电离辐射致股骨头坏死早期病理特点和机制的研究

Objective To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was re-estabhshed to detect the pathological changes of capillaries after irradiation. Result The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence(6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %)(P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries.     

大剂量γ射线致兔股骨头坏死的病理改变

目的 观察大剂量γ射线局部照射兔股骨头后的坏死改变.方法 成年雄性兔5只,分别单次接受0（1只）、30（2只）、45（2只）Gy^60Co γ射线照射,6 wk后取股骨头石蜡切片光境观察,体外培养骨髓间充质干细胞（BMSCs）,成骨细胞诱导后,单核细胞直接细胞毒性测定法（MTT）测定其生长曲线.结果 照射组兔股骨头空陷窝增加,以软骨下区最显著,骨小梁面积减少,脂肪细胞面积减少,与0 Gy照射兔比较差异显著（P＜0.001）,照射后BMSCs成骨增殖能力与0 Gy组相比明显降低（P＜0.01）.结论 表明30～45 Gy^60Co γ射线照射一次可致兔股骨头坏死改变.     

术前hs-CRP升高患者使用他汀类药物降低围手术期常见并发症的临床分析

目的 探讨使用他汀类药物对外科围手术期hs-CRP升高患者指标的影响和围手术期常见并发症发生率的观察。方法 选择175例外科围手术期合并高血压和或糖尿病和或冠心病且高敏C反应蛋白(hs-CRP)升高患者,随机分为三组,治疗组常规使用他汀类药物5天后行外科手术并复查高敏C反应蛋白(hs-CRP)并记录术后常见并发症发生率,强化组常规使用他汀类药物(加大剂量) 5天后行外科手术并复查高敏C反应蛋白(hs-CRP)并记录术后常见并发症发生率,对照组术后复查高敏C反应蛋白(hs-CRP)并记录术后常见并发症发生率。比较三组术前术后高敏C反应蛋白(hs-CRP)值变化及常见并发症发生率。结果 治疗组、强化组患者术后高敏C反应蛋白(hs-CRP)有显著下降,差异有统计学意义(P<0.01);且围手术期常见并发症发生率明显下降,差异有统计学意义(P<0.05)。结论 他汀类药物可有效降低围手术期患者hs-CRP水平及围手术期常见并发症发生率。     

氟中毒对体外培养破骨细胞数量及骨吸收功能的影响

目的 观察氟中毒对体外培养破骨细胞数量及骨吸收功能的影响,探讨其作用机制.方法 机械分离法作用于新生SD大鼠四肢长骨,于TC199培养液(含10%胎牛血清)中获得破骨细胞和骨髓基质细胞.将破骨细胞接种于96孔培养板和象牙片培养,而骨髓基质细胞接种于6孔培养板培养,分别于2 h后换液并染氟(氟化钠),对照组、低氟组、中氟组、高氟组染氟剂量分别为0、2.5×10-5、5.0×10-5、10.0×10-5mol/L.培养2、5d后对培养板中破骨细胞进行抗酒石酸酸性磷酸酶(TRAP)染色,光镜下计数破骨细胞数量;培养5 d后象牙片经1%甲苯胺蓝染色,光镜下分析破骨细胞骨吸收陷窝面积.骨髓基质细胞染氟作用8 h后提取总RNA,实时荧光定量PCR法检测细胞核因子κβ受体活化因子配体(RANKL)和骨保护素(0PG)mRNA表达水平.结果 ①体外培养2 d时,对照组、低氟组、中氟组、高氟组破骨细胞数量分别为(337.5 4-70.5)、(447.5 ±43.4)、(472.9±34.8)、(475.3±24-3)个/孔,各染氟组明显高于对照组(P均<0.05);体外培养5 d时,对照组、低氟组、中氟组、高氟组破骨细胞数量分别为(92.5±22.1)、(123.0±26.4)、(135.5 ±22.2)、(136.9 ±23.0)个/孔,各染氟组明显高于对照组(P均<0.05).②体外培养5 d时,对照组、低氟组、中氟组、高氟组破骨细胞骨吸收陷窝面积分别为(0.088±0.030)、(0.100 ±0.018)、(0.152±0.015)、(0.242±0.031)mm2/片,中氟组和高氟组明显高于对照组(P均<0.05).③对照组、低氟组、中氟组、高氟组骨髓基质细胞RANKL/OPG mRNA表达比值分别为100.00±56.02、144.95±97.21、223.25 ±184.48、193.98 ±137.93,中氟组和高氟组明显高于对照组(P均<0.05).结论 氟中毒可引起体外培养破骨细胞数量增多,促进其细胞分化及骨吸收活性,该作用可能与其上调 RANKL/OPC,mRNA表达比值有关.

