非创伤性股骨头坏死患者ADAM17介导的凝血酶受体水解活性研究及加味青娥丸对其的干预效应  

Study on Hydrolysis Activity of Thrombin Receptor Mediated by ADAM17 in Patients with Nontraumatic Osteonecrosis of the Femoral Head and Intervention Effect of Modified Qing'e Pills

作　　者：沈霖[1] 马陈[1] 帅波[1] 杨艳萍[1] 徐晓娟[1] 夏雪[1] 吕林[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院中西医结合科,武汉430022

出　　处：《中西医结合研究》2016年第3期113-117,共5页Research of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金项目(No.81273907,81403257)

摘　　要：目的观察加味青娥丸对非创伤性股骨头坏死(ONFH)患者解离素金属酶17(ADAM17)介导的凝血酶受体水解活性的影响,探讨加味青娥丸治疗缺血性ONFH的机制。方法招募临床诊断为非创伤性ONFH患者60例,随机分为治疗组及对照组,治疗组给予加味青娥丸及补钙治疗,对照组给予模拟剂及补钙治疗,2组疗程均为6个月,2组患者适当限制运动及负重,另招募60例健康体检者作为健康组。抽取2组患者治疗前后及健康组静脉血,采用ELISA法检测受试者血浆中ADAM17表达水平;流式细胞仪检测受试者凝血酶受体GPⅠb/Ⅸ/Ⅴ和GPⅠbα的表达,同步观察患者治疗前后髋关节功能评分(Harris评分)及髋部X摄片影像学变化,比较3组上述指标的差异。结果非创伤性ONFH患者ADAM17表达水平明显低于健康组;GPⅠb/Ⅸ/Ⅴ和GPⅠbα高于健康组。治疗6月后,治疗组ADAM17显著高于对照组,GPⅠb/Ⅸ/Ⅴ和GPⅠbα表达水平显著低于对照组;治疗组髋关节Harris评分优于对照组;2组髋部X摄片影像学无明显差异。结论中药加味青娥丸方提高非创伤性ONFH患者低于正常的ADAM17含量,调节其介导的凝血酶受体水解活性,可能是本方治疗非创伤性ONFH患者的疗效机制之一。Objective To observe the intervention effect of modified Qing＇e pills on the hydrolysis activity of thrombin receptor mediated by ADAM17 in patients with nontraumatic osteonecrosis of the femoral head（ONFH）, and to explore its possible mechanism. Methods 60 patients with nontraumatic ONFH were randomly divided into a treatment group and a control group. The treatment group was treated with modified Qing＇e pills while the con- trol group was treated with simulated pills. Both groups were given Caltrate D. All patients in the two groups re- ceived treatment for six months. Another 60 cases of healthy people accepted heath examination were as a healthy group. Plasma levels of ADAM17 were detected by enzyme-linked immunosorbent assay（ELISA）, and platelet membrane glycoproteins（GP） I b/IX/V complex and its component GP I ba were analyzed by flowcytometry in the healthy group and the two intervention groups before and after treatment. While X-ray examination of the hip and Harris hip score were measured in patients with ONFH before and after treatment. Results The level of AD- AM17 in patients with ONFH were significantly lower than that in the healthy group（P〈0.05）. The expression of GP I b/IX/V and GP ]~ ba in patients with ONFH were significantly lower than that in the healthy group（P〈 0.05）. After six months treatment, the level of ADAM17 in the treatment group were significantly higher than that in the control group（P〈0.05） ,and expression of GP I b/IX/V and GP 1 ba in patients with ONFH were signifi- cantly lower than that in the control group（P〈0.05）. Harris hip score in the treatment group was significantly higher than that in the control group. Difference of X-ray examination of the hip was not significant between the treatment group and the control group after treatment（P^0.05）. Conclusion Modified Qing＇e pills may play a protective role against nontraumatic ONFH by regulating the expression adiponectin signaling pathway and ghrelin. The partial mechanism of treat

关 键 词：股骨头坏死 青娥丸 解离素金属酶 凝血酶受体 

分 类 号：R274.9[医药卫生—中西医结合]