降脂、抗凝药物预防激素所致股骨头骨细胞坏死、凋亡及对BcL-2表达的影响

Antilipemics and anticoagulants in prevention of necrosis and apoptosis of osteocytes in steroid induced osteonecrosis of the femoral head

目的通过建立动物实验模型,探讨同时应用降脂、抗凝药物对激素性股骨头坏死的防治作用及病理机制。方法选用大白鼠60只,体重约200g,随机分为A、B、C、D组,A、B、C组给予不同的药物,D组不给药,空白对照。实验8周处死动物,取股骨头作组织学、超微结构观察,并用TUNEL及免疫组化技术分别检测骨细胞凋亡和BcL-2表达情况。结果①光镜下B、C两组较A组股骨头骨小梁变细、稀疏、空骨陷窝明显增多,脂肪细胞增大,A组接近D组。②电镜下B、C两组细胞体积缩小,核固缩,染色质边聚较多见于A组,A组接近D组。③C组凋亡骨细胞多见于其它组,A组接近D组,A组BcL-2表达多于其它组。结论大剂量应用激素同时给予降脂、抗凝药预防股骨头坏死的作用优于单纯应用降脂药组;激素性股骨头坏死是骨细胞坏死和凋亡共同作用的结果。

Objective To study the administration of antilipemics and anticoagulants in prevention of the DEX (dexamethasone) induced osteonecrosis of thefemoral head (ONFH) in rats and the pathogenesis of the DEX induced ONFH. Methods 60 healthy mature white rats, weighing about 200g, were selected without sexual restriction and randomly divided into A, B, C, D groups. Groups A,B,C were given different drugs. Group D served as the blank control. Pathology, apoptosis and the expression of BcL 2 protein of the femoral heads were observed in 60 days. Results 1. Compared with Group A, the trabeculae of femoral head in Groups B and C became thinner and less solid, there were obviously more bone lacunae and the fatty cells in the bone marrow cavity became more and larger. Group A was similar to Group D. 2. Under electronic microscope, in Groups B and C, a great deal of necrotic osteocytes, pyknotic nucleus, cytoplasm and organell vanished. Group A was similar to Group D. 3. More apoptosis was observed in Group C than in Groups A, B, D. And more expression of BcL 2 protein was observed in Group A than in Groups B, C, D. Conclusions When a massive dose of hormons is injected, administration of antilipemics and anticoagulants is helpful in prevention of hormone induced necrosis of the femoral head. The steroid induced osteonecrosis of the femoral head results from both the necrosis and apoptosis of osteocytes.