营养与骨质疏松症.doc

1、reform results, economy, and political system, and culture system, and social system, and discipline check system, and party of construction system reform solid advance, tax, and financial, and price, and administrative approval, and State-owned enterprises, and ecological civilization, important fi

2、eld and key link reform made major progress, market in resources configuration in the of decisive role significantly enhanced, Unprecedented burst of momentum and vitality of economic and social development. XI General Secretarys speech in this regard include the reform only when there is no complet

3、e, the notes on the 18 session of ideas into the partys spirit of the reforms more difficult to move forward, the increasing use of the Socialist system with Chinese characteristics such as the ability to run the country. 4. with regard to promoting sustained and healthy economic development. Face c

4、omplex changeable of international situation and difficult heavy of domestic reform development stable task, XI General Secretary made China economic development into new normal of science judge, proposed innovation, and coordination, and green, and open, and shared five big development concept, imp

5、lementation macro policy to stability, and industry policy to associate, and micro policy to live, and reform policy to real, and social policy to backing five big pillar sex policy, vigorously advance supply side structural reform, new concept, achieved has 2013 to 2015 during, Domestic production

6、total annual growth 7.3%, obviously fast Yu earlier world economic 2.3% of annual growth, on world economic growth of contribution over 25%, tertiary industry accounted for domestic production total share over 50%, eventually consumption on economic growth of contribution rate reached 66%, economic

7、structure adjustment made important progress, development of quality and benefits significantly upgrade, China economic show out huge of swing room and broad of development prospects. This aspects XI General Secretary of speech main including economic growth must is real and no water of growth impro

8、ve open type economic level “see missing of hand“ and “see have see of hand“ are to with good speed up from elements drive, and investment scale drive development mainly to to innovation drive development mainly of change active promoted China energy production and consumption revolution,. 5. with r

9、egard to building the rule of law in China. 18 big yilai, Central tightly around full advance law ruling, put party of led, and people masters, and law ruling organic unified up, insisted law ruling, and law ruling, and law administrative common advance, insisted rule of law national, and rule of la

10、w Government, and rule of law social one construction, full advance science legislation, and strictly law enforcement, and just judicial, and universal law-abiding, China features socialist legal system further sound perfect, leaders at all levels cadres using rule of law thinking and rule of law wa

11、y deepening reform, andpromoted development, and The ability to resolve conflicts and constantly improve, our . 6. on the building of Socialist culture in China. A country, a nation strong, always supported by culture flourished, the inheritance and development of civilization, without culture to de

12、velop and prosper, there will be no realization of the dream of China. 18 big yilai, XI General Secretary around “foster and promote Socialist core values“ “promote China excellent traditional culture“ “firmly master ideology work led right and discourse right“, aspects do has series important speec

13、h, main including put publicity thought work do have better for achieved China dream condensed powerful moral support improve national culture soft strength foster and promote Socialist core values youth to consciously practice line Socialist core values Childhood actively cultivate and practice the

14、 core values of socialism and the partys important speech on the press conference. 7. promote the reform and development of social undertakings and social management. 18 big yilai, Central insisted put guarantees and improved livelihood as ruling acting political of starting point and foothold, Xia

15、big pneumatic solution masses most care most directly most reality of interests problem, 3 years cumulative reduction poverty more than 50 million people, equivalent to a medium national population of total, annual added town employment more than 10 million people, starts construction supportability

16、 housing engineering near 4 million sets, built world Shang scale maximum, and cover universal of basic medical guarantees network and pension guarantees network, urban and rural residents income continued growth, The lives of the people of all ethnic groups have more on both material and spiritual

17、thriving. This aspects XI General Secretary of speech main including promoted poverty area poverty, and speed up development let 1.3 billion people enjoys better more fair of education speed up advance housing guarantees and supply system construction always put people life security put in first bit

18、 efforts put China construction became network power insisted general national security views, go China features national security road effective maintenance national security and social settled,. 8. with regard to comprehensive strictly administering the party. Party of 18 big yilai, Central statio

