激素性股骨头坏死与血液流变学变化的关系

Relationship between hemorrheologic alteration and the femoral head necrosis after long-term glucocorticoid treatment

目的 探讨长期大剂量使用糖皮质激素后外周血液流变学变化规律和在激素性股骨头缺血坏死 (FHNG)中的作用及两者的相关性。方法 以日本白兔为实验动物每周一次皮下注射醋酸氢化泼尼松 8mg·kg-1,测定全血和血浆黏度比、红细胞电泳时间、红细胞脆性、毛细血管内血流速度 ,用透射电子显微镜观察股骨头组织的病理改变。结果 实验组全血黏度在 8周明显高于对照组 (P <0 .0 1)。血浆黏度比在用药 4周后开始升高 ,至 12周已显著升高(P <0 .0 1)。红细胞电泳时间 (EET) 8周时显著延长。实验组红细胞渗透脆性与对照组相比有显著性增加 (P <0 .0 1) ,外周毛细血管血流速度实验组随着用药时间的延长逐渐下降。成骨细胞、脂肪细胞、血管内皮细胞和骨细胞早期均有脂肪变性发生 ,晚期则可见坏死表现。结论 全血黏度升高可以使股骨头血液灌注量减少。FHNG同时存在有全身血液流变学改变 。

Objective To explore the relationship between blood flow viscosity and femoral head necrosis after long-term glucocorticoid treatment (FHNG). Methods Blood and plasma viscosity, blood flow speed, RBC fragility, electrophoresis time, and the speed of blood flow were measured. Cellular ultrastructural changes of FHNG were studied with electron microscope. Results Blood viscosity of the treatment group increased obviously at the 8th week compared with that of control group (P< 0.01). Plasma viscosity of the treatment group increased significantly at the 12th week. Erythrocyte electrophoretic time (EET) became remarkably longer at the 8th week (F=5.57, P<0.05). Fat degeneration was observed in all kinds of cells of the femoral head in the experiment group. Pyknosis, karyorrhexis, and karyolysis were observed in osteocytes, osteoblasts, and endothelial cells. Conclusion The blood supply of femoral head can be reduced by the rise of blood and plasma viscosity. There is a close relationship between FHNG and the rise of blood viscosity.