α2-巨球蛋白在不同时相的激素性股骨头坏死组织中的表达

Expression of α2 - macroglobulin in steroid - induced femoral head necrosis at different phases

目的探讨α2-巨球蛋白（α2M）和不同时相的激素性股骨头坏死之间的关系。方法随机选取就诊的股骨头坏死患者和股骨近端骨折的患者，根据股骨头坏死国际骨循环研究会（ARCO）分期，随机分成5组，包括对照组和实验Ⅰ-Ⅳ组，每组20例，总共100例。通过组织病理学观察、免疫组织化学和实时荧光定量聚合酶链反应（FQ-PCR）等，对比不同组之间各组织α2M的表达水平等。结果（1）组织病理学：实验组Ⅰ-Ⅳ组的空骨陷窝率[（15．664±2．76）％、（28．29±1．38）％、（39．43±5．47）％和（51．27±4．85）％]明显高于对照组[（8．54±3．25）％]，各组间差异有统计学意义（P=0．000、0．000、0．008、0．010）；（2）免疫组织化学：对照组的分值（1．88±0．22）明显高于实验Ⅰ-Ⅳ组（1．24±0．16、1．17±0．19、0．73±0．11和0．26±0．09），差异有统计学意义（P=0．000、0．000、0．001、0．009）；（3）FQ．PCR对照组关节囊滑膜组织a2M的mRNA表达量（18．67±2．37）明显高于实验Ⅱ±Ⅳ组（13．67±1．87、7．59±1．01和4．89±0．54），差异有统计学意义（P=0．000、0．000、0．000）；实验Ⅰ-Ⅳ组关节液以M的mRNA表达量（13．26±1．06、12．78±1．98、4．56±0．89和3．34±0．56）明显低于对照组（17．87±2．26），差异有统计学意义（P=0．000、0．000、0．000、0．000）；对照组（16．56±2．18）股骨头组织仅2M的mRNA表达量明显高于实验Ⅰ-Ⅳ组（13．01±1．06、10．76±1．93、3．76±0．96和1．34±0．56），差异有统计学意义（P=0．000、0．000、0．000、0．000）。结论a2M在激素性股骨头坏死的不同时相和不同组织中起重要作用。

Objective To discuss the relationship between α2 - macroglobulin （ot2M） and steroid - induced femoral head necrosis at different phases. Methods The patients with femoral head necrosis and proximal femoral fracture were randomly selected. They were randomly divided into five groups according to association research circulation osseous （ARCO） stages of femoral head necrosis, including control group, experimental groups I - IV, n =20 in each group and 100 in all. Histopathology, immunohistochemistry, and realtime fluorescent quantitative polymerase chain reaction （FQ- PCR） were used to compare the expression levels of a2M in different tissues of each group. Results （ 1 ） Histopathologically, the rate of empty bone depression in the experimental groups Ⅰ-Ⅳ [ （ 15.66 ±2. 76）%, （28. 29 ± 1.38）%, （39. 43 ±5.47）% and （51.27 ±4. 85）% ] was significantly higher than that in control group [ （ 8.54 ± 3.25 ） % ], and the differences between each experimental group and control group were statisti- cally significant （ P = 0. 000, 0. 000, 0. 008, 0. 010） ; （2） Immunohistochemically, the expression of ct2M in the control group （ 1.88 ± 0. 22） was significantly higher than that in he experimental groupsⅠ-Ⅳ （ 1.24 ±0. 16, 1. 17 ±0. 19, 0. 73 ±0. 11 and 0. 26 ±0. 09 respectively） , and the difference was statistically signifieant （P = 0. 000, 0. 000, 0. 001, 0. 009） ; （3） For FQ - PCR, the mRNA expression level of a2M in the artieular capsule synovial membrane of control group （18.67 ± 2.37 ） was significantly higher than that in experimental groups Ⅱ - Ⅳ （ 13.67 ± 1.87, 7.59 ± 1.01 and 4. 89 ± 0. 54） , and the difference was statistically significant （P = 0. 000, 0. 000, 0. 000） ; The mRNA expression level of a2M in the joint fluid was significantly lower in the experimental groups Ⅰ-Ⅳ （ 13.26 ± 1.06, 12. 78 ± 1.98, 4. 56 ±0. 89 and 3.34 ±0. 56） than that in the control group （17.87 ±2. 26） , and the difference was sta- tistically significant （P =0.000,0.000, 0. 000, 0. 000） ; The mRNA expression level of et2M in the femoral head was significantly higher in the control group （ 16. 56 ± 2. 18 ） than that in the experimental groups Ⅰ - Ⅳ （ 13.01 ± 1.06, 10. 76 ± 1.93, 3.76 ±0. 96 and 1. 34 ±0. 56）, and the difference was statistieal- ly significant （ P = 0. 000, 0. 000, 0. 000, 0. 000）. Conclusion a2M can play an important role in the different phases and different tissues of steroid - indueed femoral head necrosis.