19、n in party and national survival of height, firmly grasp strengthening party of ruling capacity construction, and advanced purity construction this article mainline, to style construction for breakthrough, to developed introduced eight items provides started start, put discipline and rules is in fro

20、nt, organization carried out has party of mass line education practice activities and “three strict three real“ topic education, insisted “zero tolerance, and full cover, and no area“, insisted “Tiger“ “flies“ with playing, style political wind society continued improved, More perfect system of laws

21、 within the party, discipline of authoritative seriousness increasing, for the history of winning has a lot of new features provide a strong political营养与骨质疏松症一、 骨量的获得与丢失1、骨的结构与功能 骨骼组织分为骨、软骨以及附属结构。骨组织中其实细胞只占有 2%-5%，主要的我们知道是成骨细胞与破骨细胞，那么骨矿物质呢约占到成年人骨干重的 65%，其中钙占到 37%-40%，其余的那主要的是磷能占到 50%以上。骨矿物质主要以羟基磷灰石结

22、晶和无定形的磷酸钙存在。那么骨的有机质主要是骨胶原和那些没有定型的磷酸钙，骨的有机质占到有机成分的 90%，非胶原蛋白值约占到有机质值的 10%左右。骨骼主要是由皮质骨和小梁骨组成，皮质骨能占到骨总量的 80%，主要是在骨的外层，小梁骨又叫松质骨，主要占到骨总量的 20%。皮质骨主要位于长骨的骨干，松质骨主要位于脊椎呀、骨盆啊和骨的干骺端。说完松质骨比皮质骨的表面积要，松质骨的骨表面积与骨量的比值大大的超过了皮质骨，骨的重建呢主要是在骨的表面进行，松质骨的代谢的活性高于皮质骨的 10 倍以上。2、钙与激素调节 骨是体内钙和磷的储存库，成年人群中的钙重量能达到 1 公斤到 1.5公斤，其中 99

23、%以上储存在骨骼和牙齿中。与骨代谢有关的激素主要有甲状旁腺激素，我们简称 PTH，还有降钙素简称 CT。以及雌激素，那么雌激素只是针对女性而言的。那么皮肤中的维生素 D 的形成源于阳光中的紫外线照射，维生素 D 有助于钙的吸收的。3、钙的调整过程 当血钙浓度降低的时候，甲状旁腺激素以及维生素 D 的水平就会增高，促使那个钙在肠道内的吸收增加，那么钙排出就减少，肾脏里尿钙的排泄也会减少，那么就是造成骨钙丢失。反之，当血钙浓度增高的时候，甲状旁腺激素和维生素 D 的水平会下降，那么呢钙的它的排出就会增加，它的吸收就会减少，尿钙的排出也会增加，骨钙就会沉积在骨头骨骼里面。4、骨重建 人体的骨的新陈代

24、谢是非常非常活跃的，人的一生中骨重建都在不断地进行着，因为骨重建的周期呢，它持续两到三个月，那么人老了时候呢，它的这个周期就要延长可以达到半年，那么这个骨重建的过程呢，主要是成骨细胞不断的形成骨和破骨细胞不断地引起骨头吸收的一种动态平衡的状态下进行的。5、钙的储备和骨量 一个人刚生下来的时候新生儿的含钙量是 2530 克左右，那么以后的 20 年中呢？它平均每天要储集 150 毫克的钙，到了 20 岁的时候他才能达到 1 公斤到 1.2 公斤的钙储备量，所以呢人在青春期的时候呢，人体对钙的需求量是最高的。据报道，男孩子在 14.2 岁女孩子在 12 岁半的时候骨量增长是人生中最快的一个阶段。骨

25、的纵向生长停止就是这个人不再长高以后呢，它的骨的矿化还是在不断地进行着，其后的1015 年呢是骨的一个的加固阶段，那么骨量还要增长 510%，以达到骨的峰值。 李宁华等根据我们中国 2300 人的调查结果报告呢，男性的腰椎和股骨尽端，也就是股骨头它的骨密度峰值出现在 2029 岁组，女性腰椎峰值的骨密度出现在 3039 岁组，那么股骨头峰值出现在 2029 岁组，也就是说女性的腰椎骨密度峰值呀出现时间要稍晚于，要晚于男性，那么女性到了绝经期的时候，它的雌激素分泌下降，雌激素分泌下降的结果就会导致骨的丢失加速，腰椎的骨密度在 4049 岁的时候呢就会有缓慢的下降，到了5059 岁的时候呢就加速的

