激素性股骨头坏死血液流变学研究及探讨

Study on Hemorheology of Steroid-induced Osteonecrosis

目的：通过马血清、激素联合作用于实验家兔，研究激素与血液黏稠度间的相互关系，进一步探究激素性骨坏死的发病机理。方法：新西兰白兔60只，体重2．6～3．5kg，随机分成4组。A组：20只。经耳缘静脉单纯注射马血清，剂量为10ml／（kg·次）^-1，共2次，间隔3周。B组：15只。连续3d腹腔内注射甲基强的松龙，45mg／（kg·d）^-1，C组：20只。先静脉注射马血清10ml／（kg·次）^-1，共2次，间隔2周。第2次注射马血清后2周，连续3日腹腔内注射甲基强的松龙，45mg／（kg·d）^-1。D组：5只，单纯注射生理盐水10ml／（kg·次）^-1，方法同C组。分别于最后一次给药后1、2、3、5、7周处死取材。标本常规组织病理学检查，并在用药的不同时期进行血液流变学观察。结果：组织病理学检查证实，在马血清和激素协同作用的C组中，股骨头内小动脉损害严重，血栓形成广泛，共有74％标本发生骨坏死。而单用马血清或激素的A、B两组中。可见轻度骨内小动脉损害及骨髓内脂肪堆积，仅有28％、20％发生骨坏死。血液流变学检测结果显示，C组血液呈高黏滞状态，表现为全血黏稠度、血浆黏稠度、红细胞聚集性明显增高。与A组比较，有明显统计学意义（P〈0．05；P〈0．001）。结论：在血管炎基础上应用激素促进了血液高黏、高凝状态，加重了微血管损伤，在小动脉断裂、栓塞、出血的基础上导致骨组织缺血性坏死。

Objective： Studay the relationship between corticosteroid and blood viscosity, by employing a combined action of horse serum and corticosteroid in experimental rabbits, to further investigate the pathogenesis of steroid - induced osteonecrosis. Method： Sixty rabbits were divided into four groups. Group A consisted of twenty rabbits that received 10 ml/kg of horse serum intravenously two times at three week intervals. Group B was made up of fifteen rabbits that received an intraperitoneal injection of 45 mg/kg/day of methylprednisolone acetate for three consecutive days. Group C consisted of twenty rabbits that were treated with a combination of the protocols for Group A and Group B. They received 10 ml/kg of horse serum intravenously twice. Two weeks after the second serum injection, 45 mg/kg/day of methylprednisolone acetate was injected intraperitoneally for three consecutive days. Group D contains five rabbits that were used as the control. These rabbits were killed respectively one, two, three, five, seven weeks after their final treatment , and were examined histologically. Hemorheology were observed in some rabbits at the different time of treatment. Result： The findings of hitological studying showed that vascular wall of the arterioles was severely impaired, multible thrombi came into being, and 73 % rabbits developed osteonecrosis in group c. In group A and B Showed mild damage to intraosseous arterioles and subchondral fat accumulation, only 28 % and 20 % rabbits found osteonecrosis. Findings of hemorheological measurement showed the state of blood hyperviscosity in group C, and compared with group A had significantly statistic difference. （P 〈0.05, P〈0. 001 ）. Conclusion： Steroid aggravated microvascular damage, and caused the state of blood hyperviscosity and hypercoagulation under vasculitis. Steroid caused avascular osteonecrosis of femoral head under blood vessels rupture, thromboembolism, hemorrhages.