| Glucocorticoid is a first-factor to induce necrosis of femoral head. At present, pathogenesis of steroid-induced necrosis of femoral head (SANFH) had been unclear. Clinically, no any ideal measure to prenvent and treatment it.To study a ideal prenvention and treatment measure as well as its pathogenesy, we put something into practice.The study include three partial content:The first part: establish the model of SANFH and assay serum C-reaction protein level variation.In the studying SANFH,ideal animal model had been little.and ideal animal model is the most important in clinical directions. Its value is made decision by its pathogenesis and course of disease coincidencing with human'pathogenesis and course of disease.including: pathology in early stage and collapse in advanced stage;animol gene; anatomy structural feature,measure of prevent and treatment,et al.at the present,in the early stage of SANFH,no index of prediction refer to suppose SANFH. for this reason, establishing the ideal animol model of SANFH and finding a prediction factor have important significance.â… . Establish the model of SANFHNecrosis of femoral head is correlation with weight loading of femoral head.The ideal animol model must be more and cheap and simple in the operation,and model is made in shortly time,and model formation Incidence increase,its pathogenesis and course of disease coincidencing with human',and can be used for clinic.90% rat gene its pathology characteristics are conform to human,its experiment result can be used for clinic.at the present,the reason that rat model were made seldomly is why weight loading in its femoral head is less in its mouse cage. As above-mentioned,in the study,the rats were forced standing at interval to incease their weight loading,to promote SANFH.and glucocorticoid was injected only.we used hematoxylin-eosin staining(H-E staining); Masson's staining;light microscope observation;determination osteonecrosis.in the report,90% femoral head under light microscope show osteonecrosis in the weekend4th.namely: bone trabecula become thinningz and rarefaction and even fragmentation; empty bone lacuna increase remarkably,the maximum arrive to 28.72%;osteoclast increase remarkably; hematopoietic cell decrease remarkably; adipocyte in the bone marrow increase and proliferation and hypertrophy;in the weekend6th, above-mentioned variation are highly significant.these variation conform to osteonecrosis.â…¡. Detect CRP levelC-reaction protein (CRP) is a acute stage reaction protein, CRP survey and evaluate has an important reference worth in the diagnosis and observation therapeutic result of the inflammation and tissue damage. CRP level is more sensitive indicatrix with regard to judgement of tissue damage: it can raise quickly in 6-8 hours after tissue damage, and arrive to peak time in 48-72 hours, and maintain high level under circumstances of lasting tissue necrosis. now, CRP had been prediction factor of angiocardiopathy for instance myocardial infarction and stroke and 2 type diabetes, As main pathogenesy of SANFH include hyperlipemia and highly blood coagulation, then,we assume CRP can be a prediction factor of SANFH.At present, It has been reported that high sensitive CRP (hsCRP) is very high in osteopenia and osteoporosis patients. To confirm if it can be prediction index of SANFH,we detect CRP level variation with immunoturbidimetry in the early stage of SANFH.The result show:in the SANFH early stage, CRP level increase by degrees along with experiment time, fluctuation from 15mg/L to 20mg/L. moreover, its fluctuationnextent have characteristic, namely it is taller than infarction and stroke when CRP increase slightly and detected only by high sensitive CRP, nevertheless, lower than other acute inflammation when CRP step up sharply.In the propylene glycol alginate sodium sulfate(PSS) group or propylene glycol alginate sodium sulfate and alendronate and osteoform group, CRP level close to normal control group, P>0.05; CRP level is difference significant compared with the glucocorticoid group, P<0.01. it indicated PSS can inhibit that glucocorticoid induced CRP lever variation.The second part: propylene glycol alginate sodium sulfate and alendronate prevent SANFHSANFH is relate to lipid metabolism disorder and intravascular coagulation and highly intraosseous pressure and osteoporosis.in recently years, the pathogenesis of steroid-induced femoral head necrosis is osteocyte apoptosis.now,no ideal measure prevent SANFH.signal medicine therapeutic result is limitated, associated medicine prevention is less in animol study and clinic pratice.To prevent SANFH thoroughly,we associate the propylene glycol alginate sodium sulfate and alendronate.The result show:blood-fat and CRP level close to control. femoral head histomorphology show: trabecula bone is thick, regulation; scatter osteoblasts in trabecula bone edge; empty bone lacuna is few; osteoclast is few; hematopoietic cell is abundant; fat cell is fewer. The difference is not significantthat that compare with the control group, P>0.05; The difference is significantthat that compare with the glucocorticoid group, P<0.01. It indicate that SANFH can be prevented by fat-clear dose; anticoagulation; anti-osteoporosis and antiapoptosis associated way.The third part: propylene glycol alginate sodium sulfate and alendronate effect bcl-2 and caspase-3 expressionAt present, study of pathogenesy of osteocyte apoptosis and prevention through inhibition apoposis has been warm spots. Meanwhile, abroad scholar demonstrate It was reported that bisphosphonates can inhibit significant osteocyte apoptosis overseas.but it has been reported in China. it has been reported that glucocorticoid effect bcl-2 expression,but it hasn't been reported that glucocorticoid effect caspase-3 expression in China or overseas. To study that glucocorticoid effect caspase-3 expression and mechanism of propylene glycol alginate sodium sulfate and alendronate,we detect caspase3 and bcl-2 expression by immunohistochemical method.The result demonstrate: in the glucocorticoid group, bcl-2 expression decrease, cascape3 expression increase, difference is significant compared with the control group, P<0.01. in the propylene glycol alginate sodium sulfate and alendronate and osteoform group, bcl-2 and cascape3 expression are close to the control group, P>0.05, but it is difference significant compared with the glucocorticoid group, P<0.01.the research brings forth new ideas in medical science:It is the first to establish typical rats SANFH model induced by forced standing; It is also the first to observe CRP level variation and regular, to presume that CRP must be prediction factor in SANFH; It is also first time to detect caspase3 expression in the early stage of SANFH; It is also first time to associate propylene glycol alginate sodium sulfate with alendronate to prevent SANFH in the early stage, and discover that glucocorticoid decrease bcl-2 expression but increase caspase3 expression, but propyle neglycol alginate sodium sulfate and alendronate can prevention SANFH by promoting bcl-2 express and inhibiting caspase3 express. |
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