微循环与骨质疏松的关系

The relationship between microcirculation and osteoporosis

骨质疏松主要与绝经、老龄以及某些影响骨代谢的疾病或药物有关,在骨代谢上主要表现为破骨细胞与成骨细胞功能的失衡。而骨骼主要由支配它的血管来完成新陈代谢,如果支配它的微循环出现障碍,是否会影响骨代谢以及是否会导致骨质疏松?国内相关方面研究较少。国外研究认为,从细胞分子方面而言,骨细胞能够产生血管生成因子,而血管内皮可以产生成骨因子,血管网的增长由软骨细胞和骨细胞产生的信号因子调控,同时,血管也具有影响新骨的成骨作用,血管生成和成骨通过CD31及Emcn抗体强阳性的H型血管内皮细胞相耦合。动物实验发现,骨质疏松的大鼠其微血管数量和VEGF较正常对照组明显减少,运动组的大鼠骨和骨髓血流量与股骨骨小梁体积分数(BV/TV)增加相关;临床实验中通过对腰椎的CT动态增强扫描灌注成像及BMD检查发现微循环与骨密度的变化规律一致,由此推测微循环灌注障碍是骨密度流失和加速IDD(椎间盘退变)的潜在原因。本文将从分子生物、动物实验到临床观察方面将国外有关研究进展做一介绍。

Osteoporosis is mainly related to menopause,aging and some diseases or drugs that affect bone metabolism,and is characterized by the imbalance of osteoblasts and osteoblasts function. Since bones relay on its blood vessels to complete the metabolism,the question is,if the microcirculation is impaired,whether it will affect bone metabolism and lead to osteoporosis？There are limited related reports in China in this area. International studies suggest that,from the cell molecular aspects,bone cells can produce angiogenic factors,and vascular endothelium can produce osteogenic factors; the growth of vascular network is regulated by signal factors produced by chondrocytes and bone cells; at the same time the blood vessels also affect the osteogenesis of newbone,and angiogenesis and bone formation are coupled by CD31 and Emcn antibody strongly positive H-type vascular endothelial cell. Animal experiments showed that the number of micro vessels and VEGF in osteoporotic rats was significantly decreased compared with the normal control group. Exercise-induced elevations in bone and marrowblood flowwere associated with greater BV/TV. In clinical experiments,CT perfusion imaging and BMD examination of lumbar spine showed that microcirculation was positively correlated with bone mineral density,which indicated that microcirculation perfusion disorder was a potential cause of bone mineral density loss and acceleration of IDD（ intervertebral disc degeneration）. This article reviewed international research progress from molecular biology,animal experiments to clinical observation studies.