Abstract：

Objective To determine the effects of fluoride on osteoclasts's quantity and bone resorption function in vitro and its mechanisms. Methods The osteoclasts and bone marrow stromal cells(BMSCs) isolated from long bone of new born rats were cultured respectively in TC199 medium (containing 10% fetal bovine serum) with fluoride. The osteoclasts were inoculated in 96-well culture plate and ivory slice, BMSCs were inoculated in 6- well culture plate, respectively, medium were changed after 2 hours incubation. They were divided into control group, low-dose fluoride, medium-dose fluoride and high-dose fluoride groups, the doses of sodium fluoride were 0,2.5 × 10-5,5.0 × 10-5,10.0 × 10-5 mol/L, respectively. Tartrate-resistant acid phosphatase(TRAP) staining positive cells were counted under light microscope after TRAP staining on the 2nd and the 5th day and the pit formed in ivory slices were measured by histomorphometry after staining with toludine blue. The expression of receptor activator of NK-κβ ligand(RANKL) and osteoprotegerin(OPC) was detected by real-time fluorescence quantitative (337.5 ± 70.5), (447.5 ± 43.4), (472.9 ± 34.8), (475.3 ± 24.3)/well in the control group, the low-dose, mediumdose and high-dose fluoride groups, respectively. The differences were statistically significant between these groups and the control group (all P < 0.05). After in vitro culture for 5 days, the numbers of osteoclasts were (92.5 ± 22.1), (123.0 ± 26.4), (135.5 ± 22.2), (136.9 ± 23.0) per well in the control group, the low-dose, medium-dose and high-dose fluoride groups, respectively. The differences were statistically significant between these groups and the (0.088 ± 0.030), (0.100 ± 0.018), (0.152 ± 0.015), (0.242 ± 0.031 )mm2 per piece in the control group, the lowdose, medium-dose and high-dose fluoride groups, respectively. The values of medium-dose and high-dose fluoride BMSCs in the control group, the low-dose, medium-dose and high-dose fluoride groups were 100.00 ± 56.02, 144.95 ± 97.21,223.25 ± 184.48,193.98 ± 137.93, respectively. The values of medium-dose and high-dose fluoride groups were significantly higher than that of control group (all P < 0.05). Conclusions Fluoride can cause increase in the number of osteoclasts in vitro and promote their cell differentiation and bone resorption activity, which may be related to increased expression ratio of RANKL/OPG mRNA in BMSCs.     

电离辐射致股骨头坏死早期病理特点和机制的研究

Objective To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was re-estabhshed to detect the pathological changes of capillaries after irradiation. Result The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence(6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %)(P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries.     

雷尼酸锶对OVX大鼠骨质疏松的治疗作用

目的 研究雷尼酸锶(Strontium Ranelate)对卵巢摘除模型大鼠骨质疏松的治疗作用.方法 取6月龄SD雌性大鼠经双侧卵巢摘除3个月建立骨质疏松模型,分别灌胃给药雷尼酸锶(180mg·kg-1·d-1)和阿仑膦酸钠(Alendronate,14mg·kg-1·w-1)13周,观察骨质疏松大鼠骨量、骨微结构、骨体积和骨强度等生物学指标的变化.结果药物治疗13周,雷尼酸锶和阿仑膦酸钠可有效提高股骨和腰椎骨量,增加骨小梁面积、缩小小梁间距.同时股骨和腰椎体积增加,股骨抗弯最大载荷恢复至Sham组水平,腰椎抗压最大载荷较OVX组分别增加21.7%(雷尼酸锶)和23.3%(阿仑膦酸钠).雷尼酸锶组矿化沉积率增加,阿仑膦酸钠组TRAP5b下降.结论 雷尼酸锶治疗有效提高骨质疏松大鼠骨强度,该作用与其增加骨体积、修复微结构和提高骨最有关.     

补肾中药复方和尼尔雌醇对卵巢摘除大鼠骨丢失及血1,25(OH)2D水平的影响

 目的 以卵巢摘除法建立大鼠雌激素缺乏型骨质疏松模型,研究补肾中药复方和尼尔雌醇对卵巢摘除大鼠骨丢失和维生素D代谢的影响,探讨血清1,25(OH)2D水平与骨量丢失的相关性。方法 手术摘除雌性大鼠双侧卵巢,以子宫重、子宫重/体重、子宫内膜厚度和血E2判断卵巢摘除是否完整;以骨干重、灰重、骨密度等骨量指标和骨组织形态计量、骨代谢生化标志物等鉴定骨质疏松模型建立。将实验大鼠随机分为假手术组(SHAM)、卵巢摘除组(OVX)、卵巢摘除尼尔雌醇干预组(OVX＋CEE3)和卵巢摘除补肾中药干预组(OVX＋TCM),每组10只。手术后35天开始灌服药物,给药13周后处死,检测上述指标和血25(OH)D、1,25(OH)2D、Ca、P等指标,观察尼尔雌醇和补肾中药对切卵大鼠骨量和骨结构的改善作用。结果 OVX大鼠双侧卵巢摘除完整,雌激素缺乏诱发骨质疏松指标明显;OVX组血清钙较SHAM组明显降低(P<0.01),给予尼尔雌醇干预后血清钙明显恢复(P<0.01),而补肾中药组血清钙仍在低水平。各组血25(OH)D 水平并无明显改变,而OVX组血清1,25(OH)2D水平明显升高,较SHAM组［(38.45±10.99)nmol/L］增加64.1％(P<0.01);OVX+CEE3组血清1,25(OH)2D水平明显回落,较OVX组降低60.8％(P<0.01);OVX+TCM组血清1,25(OH)2D仍处于OVX组水平,明显高于SHAM组(P<0.01)。结论 与尼尔雌醇比较,补肾中药复方改善卵巢摘除大鼠骨量和骨结构的作用不明显,可能与其未有效改善血清低钙和代偿性高1,25(OH)2D水平有关。     

