【作者】 金福强；

【导师】 扈文海；

【作者基本信息】 河北医科大学 ， 外科学， 2010， 硕士

【摘要】 目的:股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)是骨科多发病、常见病,多发于青壮年,是一种严重威胁人类健康的骨科疾病。因其发病隐匿,病理过程复杂,其确切病因及发病机理尚未完全明了,备受国内外学者关注。长期以来,许多学者发现脂类代谢异常与股骨头缺血性坏死有着密切关系。为此,在总结了前人实验动物模型研究与临床试验研究的基础上,本研究对股骨头缺血性坏死病人的血脂变化进行监测与研究,从临床方面客观评价股骨头缺血性坏死的确切病因及发病机制,验证脂类代谢异常与股骨头缺血性坏死的关系,并为临床早期筛选诊断和防治股骨头缺血性坏死提供理论和试验依据。方法:分别选则河北医科大学第三医院2009年3月～2009年12月的股骨头缺血性坏死的病人和同期非股骨头缺血性坏死的病人各89例,分为股骨头缺血性坏死组(经查CT或MRI或病理学确诊为股骨头缺血性坏死者,年龄23～62岁,平均年龄44.6岁,男性71例,女性18例)与对照组(经查CT或MRI或病理学排除股骨头缺血性坏死者且排除近期内使用降脂药物的病人,年龄25～58岁,平均年龄41.4岁,男性64例,女性25例)。分别抽取空腹静脉血4ml,用日立7000全自动生化分析仪检测血脂。血脂数据收集:所有统计学分析应用SPSS 13.0统计软件进行。计量数据采用均数±标准差(x±s)表示。设定α=0.05,若P<0.05为差异有统计学意义,P<0.01为差异有显著统计学意义。结果:股骨头缺血性坏死组胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、载脂蛋白B(Apo-B)的含量分别为(4.99±1.06mmol/L,1.62±0.77mmol/L,3.10±1.01mmol/L,0.99±0.28g/L),显著高于对照组(3.38±1.10mmol/L,1.06±0.40mmol/L,2.50±0.45mmol/L,0.85±0.18g/L),有统计学意义(p<0.01和p<0.05);而高密度脂蛋白(HDL)、载脂蛋白AI (Apo-AI)的含量分别为(0.88±0.18mmol/L,1.20±0.17g/L),显著低于对照组(1.36±0.32mmol/L,1.55±0.31g/L),有统计学意义(p<0.01)。结论:1股骨头缺血性坏死的发生与脂类代谢、脂质分布异常有关。2高脂血症导致血液粘稠度异常,血液流动减缓;此外,高脂血症造成血管内皮细胞损害,导致动脉粥样硬化的发生及血液凝溶系统紊乱,患者处于血栓形成前的高危状态。同时,脂肪代谢紊乱,脂肪滴不断入血,脂肪栓塞不断形成,恶化股骨头供血区域的微循环环境,直至发生骨缺血坏死。3脂肪代谢紊乱,可诱导骨髓基质细胞大量分化成脂肪细胞而造成髓内脂肪组织堆积,其填塞作用也必然引起骨内压增高,骨内血液灌注量减少,使股骨头血供明显减少,导致骨细胞缺血性死亡。4脂肪代谢紊乱,脂肪或其组成成分被骨细胞摄取,引起骨细胞内脂质沉积并融合成脂肪滴,导致细胞核受压、边聚,出现所谓“外周化”现象,进而引起骨细胞核固缩、裂解、死亡。同时,成骨细胞分化减少,又减慢了骨的修复和塑型,最终造成塌陷,加剧股骨头坏死。5股骨头缺血性坏死存在脂质代谢紊乱,而脂质代谢的异常可通过上述多种机制导致骨坏死的发生,对股骨头缺血性坏死病人进行血脂的监测,干扰异常的血脂指标,对股骨头缺血性坏死的治疗、远期疗效的评定有重要的指导意义。6阻碍脂质代谢异常并相应地增强成骨作用可能会提供一种新的预防或治疗股骨头缺血性坏死的方法。更多还原

