大骨节病与骨关节病患者软骨细胞凋亡及其机制的比较研究

目的比较分析大骨节病与骨关节病关节软骨中细胞凋亡及相关调控因子Bcl-2、Bax、Fas及iNos的表达分布特点，探讨两病发病机制的异同。方法收集大骨节病和骨关节病的关节软骨各15例．并以15例正常人作对照。采用脱氧核糖核酸末端转移酶介导的脱氧核糖核酸缺口标记（TUNEL）技术和免疫组化抗生物素蛋白-生物素-碱性磷酸酶（B-SA）法染色，观察大骨节病、骨关节病和正常对照关节软骨的凋亡细胞和Bcl-2、Bax、Fas及iNOS蛋白阳性表达率及其分布特点。结果（1）大骨节病及骨关节病关节软骨凋亡阳性细胞数较正常关节软骨增多（F=20．90～53．16，df=42，P〈0．01），且关节软骨剥蚀区的凋亡阳性细胞数较未剥蚀关节软骨区增多（t=4，154-6.004，df=28，P〈0.01），但大骨节病与骨关节病之间软骨细胞凋亡阳性数无显著性差异（t=1.329～1.362，df=28，P〉0.05）。（2）大骨节病与骨关节病关节软骨Bcl-2、Bax、Fas及iNos表达阳性细胞数较正常关节软骨增多（F=25.46-215.31，df=42，P〈0．01），且关节软骨剥蚀区Bcl-2、Bax、Fas及iNos表达阳性细胞数较未剥蚀区增多忙2．278～7.77，df=28，P〈0．05），但大骨节病患者与骨关节病Bcl-2、Bax、Fas及iNos的表达阳性细胞数无显著性差异（t=0.284-1．590，df=28，P〉0．05）。结论大骨节病与骨关节病均有相似的细胞凋亡，而且凋亡机制相同，即Bcl-2、Bax、Fas及iNos途径。

Mechanism of chondrocyte apoptosis in Kashin-Beck disease and primary osteoarthritis: a comparative study

Objective To investigate chondrocyte apoptosis and the expressions of Bcl-2, Bax, Fas and iNOS in the articular cartilage between Kashin-Beck disease (KBD) and primary osteoarthritis (OA) and explore the difference in pathogenesis between the two diseases. Methods The articular cartilage specimens were collected from 15 normal human subjects, 15 adult patients with KBD and 15 with OA. Chondrocyte apoptosis was detected by TUNEL method, and the expressions of Bcl-2, Bax, Fas and iNOS in articular cartilage were examined with B-SA immunohistochemistry. Results The percentages of apoptotic chondrocytes positive for TUNEL staining in the articular cartilage were significantly higher in patients with KBD and OA than in normal control subjects (F=20.90-53.16, df=42, P<0.01), and the erosive areas of the articular cartilage contained greater percentage of apoptotic chondrocytes than the non-erosive areas in the same patient with KBD (t=4.154, df=28, P<0.01) or OA (t=6.004, df=28, P<0.01). No significant difference was noted in the positive apoptotic chondrocytes between KBD and OA (t=1.329-1.362, df=28, P>0.05). The percentage of chondrocytes positive for Bcl-2, Bax, Fas and iNOS were significantly higher in KBD and OA patients than in the control subjects (F=25.46-215.31, df=42, P<0.01), and significant differences were observed in Bcl-2, Bax, Fas and iNOS expressions between the erosed areas and non-erosed areas in articular cartilage in patients with KBD (t=2.608-7.77, df=28, P<0.05) and OA (t=2.278-5.413, df=28, P<0.05), but their expressions showed no significant difference between the two diseases (t=0.284-1.590, df=28, P>0.05). Conclusion There was no significant difference in apoptotic chondrocytes and Bcl-2, Bax, Fas and iNOS expressions in the cartilage between adult patients with KBD and OA.