Hsu-Chang C Y
Second Department of Surgery, School of Medicine, Yokohama City University, Japan.
Nihon Geka Gakkai Zasshi. 1990 Oct;91(10):1581-90.
To study the pathophysiology of bone disorder after gastrectomy, 320 patients and 40 Wistar male rats were used. Clinically, patients who had received gastrectomy 1-15 years previously, were examined for skeletal symptoms, serum biochemistry, microdensitometry of second metacarpal bone, and 20 of them were then studied in a calcium infusion test. Using microdensitometry, abnormality of bone metabolism was observed in 38% of the patients. In severe cases, a significant decrease of serum Ca. and increase of alkaline phosphatase were observed (p less than 0.05), 65% complained of joint pain. In the calcium infusion test, severe cases showed a low urinary excretion of Ca, like osteomalacia, and unlike osteoporosis. Experimentally, body weight & amount of food intake decreased and fatty diarrhea was observed in rats after total gastrectomy. Skeletal changes including thinning of the cortex, loss of medullary trabeculation & decrease of bone ash and biochemical changes such as low serum Ca. 25(OH)D3, 24, 25(OH)2D3 and high iPTH levels were observed. Also the bone formation rate was lower than control as detected by tetracycline double labelling method. As low food intake & fatty diarrhea after gastrectomy which result in Ca. & vit. D insufficiency may be the major etiology of bone disorder.
为研究胃切除术后骨病的病理生理学，使用了320例患者和40只雄性Wistar大鼠。临床上，对1至15年前接受胃切除术的患者进行骨骼症状、血清生化、第二掌骨微密度测定检查，其中20例随后进行钙输注试验。通过微密度测定法，在38%的患者中观察到骨代谢异常。在严重病例中，观察到血清钙显著降低和碱性磷酸酶升高（p<0.05），65%的患者抱怨关节疼痛。在钙输注试验中，严重病例显示尿钙排泄量低，类似于骨软化症，与骨质疏松症不同。实验中，全胃切除术后大鼠体重和食物摄入量下降，并观察到脂肪性腹泻。观察到骨骼变化，包括皮质变薄、髓质小梁丢失和骨灰减少，以及生化变化，如血清钙、25(OH)D3、24,25(OH)2D3水平低和iPTH水平高。此外，通过四环素双标记法检测到骨形成率低于对照组。由于胃切除术后食物摄入量低和脂肪性腹泻导致钙和维生素D不足，可能是骨病的主要病因。
