本综述阐明了PCOS与骨质疏松症之间的多方面激素水平、炎症及氧化应激反应的联系,强调了它们对PCOS患者骨骼健康管理的影响。Polycystic ovary syndrome (PCOS) and osteoporosis are both endocrine diseases of women, and there is a complex relationship between them. PCOS is characterized by elevated androgen levels, insulin resistance and weight gain and has historically been thought to protect against the brittle bone disease. However, emerging research suggests that chronic inflammation, which is prevalent in PCOS, can adversely affect bone health. Studies have shown that the bone mineral density loss in patients with PCOS varies, and key factors such as insulin imbalance, androgen and growth hormone abnormalities, oxidative stress, and chronic inflammation play a key role in the complex interaction between PCOS and osteoporosis, affecting the bone metabolism mechanism, leading to osteoporosis. This intricate mechanism of influence on bone metabolism underscores the need for a deeper understanding of their interrelationships. Therefore, this review elucidated the association of multiple hormone levels, inflammation, and oxidative stress responses between PCOS and osteoporosis, highlighting their impact on bone
骨形态发生ⅠA型受体(bone morphogenetic protein receptorⅠA,BMPRⅠA)在骨代谢疾病中发挥关键作用。BMP受体与转化生长因子β(TGF-β)配体结合传递信号,介导成骨细胞性骨形成与破骨细胞性骨吸收,参与骨发育、重塑等骨代谢过程。中药在防治骨代谢疾病方面历史悠久,对骨量、骨质量的促进作用显著。本文综述了BMPRⅠA与骨代谢疾病的作用机制,总结干预BMPRⅠA及其信号通路调节骨代谢的中药研究现状,以期为后续的药物研究提供思路。