26、下降，其他部位的骨密度的减少，比其他部位还要提早 10 年，那么男性和女性不同，他各个部位的骨密度都是从 30 到 39 岁以后，就逐渐的下降，那么不同的是没有明确的丢失期。综上所述，骨质疏松的发生与年轻时峰值骨密度的高低和年老时骨丢失的速率关系很密切，两者都受遗传基因、营养状况，运动负荷以及激素调控的影响。二、骨质疏松的分类与临床表现reform results, economy, and political system, and culture system, and social system, and discipline check system, and party of con

27、struction system reform solid advance, tax, and financial, and price, and administrative approval, and State-owned enterprises, and ecological civilization, important field and key link reform made major progress, market in resources configuration in the of decisive role significantly enhanced, Unpr

28、ecedented burst of momentum and vitality of economic and social development. XI General Secretarys speech in this regard include the reform only when there is no complete, the notes on the 18 session of ideas into the partys spirit of the reforms more difficult to move forward, the increasing use of

29、 the Socialist system with Chinese characteristics such as the ability to run the country. 4. with regard to promoting sustained and healthy economic development. Face complex changeable of international situation and difficult heavy of domestic reform development stable task, XI General Secretary m

30、ade China economic development into new normal of science judge, proposed innovation, and coordination, and green, and open, and shared five big development concept, implementation macro policy to stability, and industry policy to associate, and micro policy to live, and reform policy to real, and s

31、ocial policy to backing five big pillar sex policy, vigorously advance supply side structural reform, new concept, achieved has 2013 to 2015 during, Domestic production total annual growth 7.3%, obviously fast Yu earlier world economic 2.3% of annual growth, on world economic growth of contribution

32、over 25%, tertiary industry accounted for domestic production total share over 50%, eventually consumption on economic growth of contribution rate reached 66%, economic structure adjustment made important progress, development of quality and benefits significantly upgrade, China economic show out hu

33、ge of swing room and broad of development prospects. This aspects XI General Secretary of speech main including economic growth must is real and no water of growth improve open type economic level “see missing of hand“ and “see have see of hand“ are to with good speed up from elements drive, and inv

34、estment scale drive development mainly to to innovation drive development mainly of change active promoted China energy production and consumption revolution,. 5. with regard to building the rule of law in China. 18 big yilai, Central tightly around full advance law ruling, put party of led, and peo

35、ple masters, and law ruling organic unified up, insisted law ruling, and law ruling, and law administrative common advance, insisted rule of law national, and rule of law Government, and rule of law social one construction, full advance science legislation, and strictly law enforcement, and just jud

36、icial, and universal law-abiding, China features socialist legal system further sound perfect, leaders at all levels cadres using rule of law thinking and rule of law way deepening reform, andpromoted development, and The ability to resolve conflicts and constantly improve, our . 6. on the building

37、of Socialist culture in China. A country, a nation strong, always supported by culture flourished, the inheritance and development of civilization, without culture to develop and prosper, there will be no realization of the dream of China. 18 big yilai, XI General Secretary around “foster and promot

38、e Socialist core values“ “promote China excellent traditional culture“ “firmly master ideology work led right and discourse right“, aspects do has series important speech, main including put publicity thought work do have better for achieved China dream condensed powerful moral support improve natio

39、nal culture soft strength foster and promote Socialist core values youth to consciously practice line Socialist core values Childhood actively cultivate and practice the core values of socialism and the partys important speech on the press conference. 7. promote the reform and development of social

40、undertakings and social management. 18 big yilai, Central insisted put guarantees and improved livelihood as ruling acting political of starting point and foothold, Xia big pneumatic solution masses most care most directly most reality of interests problem, 3 years cumulative reduction poverty more

41、than 50 million people, equivalent to a medium national population of total, annual added town employment more than 10 million people, starts construction supportability housing engineering near 4 million sets, built world Shang scale maximum, and cover universal of basic medical guarantees network

42、and pension guarantees network, urban and rural residents income continued growth, The lives of the people of all ethnic groups have more on both material and spiritual thriving. This aspects XI General Secretary of speech main including promoted poverty area poverty, and speed up development let 1.

