自体髂骨异烟肼、利福平以及吡嗪酰胺缓释涂层对脊柱结核兔的治疗效果及DPD和ALP的影响

The therapeutic effect of autogenous iliac bone isoniazid,rifampicin and pyrazinamide sustained-release coating on spinal tuberculosis rabbits and the effects of DPD and ALP

目的自体髂骨异烟肼、利福平以及吡嗪酰胺缓释涂层对脊柱结核兔的治疗效果及脱氧吡啶啉(DPD)和碱性磷酸酶(ALP)的影响。方法以40只脊柱结核兔为研究对象,按随机数字表法分为研究组和对照组,每组各20只。制备异烟肼、利福平以及吡嗪酰胺缓释涂层和不含药物的空白涂层,研究组将药物缓释涂层包裹于兔的自体髂骨表面,植入骨缺损部位,对照组使用空白涂层。分别于术前1 d和术后60 d检测红细胞沉降率(ESR)、C-反应蛋白(CRP)、DPD及ALP水平和尿肌酐(Cr)浓度;于术后60 d,HE染色观察植骨愈合情况,测定骨小梁面积。结果术前1 d,2组ESR和CRP水平比较,差异均无统计学意义(P>0.05);术后60 d,研究组ESR和CRP水平分别为(2.43±1.07)mm/h、(1.27±0.51)mg/L,均显著低于对照组[(7.61±1.38)mm/h、(5.32±1.05)mg/L],差异均有统计学意义(P<0.05)。术后60 d,研究组镜下观察可见少量炎性细胞,缓释涂层材料在新生骨的包绕内降解,表现为成颗粒状或散在岛状,有增生的淋巴细胞以及新生血管,成骨细胞表现活跃,有新骨形成。对照组镜下观察可见肉芽肿性结节,骨小梁见有散在淋巴细胞和中性粒细胞,成骨细胞增生不活跃。术后60 d,研究组骨小梁总面积为(12453.17±884.21)mm^(2),对照组骨小梁总面积为(7513.3±438.19)mm^(2),研究组骨小梁总面积显著大于对照组,差异有统计学意义(P<0.001)。术前1 d,2组尿DPD和血清ALP水平比较,差异均无统计学意义(P>0.05);术后60 d,研究组术后尿DPD和血清ALP为(13.58±4.14)nmol/mmol·Cr、(18.27±3.24)μg/L,均显著低于对照组[(25.51±4.85)nmol/mmol·Cr、(21.35±4.15)μg/L],差异均有统计学意义(P<0.05)。结论自体髂骨异烟肼、利福平以及吡嗪酰胺缓释涂层对脊柱结核兔的治疗效果良好,能改善DPD和ALP水平。

Objective The therapeutic effect of autogenous iliac bone isoniazid,rifampicin and pyrazinamide sustained-release coating on spinal tuberculosis rabbits and the effects of deoxypryidinoline(DPD)and alkaline phosphatase(ALP).Methods Taking 40 spinal tuberculosis rabbits as the research objects,they were randomly divided into study group and control group,with 20 rabbits in each group.Isoniazid,rifampicin and pyrazinamide sustained-release coatings and drug-free blank coatings were prepared.The study group wrapped the drug slow-release coating on the surface of the rabbit's autologous iliac bone and implanted it into the bone defect.The control group used a blank coating.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),DPD and ALP levels and urine creatinine(Cr)concentration were detected on the 1 day before and 60 after the operation;At 60 days after the operation,HE staining was used to observe the bone graft healing and the bone trabecular area was measured.Results At 1 d before operation,there was no significant difference in ESR and CRP levels between the two groups(P>0.05);at 60 d after operation,the ESR and CRP levels in the study group were(2.43±1.07)mm/h,(1.27±0.51)mg/L,which were significantly lower than thoe in the control group[(7.61±1.38)mm/h,(5.32±1.05)mg/L],the differences were statistically significant(P<0.05).At 60 days after the operation,the research group observed a small amount of inflammatory cells under the microscope.At 60 days after the operation,the total area of trabecular bone in the study group was(12453.17±884.21)mm^(2),and the total area of trabecular bone in the control group was(7513.3±438.19)mm^(2),the total area of trabecular bone in the study group was significantly larger than that in the control group(P<0.001).At 1 d before operation,there was no significant difference in urine DPD and serum ALP levels between the two groups(P>0.05);At 60 days after the operation,the postoperative urine DPD and serum ALP of the study group were(13.58±4.14)nmol/mmol·Cr,(18.27±3.24)μg/L,which were significantly lower than those in the control group[(25.51±4.85)nmol/mmol·Cr,(21.35±4.15)μg/L],the differences were statistically significant(P<0.05).Conclusion Autologous iliac bone isoniazid,rifampicin and pyrazinamide sustained-release coating have good therapeutic effects on spinal tuberculosis rabbits,and can improve DPD and ALP levels.