激素性股骨头坏死和酒精性股骨头坏死的病理学差异及其分子机制研究  

Pathological differences between steroid-induced and alcohol-induced osteonecrosis of the femoral head and their molecular mechanisms

作　　者：沈莹姗 何敏聪 庄至坤 何晓铭 李子祺 郑越生 何伟 魏秋实 SHEN Yingshan;HE Mincong;ZHUANG Zhikun;HE Xiaoming;LI Ziqi;ZHENG Yuesheng;HE Wei;WEI Qiushi(The First Affliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;The Third Afiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510240,Guangdong,China;Quanzhou Orthopedic-Traumatological Hospital,Quanzhou 362000,Fujian,China;Jinshazhou Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510168,Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405 [2]广州中医药大学第三附属医院,广东广州510240 [3]泉州市正骨医院,福建泉州362000 [4]广州中医药大学金沙洲医院,广东广州510168

出　　处：《中医正骨》2023年第5期1-7,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81873327,81904226);广东省自然科学基金项目(2017A030313698)。

摘　　要：目的:探讨激素性股骨头坏死(osteonecrosis of the femoral head,ONFH)和酒精性ONFH的病理学差异及其分子机制。方法:纳入接受人工全髋关节置换术治疗的ONFH患者的股骨头60个,根据患者发生ONFH的病因,将股骨头分为激素性ONFH组和酒精性ONFH组。将股骨头做冠状面逐层切片后,观察2组股骨头的分区情况及病理特点;于股骨头正中切片上分别取坏死区、硬化区、正常区的骨组织,处理后采用扫描电镜观察2组股骨头不同区域骨组织的结构特点;分离股骨头坏死区、硬化区、正常区的骨组织,采用蛋白印迹法检测2组股骨头各区骨组织中血小板-内皮细胞粘附分子-1(platelet endothelial cell adhesion molecule-1,PECAM-1)、内皮粘蛋白(endomucin,EMCN)、血小板衍生生长因子(platelet derived growth factor,PDGF)-BB、表皮生长因子样结构域8(epidermal growth factor-like domain 8,EGFL8)及骨形态发生蛋白-2(bone morphogenetic protein-2,BMP-2)的表达量。结果:股骨头切片显示,激素性ONFH组股骨头坏死区与硬化区交界处有新鲜肉芽组织,酒精性ONFH组股骨头坏死区与硬化区交界处无新鲜肉芽组织,有纤维组织填充。扫描电镜图像显示,激素性ONFH组股骨头的坏死区骨细胞胞体呈现粗糙、溶解样,周围有树突包裹,有骨小管分布;硬化区骨细胞胞体较正常骨细胞略小,树突缩短、数量减少,有骨小管分布;正常区有丰富的骨小管分布。酒精性ONFH组股骨头的坏死区骨细胞萎缩,甚至消失,未见树突与骨小管分布;硬化区骨细胞萎缩、体积较小,树突稀疏,骨小管小、数量少;正常区骨小管较小、数量较少。激素性ONFH组股骨头坏死区、硬化区、正常区骨组织中PECAM-1、EMCN、EGFL8,坏死区、硬化区骨组织中PDGF-BB,硬化区骨组织中BMP-2的蛋白表达量均高于酒精性ONFH组(PECAM-1:1.970±0.053,0.493±0.076,t=0.453,P=0.000;0.797±0.047,0.467±0.025,t=1.910,P=0.000;2.207±0.045,1.443±0.Objective:To explore the pathological differences between steroid-induced osteonecrosis of the femoral head(ONFH)and alcohol-induced ONFH,and to explore their molecular mechanisms.Methods:Sixty femoral heads from ONFH patients who underwent artificial total hip arthroplasty were enrolled in the study and were divided into steroid-induced ONFH group and alcohol-induced ONFH group according to the etiology of ONFH.The femoral heads were sectioned in coronal plane layer by layer,and their subregion and pathological characteristics were observed.The bone tissues from the necrotic zone,sclerotic zone and normal zone of the femoral head were harvested from the median section of the femoral head,and their structural characteristic were observed in the 2 groups using a scanning electron microscope after processing.The bone tissues from the necrotic zone,sclerotic zone and normal zone were isolated,and the protein expression levels of platelet endothelial cell adhesion molecule-1(PECAM-1),endomucin(EMCN),platelet-derived growth factor(PDGF)-BB,epider-mal growth factor-like domain 8(EGFL8)and bone morphogenetic protein-2(BMP-2)in the bone tissues of each zone were detected using Western blot.Results:The femoral head sections showed that there were fresh granulation tissues at the junction of the necrotic zone and sclerotic zone in the steroid-induced ONFH group,while no fresh granulation tissues were observed,but fibrous tissues were found in alco-hol-induced ONFH group.The scanning electron microscopy images showed that,in steroid-induced ONFH group,the osteocytes in the nec-rotic zone displayed as rough,dissolved cell bodies surrounded by dendrites,with distributed bone canaliculi.The osteocytes in the sclerotic zone displayed as slightly smaller cell bodies compared with that of normal osteocytes,with shorter and fewer dendrites and distributed bone canaliculi.The abundant bone canaliculi were found in the normal zone.While in alcohol-induced ONFH group,the osteocytes in the necrotic zone were atrophied or even disappea

关 键 词：股骨头坏死 激素类 饮酒 病理学特点 显微镜检查 电子 扫描 印迹法 蛋白质 

分 类 号：R681.8[医药卫生—骨科学]