【Abstract】 Objective: avascular necrosis of the femoral head(ANFH) is a frequently occurring bone, common diseases, mainly in the young adults, is a bone disease of serious threat to human health. ANFH begin insidious, its pathological process is complex, its exact etiology and pathogenesis has not yet fully clear, so domestic and foreign scholars are highly concerned about it. For a long time, the close relationship between disorders of lipid metabolism and avascular necrosis of the femoral head have been found by many scholars. Therefore, On the basis of the predecessors experimental research of animal’s models and clinical trials, we monitor and research the lipid levels of patients with ANFH, to evaluate the exact cause and pathogenesis of ANFH, to verify the relation between disorders of lipid metabolism and ANFH,and to provide theoretical and experimental basis of the early clinical diagnosis and prevention of ANFH.Methods: Select 89 patients with avascular necrosis of femoral head and 89 the same time patients with non-avascular necrosis of femoral head in the Third Hospital of Hebei Medical University(2009.3-2009.12), they been divided into the ANFH groups (patients been diagnosed as ANFH by CT or MRI or Pathology, age:23 years to 62 years, average age:44.6 years, male 71, female 18) and the control group (patients been diagnosed as non-ANFH by CT or MRI or Pathology and been eliminate the use of lipid-lowering drugs in the near future, age:25 years to 58 years, average age:41.4 years, male 64, female 25). To collect 4ml Fasting venous blood, instrument:the Hitachi 7000 automatic biochemical analyzer. Blood-lipid data Statistical analysis was performed using SPSS 13.0 statistical software.Measurement data were presented as mean±standard deviation( x±s). Settingα= 0.05,there was statistical significance if P<0.05 for the difference, and significant statistical significance if P<0.01 for the difference.Results: TC、TG、LDL、Apo-B disturb in the avascular necrosis of femoral head group were (4.99±1.06mmol/L, 1.62±0.77mmol/L, 3.10±1.01mmol/L, 0.99±0.28g/L)respectively, which increased remarkably compared with the control group (3.38±1.10mmol/L, 1.06±0.40mmol/L, 2.50±0.45mmol/L, 0.85±0.18g/L), there are statistically significant difference (p<0.01 and p<0.05); while HDL、Apo-AI levels in the avascular necrosis of femoral head group were (0.88±0.18mmol/L, 1.20±0.17g/L), which lower remarkably compared with the control group (1.36±0.32mmol/L, 1.55±0.31g/L), there are statistically significant difference (p<0.01).Conclusion: 1 There are disorders of lipid metabolism in the patients with the avascular necrosis of femoral head. 2 Hyperlipemia led to abnormal blood viscosity, blood flow down; In addition, hyperlipemia damage vascular endothelial cell, resulting in the occurrence of atherosclerosis and blood coagulation solvent system disorders, patients are at high risk of thrombosis. At the same time, disorders of lipid metabolism, lipid droplets come into the blood, fat embolism evolve continuously, these worsen the region of the femoral head blood-supply microcirculation, until the occurrence of bone necrosis. 3 The disorders of lipid metabolism can differentiate a large number of bone marrow stromal cells into fat cells, accumulation of adipose tissue would stuff inevitably bone marrow,then lead to abnormally elevated iop (intraosseous pressure), which decreases blood perfusion,so that the blood supply of femoral head significantly reduced.The last,bone cells die. 4 The disorders of lipid metabolism, fat or its components were uptaked bone cells, causing lipid deposition of the bone cells and fused into lipid droplets, resulting in Compression of karyon and side-together of karyon, this is so-called the phenomenon of "peripheral", thereby bone cells shrinkage, pyrolysis and die. Meanwhile, the reduction of osteoblast differentiation, which slow down the bone repair and plastic, eventually leading to collapse, increasing femoral head necrosis. 5 There are disorders of lipid metabolism in the patients with the avascular necrosis of femoral, abnormal lipid metabolism leading to occurrence of osteonecrosis of femoral head through the above-mentioned a variety of mechanisms, to monitor the lipid levels of patients with ANFH, and to disturb abnormal blood-lipid levels, there is an important guiding significance to the treatment and the assessment of long-term efficacy with ANFH. 6 The inhibition of lipid etabolism and the concomitant enhancement of osteogenesis may provide a novel approach to the prevention or treatment of the avascular necrosis of femoral head.更多还原