酒精和激素性股骨头缺血性坏死发病机制的实验研究

Experimental study on the mechanism of alcoholic and hormonal ischemic necrosis of femoral head

目的研究酒精和激素性股骨头缺血坏死的发病机制。方法选用健康成熟的中国白兔６０只，体重２．５±０．５ｋｇ，雌雄不限，随机分成两组。Ａ组３０只为酒精组，Ｂ组３０只为激素组。分别于实验前和实验后２、４、６、８周测血脂、前列腺素Ｅ２和血栓烷素Ｂ２。并于第４、８、１０周分批处死，取肝脏和股骨头作常规病理组织学和超微结构观察。结果两组血脂水平明显升高，差异无显著性意义；从实验第４周开始两组前列腺素Ｅ２较处理前明显增高（Ｐ＜０．０１）；而实验第４周和第８周前列腺素Ｅ２的含量Ａ组较Ｂ组明显增高（Ｐ＜０．０１）。两组动物都出现股骨头骨细胞坏死，同时有大量骨细胞发生脂肪变性及坏死。电镜下两实验组可见股骨头部骨细胞内出现异常增多的脂滴，核变性深染，细胞器消失。但Ａ组动物骨细胞坏死程度比Ｂ组动物严重，表现为损伤作用强烈，经过急剧，呈急性坏死表现。而Ｂ组动物骨细胞坏死呈慢性进行性坏死表现。结论激素所致的股骨头缺血坏死是多种因素引起股骨头血液循环障碍，导致骨坏死；而酗酒使血中游离脂肪酸升高，前列腺素增多，易发生血管炎而栓塞。

Objective To study the mechanism of alcoholic and hormoral ischemic necrosis of femoral head.Methods Sixty healthy mature Chinese white rabbits,weighing 2.5±0.5kg were selected without sexual restriction and randomly divided into two groups:30 as group A or group of alcohol and 30 as group B or group of hormone.The serum lipid,prostaglandin E 2(PGE 2) and thromboxane B 2(TXB 2) were measured before and after the 4th,8th and 10th week of the experiment.The rabbits were killed by parcel after 4,8 and 10 weeks of experiment,when the liver and femoral head were taken and pathohistology and supra-micro structure were observed.Results The lipid of both groups increased obviously and no significant difference existed between 2 groups.The level of PGE 2 of both groups rose obviously by the 4th week of the experiment,which showed statistical difference between them (P<0.01).By the 4th and 8th week,the content of PGE 2 of group A increased remarkably compared with that of group B,and the difference is very significant(P<0.01).The necrosis of femoral head appeared in both groups,and a great deal of osteocytes had fatty degeneration and necrosis.Under electronic microscope,the osteocytes of femoral head had abnormal increase of lipid drop,lateral movement,degeneration and dark dye of nucleus,and the dissappearance of organelles.However,the necrosis of group A was more severe than that of group B with more intensive injury,sharp process and acute necrosis,while the necrosis of osteocytes of group B showed chronic progressive necrosis.Conclusion The ischemic necrosis of femoral head induced by hormon is caused by the disorderly circulation of femoral head led by the combination of many factors,while that in alcohol group is due to the elevation of FFA and PGE 2 which is liable to thrombosis.