激素性股骨头坏死与髋关节骨关节炎患者离体标本相关因子表达水平的比较研究  

Comparing study on expression levels of related factors in glucocorticoid-induced osteonecrosis of femoral head and hip osteoarthritis

作　　者：谭钢[1] 康鹏德[1] 裴福兴[1] 谢小伟[1] 杨静[1] 沈彬[1] 周宗科[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华关节外科杂志（电子版）》2012年第2期59-62,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81171763;30772202/C1607);教育部博士点基金新教师基金(850-20070610005)

摘　　要：目的探讨激素性股骨头坏死与髋关节骨关节炎患者股骨头标本内PPARγ、Runx2、DKK-1表达水平的差异性。方法选取于四川大学华西医院骨科因股骨头坏死和髋关节骨关节炎行全髋关节置换术患者共40例,其中激素性股骨头坏死(A组)和髋关节骨关节炎(B组)患者各20例。经患者及家属同意后收集该40例患者所置换的股骨头标本进行HE染色及免疫组化检测PPARγ、Runx2、DKK-1三因子表达水平。结果 A组患者股骨头标本HE染色显示空骨陷窝率均大于50%,符合股骨头坏死病理诊断标准;免疫组化结果显示PPARγ、DKK-1因子大量阳性表达,其中PPARγ阳性表达面积百分比约13%,DKK-1阳性表达面积百分比约53%,而runx2极少阳性表达,阳性表达面积百分比约2%。而骨关节炎组患者股骨头标本HE染色显示较少空骨陷窝。免疫组化结果显示PPARγ、DKK-1少量阳性表达,其中PPARγ阳性表达面积百分比约2%,DKK-1阳性表达面积百分比约4%,而Runx2大量阳性表达,阳性表达面积百分比11%左右。结论 PPARγ和DKK-1两因子在A组表达水平显著高于B组,而Runx2则在骨关节炎组表达水平显著高于A组,均具有显著统计学意义(P<0.05)。PPARγ、DKK-1、Runx2三因子属于调控骨髓基质细胞向成骨细胞和脂肪细胞分化以及骨吸收的重要调控因子。因此,激素性ONFH发生可能是通过影响骨髓基质细胞代谢失衡导致ONFH的发生,主要为通过增加PPARγ表达量减少Runx2表达量使骨髓基质细胞向脂肪细胞分化增加而向成骨细胞分化减少,同时破骨细胞活性增强,骨坏死修复作用减弱,最终导致ONFH发生。Objective To study the mechanism of glucocorticoid-induced osteonecrosis of femoral head（ONFH） by comparing the histopathological changes and expression levels of PPARγ,Runx2,DKK-1 of ONFH and hip osteoarthritis.Methods 40 patients who were diagnosed as ONFH or hip osteoarthritis were enrolled in the study.ONFH group and osteoarthritis group contained 20 patients each.Histopathological and immunohistochemistry studies were performed for expression of PPARγ、Runx2、and DKK-1.Results Percentage of empty lacunae in ONFH group was over 50%.The positive expression of PPARγ and DKK-1 was abundant while expression of Runx2 was poor in glucocorticoid-induced ONFH.Comparing with ONFH group,in the hip osteoarthritis group,the number and diameter of empty lacunae were more small and the columnar trabeculae showed lower expression level of PPARγ,and DKK-1,yet expression of Runx2 was much higher.Conclusions PPARγ,DKK-1,Runx2 are key factors in regulation of bone marrow stromal cells（MSC） differentiation.Exogenous glucocorticoids could up regulate the level of PPARγ and DKK-1 while reduce the level of Runx2,which would cause obvious decrease of osteoblasts but significant increase of MSC derived adipocytes.Meanwhile,the activation of osteoclasts is enhanced and the bone remodeling is impaired,so that ONFH will be induced.

关 键 词：糖皮质激素类 股骨头坏死 骨关节炎 PPARγ RUNX2 DKK-1 

分 类 号：R681.8[医药卫生—骨科学]