骨髓间充质干细胞治疗激素性股骨头缺血性坏死的研究进展

Research Progress of Bone Marrow Mesenchymal Stem Cells in the Treatment of Glucocorticoid-Induced Osteonecrosis of Femoral Head

糖皮质激素所导致的股骨头缺血性坏死,被认为是长期或过量使用类固醇治疗中最严重的副作用。糖皮质激素可以破坏骨髓间充质干细胞的正常分化,导致骨量的减少和骨髓脂肪组织的增加。然而,其潜在的发病机制仍不明确。尽管全髋关节置换术是治疗晚期股骨头缺血性坏死最有效的方法,但在年轻患者或活跃人群中,因为一些与假体相关的并发症,全髋关节置换术的效果往往不佳。骨髓间充质干细胞具有自我更新和多向分化的能力,包括分化为成骨细胞和内皮细胞,从而介导骨修复和血管生成。此外,骨髓间充质干细胞还可以通过旁分泌作用提供生长因子,从而促进坏死区的血液供应。因此,骨髓间充质干细胞治疗可以作为激素性股骨头缺血性坏死的保髋方案之一。

Glucocorticoid (GC)-induced osteonecrosis is the most serious effect in long-term or over-dose steroid therapy. GC can destroy the normal differentiation balance of bone marrow mesenchymal stem cells (BMSCs), resulting in a decrease bone mass and an increase marrow fat tissue. However, its underlying pathogenesis is still unclear. Although total hip arthroplasty (THA) is the most effective treatment for patients with osteonecrosis of femoral head (ONFH) in the terminal stages, the outcomes of THA in young adults or active populations are often not excellent, due to some complications related to the prosthesis. BMSCs have been shown to have the ability to self-renew and to differentiate into multiple cell types including differentiate into osteoblasts and endothelial cells to affect bone repair and angiogenesis, and can produce growth factors to promote the blood supply to necrotic regions by paracrine effects. Therefore, BMSCs therapy can be used as one of the hip-saving programs for GC-induced ONFH.