43、3 billion people enjoys better more fair of education speed up advance housing guarantees and supply system construction always put people life security put in first bit efforts put China construction became network power insisted general national security views, go China features national security

44、road effective maintenance national security and social settled,. 8. with regard to comprehensive strictly administering the party. Party of 18 big yilai, Central station in party and national survival of height, firmly grasp strengthening party of ruling capacity construction, and advanced purity c

45、onstruction this article mainline, to style construction for breakthrough, to developed introduced eight items provides started start, put discipline and rules is in front, organization carried out has party of mass line education practice activities and “three strict three real“ topic education, in

46、sisted “zero tolerance, and full cover, and no area“, insisted “Tiger“ “flies“ with playing, style political wind society continued improved, More perfect system of laws within the party, discipline of authoritative seriousness increasing, for the history of winning has a lot of new features provide

47、 a strong political2骨质疏松分为两大类，一类是原发性骨质疏松症，第二类是继发性骨质疏松症。1、分类：原发性骨质疏松症：是伴随着年龄的增长或妇女绝经后发生的一种“生理性”退行性病变。I 型：绝经后骨质疏松症，大多为高转换型。骨吸收与骨形成均很活跃，但以骨吸收为主。妇女绝经后 1520 年内，骨丢失主要在松质骨（椎骨和桡骨远端）。II 型：老年性骨质疏松症，大多为低转换型。骨吸收与骨形成均不活跃，但仍以骨吸收为主。多见于 70 岁以上的男性和 60 岁以上的女性，松质骨和皮质骨均有骨量丢失（椎骨、髋骨及长管状骨的干骺端。继发性骨质疏松症：由于某些疾病或者使用的药物导致骨代谢异常

48、从而引发的骨质疏松症（如糖尿病、慢性肾病、甲状腺疾病、营养不良、长期使用糖皮质激素等）。2、临床表现（1）骨质疏松-症状与体征 常常在发生骨折之前并无任何症状 椎骨、腕部、髋部、肱骨及胫骨的骨折 椎骨破坏导致疼痛 驼背 身高变矮 目前在骨质疏松引起的骨折中最常见的就是锥体的骨折，可是由于缺乏平常骨折的一些常见的症状那很容易就造成了误诊和漏诊，。髋部的骨折它的致残致死率都非常高，后果最为严重，老年人髋骨骨折以后，50%的患者在以后的生活中不能独立行走， 20%的患者在一年内会死亡，如果骨折以后没有采取抗骨质疏松药物的治疗，那么还有 20%的患者会在一年内再次发生骨折。骨质疏松性骨折也是非常常见的

49、，我们北京在妇女中做了一次调查，那么椎骨骨折的发生率是非常高的，60 岁年龄组已经有 16.2%的妇女发生了骨折，到了 80 岁以上，将近40%的老年妇女都会发生椎体骨折。（2）骨质疏松性骨折的病理变化骨质疏松不仅有骨密度减少，而且有骨微结构的病变： 早期表现为松质骨中骨小梁结构变细、变薄甚至发生断裂、消失，骨小梁数量减少，使剩余骨小梁负荷加大，降低了骨小梁的强度，发生显微骨折 进一步发展后骨皮质内表面 1/3 逐渐转换成类似于松质骨的结构，骨皮质变薄，造成骨强度明显下降，包括弹性和硬度均降低，在轻微外来损伤及其他因素的影响下即可导致骨折。reform results, economy, and political system, and culture system, and social system, and discipline check system, and party of construction system reform solid advance, tax, and financial, and price, and administrative approval, and State-owned enterprises, and ecological civiliza