体外培养成骨细胞成纤维生长因子23表达及其对激素的反应

 目的 研究体外培养大鼠成骨细胞在不同分化阶段的成纤维生长因子23（fibroblast growth factor 23,FGF23）基因表达水平,并观察其对钙、磷、甲状旁腺激素（PTH）和1,25二羟维生素D［1,25(OH)₂D₃］的反应。方法 酶消化法分离培养新生SD大鼠头盖骨成骨细胞,于细胞半汇合、汇合、基质堆积和矿化4个阶段收获细胞,Trizol一步法提取总RNA,Real-time PCR法检测其FGF23 mRNA水平,并通过其碱性磷酸酶（alkaline phosphatase,ALP）、骨钙素（bone gla-protein,BGP）和骨桥蛋白（osteopontin,OPN）的mRNA表达水平变化评价成骨细胞分化状态。进一步取汇合细胞,分别用3.2 mmol/L氯化钙、4.4 mmol/L β甘油磷酸钠（βGP）、10^-9 mol/L rhPTH(1-34)和10^-8 mol/L 1,25(OH)₂D₃作用3 d,检测其FGF23的mRNA表达变化,结果与空白对照组比较。结果 体外培养成骨细胞生长良好,成骨细胞FGF23的mRNA水平在汇合时显著上调,为半汇合阶段的7.5倍（P<0.001）,于基质堆积和矿化时期回落至半汇合水平,提示成骨细胞FGF23的表达呈阶段特异性。10^-8 mol/L 1,25(OH)₂D₃刺激后,FGF23的mRNA表达水平明显上调,约为对照组的16倍（P<0.001）;而CaCl₂、βGP、PTH刺激后,FGF23的mRNA表达水平与对照组相比,差异无统计学意义。结论 FGF23的表达与成骨细胞的分化状态有关,1,25(OH)₂D₃能强烈刺激体外培养成骨细胞FGF23的表达。     

大豆苷原(DA)对成骨细胞雌激素受体(ER)和过氧化物酶体增殖物激活受体γ(PPARγ)表达的调节作用及其受雌激素的影响(英文)

目的研究大豆苷原(daidzein,DA)对成骨细胞雌激素受体(estrogen receptor,ER)和过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptorγ,PPARγ)表达的调节作用,并观察雌激素对这种调节的影响。方法小鼠成骨细胞MC3T3-E1体外低血清(α-MEM,含2%FBS)培养,分别用0.1和10μmol/L的DA处理,采用实时定量PCR或Western blot分析细胞ERα、ERβ和PPARγ的表达变化。加入浓度均为0.1μmol/L的ER拮抗剂ICI182780或PPARγ拮抗剂GW9662,观察ER和PPARγ在DA调节中的作用。为观察雌激素的影响,采用无血清培养,在10nmol/L 17β-雌二醇(E2)条件下研究DA对细胞受体表达的作用。结果 DA抑制体外培养成骨细胞ER表达,而刺激其PPARγ表达。0.1和10μmol/L的DA分别下调ERα蛋白水平44%和38%(P<0.05),下调ERβ蛋白水平50%(P<0.05)和31%(P<0.05),上调PPARγ74%和78%(P<0.05)。ICI182780可阻断DA对ERα转录水平的抑制作用,DA对成骨细胞ERβmRNA水平的下调无统计学意义(P=0.087 4);GW9662可阻断DA对PPARγ表达的上调作用,提示成骨细胞ER和PPARγ参与自身表达调节。在10nmol/L 17β-雌二醇条件下,DA对无血清培养的成骨细胞ERα转录水平的抑制作用由28.0%～29.6%(P<0.05)增强至74.0%～82.8%(P<0.01),其对ERβ表达的抑制作用也明显增强,而对PPARγ的上调作用几乎丧失。结论 DA可通过调节ERs和PPARγ等受体表达间接影响成骨细胞的药物反应,雌激素可明显影响DA的受体调节作用。DA对细胞受体表达的调节作用可能是其对成骨细胞时间相关双相调节的重要机制之一。