激素性股骨头坏死晚期患者中相关基因表达

Expression of related genes in necrotic tissue of the patients with advanced steroid-induced osteonecrosis of the femoral head

目的 观察激素性股骨头坏死（ONFH）晚期患者坏死区骨组织中相关基因的表达.方法 收集手术切除的20个股骨头,其中,10例晚期激素性ONFH作为实验组,10例头下型股骨颈骨折作为对照组.采用实时定量聚合酶链反应（Real-time PCR）分别测定两组坏死骨组织中骨形态发生蛋白-2（BMP-2）、过氧化物酶体增殖子活化受体γ（PPARγ）、护骨素（OPG）、成骨转录因子（Runx2）及核因子（NF）-κB受体活化因子配基（RANKL） mRNA的表达水平.结果 实验组坏死骨组织中BMP-2、PPARγ、OPG、Runx-2及RANKL mRNA水平均较对照组明显下调,2-△△Ct分别为0.38±0.05、0.47 ±0.05、0.44±0.06、0.37 ±0.05、0.43 ±0.05,差异均有统计学意义（P＜0.05）.结论 晚期激素性ONFH坏死区面积大,其内残存骨活性成分很少,其成骨与成脂基因表达均下调,股骨头已毁损而不可能再生,应施以全髋关节置换术.

Objective To observe the related gene expression levels in necrotic tissue of the advanced steroid-induced osteonecrosis of the femoral head （ONFH）.Methods Twenty femoral heads have been gathered during total hip arthroplasty from 10 patients with advanced steroid-induced ONFH as the experimental group, and from 10 patients with intracapsular fracture of the femoral neck as the control group.Rreal-time quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression levels of bone morphogenetic protein-2 （BMP-2）, peroxisome proliferators-activated receptor γ （PPARγ）, osteoprotegerin （OPG）, runt-related transcription factor-2 （Runx-2） and receptor activator of NF-κB ligand （RANKL） in the necrotic bone tissue of the two groups.Results Compared with the control group, the mRNA expression levels of BMP-2, Runx-2, OPG, PPARγ and RANKL were significantly reduced in the experimental group, wityh the 2-△△Ct values in the experimental group being 0.38 ± 0.05, 0.47 ± 0.05, 0.44 ± 0.06, 0.37 ± 0.05, and 0.43 ± 0.05, respectively （P 〈 0.05）.Conclusion The very large size of necrotic tissue area was seen in the advanced steroid-induced ONFH, the necrotic bone tissue is abundant and the vital bone tissue is low, the expression levels of osteogenic and adipogenic genes are depressed, and the femoral head is seriously damaged, which is suitable for the total hip arthroplasty.