目的:了解城市社区中老年人膝骨性关节炎(KOA)的患病率,探讨其发病特点及相关影响因素,为早期预防与治疗提供科学依据.方法:于2019年6月至10月随机抽取6个社区服务站点1020名汉族居民为研究对象,其中男性435人,女性585人,平均年龄为(72.40±5.96)岁.采用自行设计的量表和WOMAC评分量表开展问卷调查.结果:中老年人KOA患病率为31.8％.单因素分析结果显示KOA与性别、年龄、体重指数(BMI)、骨关节炎(OA)家族史、膝关节外伤史、痛风史、吸烟史、体育锻炼及睡眠质量显著相关(P<0.05).Logistic回归分析显示女性、高龄、BMI偏高、OA家族史、膝关节外伤史、缺乏体育锻炼、睡眠质量差是患KOA的危险因素(P<0.05).此外女性,高年龄,有OA家族史、有膝关节外伤,不经常体育锻炼患者WOMAC评分较高(P<0.05).结论:性别、年龄、BMI、OA家族史、膝关节外伤史、体育锻炼、睡眠质量与患KOA相关,应在预防与治疗中给予重视.

In order to provide quality rehabilitation care for patients in the hierarchical medical service system,a joint rehabilitation team of general practitioner and specialists from secondary and tertiary hospital was formed in Shanghai Xujiahui Community Health Service Center,and the community rehabilitation has been implemented with "integrated general-specialty" model.This article introduces the characteristics,structure,service contents and advantages of the "integrated general-specialty" rehabilitation service mode,also presents suggestions for solving the existing problems of the mode.

目的 探讨糖尿病合并骨质疏松患者的相关危险因素.方法 选择我院2016年7月至2017年7月收治的2型糖尿病患者60例,根据患者是否发生骨质疏松进行分组,分别为糖尿病合并骨质疏松组(合并组)和单纯糖尿病组.使用流式细胞术检测外周血Th1、Th2、Th17、Treg细胞水平,采用酶偶联紫外分光光度法测定血浆D-乳酸水平,采用全自动生化仪测定血氨水平.利用免疫比浊法检测免疫球蛋白IgA、IgC、IgM、IgE和补体C3、C4水平,比较两组患者治疗后的营养指标水平、钙磷水平和ALP(碱性磷酸酶).采用Logistic回归分析高危因素.结果 ①与单纯糖尿病组对比,合并组Th1/Th2明显降低,差异有统计学意义(P＜0.05).两组Treg/Th17差异无统计学差异(P＜0.05).②与单纯糖尿病组对比,合并组补体C3明显降低,差异有统计学意义(P＜0.05);免疫球蛋白CD3+水平、CD4+水平、CD4+/CD8+降低,差异具有统计学意义(P＜0.05);D-乳酸和血氨水平明显升高,差异具有统计学意义(P＜0.05).③经治疗后,单纯糖尿病组患者各项营养指标明显优化,TSF、AMC、TP、ALB水平和钙磷水平明显升高,ALP水平明显降低,与合并组对比差异具有统计学意义(P＜0.05).结论 Th1/Th2、C3、钙、磷、D-乳酸是糖尿病患者发生骨质疏松的危险因素.

目的 探讨跟骨定量超声测量(QUS)对筛查社区绝经期妇女骨质疏松症的临床价值.方法 选取在上海市社区健康体检的500名绝经期妇女作为研究对象,根据年龄将500例妇女分为三组,年龄≤59岁组,年龄60~69岁组,年龄≥70岁组,对所有入选对象同时进行双能X线吸收仪(DXA)和QUS骨密度检测,以DXA诊断结果为金标准,分析QUS对绝经期妇女骨质疏松症的诊断价值.结果 经DXA测量结果显示,500名绝经期妇女中,诊断为骨质疏松症89例,不同年龄组之间骨密度存在明显差异,随着年龄的增长,骨质疏松症所占比例明显升高,差异有统计学中意义(P<0.05);经QUS测量结果显示,500位绝经期妇女中,诊断为骨质疏松症71例,且不同年龄组绝经期妇女之间骨密度存在明显差异,随着年龄的增长,骨质疏松症所占比例明显升高,差异有统计学意义(P<0.05);以DXA诊断结果为金标准,DXA共确诊89例骨质疏松,QUS正确诊断骨质疏松69例,诊断特异度为99.51%,灵敏度为77.53%,阳性预测值为97.18%,阴性预测值为95.34%,误诊率为0.47%,漏诊率为22.47%,诊断符合率为95.60%.结论 QUS筛查社区绝经期妇女骨质疏松症具有较好的特异度及灵敏度,并具有较高的诊断符合率,可以作为社区绝经期妇女骨质疏松筛查工具.

目的 探讨定量超声检测在社区骨质疏松筛查中的临床应用价值.方法 对357例研究对象分别行右侧跟骨定量超声检测(QUS)和双能X线吸收法(DXA)测量腰椎及髋部骨密度、t值,应用Spearman相关性分析,了解QUS的诊断价值.以DXA法为诊断骨质疏松症金标准,分析QUS诊断ROC曲线,确定最佳阈值,判定灵敏度、特异度,评估诊断效能.结果 入组对象骨量减少227例(63.6％),骨质疏松112例(31.4％);QUS-T和DXA-T呈正相关.QUS-T与DXA-T腰椎、髋部的相关性系数男性分别为0.092、0.234,女性为0.308、0.218.QUS检测骨量减少的ROC曲线面积为0.716,最佳界值为-2.325,敏感度为0.90,特异性为0.50,尤登指数为0.400.骨质疏松的ROC曲线线下面积为0.687,最佳界值为-2.48,敏感度为0.870,特异性为0.420,尤登指数为0.290.结论 QUS检测虽不能用于骨质疏松的诊断,但可作为社区筛查骨质疏松的有效工具,根据筛查结果适时用DXA确诊,有益于家庭医生早期开展干预和防治工作.

Objective: To investigate the distribution characteristics of the bone mass of the elderly people in the community and their prevalence of osteoporosis and to analyze their related factors. Methods: The data of age, weight, height and the determination result of the quantitative ultrasonic bone density were collected from the elderly people over 60 years old in a community and statistically analyzed after grouping them according to the gender, age and BMI. Results: The bone mass distribution of the men and women in all age groups had the statistically significant differences (P<0.01). The incidence of osteoporosis in the women was higher. The age and bone mass distribution had the negative correlation. The greater the age, the less bone mass and the higher the incidence of osteoporosis. The comparison of the index of the bone mass distribution (BMI) between groups had an obviously statistical difference (P<0.01). The index of the female BMI and osteoporosis occurrence had a weak positive correlation (r=0.315, P<0.01). Conclusion: The community elderly women are the high incidence population of osteoporosis. The determination of the quantitative ultrasonic bone density is the first choice for the osteoporosis screening in the community.

Objective To investigate the situation of diet and movement of young people in some area of Shanghai city,and provide scientific basis for schools and departments concerned for the sake of making more comprehensive related policies and methods.Method Employing " Investigation Sampling Method for Danger to health Behavior in Chinese City Young people " for high and junior middle schools,altogether 1182 students of 5 middle schools participated.Results Middle-school students involved in the investigation generally do not have reasonable diet habits and movements,and show significant difference in different gender and school grade groups.Conclusion The investigation demonstrated middle-school students in this area have diet and movement problems,much attention should be paid by the school,guardians and the whole society.