降脂联合抗凝与单纯降脂干预对兔激素性股骨头坏死的影响对比分析

THE EFFECT OF LIPID LOWERING COMBINED WITH ANTI-COAGULANT ON THE TREATMENT OF CORTICOSTEROID-INDUCED OSTEONECROSIS OF FEMORAL HEAD IN RABBITS

目的:观察降脂联合抗凝与单纯降脂干预对兔激素性股骨头坏死(ONF)的影响。方法:将52只大白兔随机分为4组:生理盐水对照组(CTR组,n=10)、激素性ONF实验组(EXP组,n=14)、阿托伐他汀联合华法林治疗组(AW组,n=14)、单纯阿托伐他汀治疗组(AT组,n=14)。利用静脉注射大肠杆菌内毒素及肌肉注射甲基强的松龙,建立兔激素性ONF动物模型。实验过程不同时点检测各组实验动物静脉血总胆固醇(TCH)、低密度脂蛋白与高密度脂蛋白比值(LDL∶HDL)及血浆凝血酶原时间(PT)变化。实验结束后处死动物,观察股骨头大体病理及骨组织形态学改变,判断ONF发生情况。结果:从实验第4周开始,与CTR组、AW组、AT组比较,EXP组TCH、LDL∶HDL显著升高(P<0.05),AW组和AT组虽高于CTR组,但组间比较差异无统计学意义(P>0.05)。从实验第2周开始,AW组PT较CTR组、EXP组及AT组明显延长(P<0.05)。AW组、AT组实验动物ONF发生率分别为31%、42%,两组间比较差异无统计学意义(P>0.05),但均显著低于EXP组67%(P<0.05)。结论:降脂与抗凝联合应用可显著降低兔激素性ONF发生,但与单纯降脂干预比较无显著差异,提示其作用可能主要从改善高脂状态中获益。

Objective： To investigate the effect of lipid lowering combined with anti-coagulant on the treat-ment of corticosteroid-induced osteonecrosis of femoral head （ONF） in rabbits. Methods： 52 rabbits wererandomized into four groups： the normal saline group （CTR group, n =10） , the experimental group （EXP group,n =14）,the atorvastatin plus warfarin-treated group （AW group,n =14） and the atorvastatin-trea- ted group （AT group, n = 14）. The rabbit ONF model was established by i. v. injection with endotoxin of E. coii and i. m. injection with methylprednisolone. The level of total cholesterol （TCH）,the low-density lipoprotein and high-density lipoprotein ratio （LDL/HDL） and prothrombin time （PT） were measured at different time points. At the end of the experiment,the rabbits were sacrificed,and the pathologic and his- tomorphologic changes of femoral head as well as the occurrence of ONF were observed. Results： TCH lev-el and the ratio of LDL/HDL were significantly increased in the EXP group,compared （ P 〈 0. 05）. The PT of the AW group was the longest among the four groups （ P 〈 0. 05）. The ONF inri-dence in the EXP group was higher than those in AW and AT groups （ P 〈 0. 05）. No significant differencein the incidence of ONF between AW group and AT group （31% vs. 42% , P 〉 0 . 05）. Conclusion： Lipid lowering combined with anti-coagulant treatment could effectively reduce the occurrence of corticosteroid- induced ONF in rabbits, but no significant differences was found between this combination id-lowering intervention suggesting that the anti-ONF effect may rely on improving the blood lipid.