激素性股骨头坏死成脂分化学说及治疗现状

摘要

BACKGROUND:Glucocorticoids may induce local bone trabecular and bone marrow necrosis, femoral head col apse and deformation, thus resulting in hip dysfunction. However the pathological mechanisms and treatment of glucocorticoids-induced osteonecrosis of the femoral head remain unclear, and the pathogenesis mechanisms are controversial. The current studies focus on the understanding of the pathological mechanisms. OBJECTIVE:To summary the research progress of adipogenic differentiation theory of glucocorticoids-induced osteonecrosis of the femoral head and the treatment. METHODS:The first author searched literature from CNKI and PubMed database from 1988 to 2010, by using the key words is“Glucocorticoids, osteonecrosis of femoral head, bone marrow stromal stem cells, adipogenic differentiation, differentiation factors, treatment, choices”in English, and“glucocorticoids induced osteonecrosis of femoral head, adipogenic differentiation, treatment, research progress”in Chinese. Articles regarding the adipogenic differentiation theory of glucocorticoids-induced osteonecrosis of the femoral head and the treatment were included. RESULTS AND CONCLUSION:A total of 112 literatures were screened out, according to inclusion and exclusion criteria for literature screening, 54 articles were included. Modern researches emphasize the celland molecular biology level, and show that the biological base of glucocorticoids-induced osteonecrosis of the femoral head is abnormal adipogenic differentiation of bone cells, glucocorticoids cause the variations of adipogenic differentiation factors, leading to adipogenic differentiation of bone marrow stromal cells. But glucocorticoids affects multiple differentiation factors, it may cause great error in the evaluation of the pathogenesis of glucocorticoids-induced osteonecrosis of the femoral head purely from one factor. The abuse of glucocorticoids is the leading cause for the osteonecrosis of femoral head. Further studies are needed to investigate the pathogenesis of osteonecrosis of the femoral head and treatment programs.%背景：激素引起股骨头局部区域骨小梁和骨髓坏死，股骨头塌陷、变形，最终导致髋关节功能障碍，但是激素性股骨头坏死的病理机制及治疗仍未为人所破解，医学界存在多种病机学说争议，但是目前对病理机制的了解仍然不够深入，其研究一直是国际研究的热点及难点。　　目的：综述激素性股骨头坏死的成脂分化学说及治疗研究进展。　　方法：由第一作者用计算机检索中国期刊全文数据库CNKI及PubMed数据库(1988/2010)，英文检索词分别为“Glucocorticoids, osteonecrosis of femoral head, bone marrow stromal stem cel s, adipogenic differentiation, factors,treatment, choice”，中文检索词为“激素性股骨头坏死，成脂分化，治疗，研究进展”，从激素性股骨头成脂分化及治疗现状2方面进行归纳概述。　　结果与结论：共检索到112篇文章，按纳入和排除标准对文献进行筛选，共纳入54篇文章。现代研究主要从细胞分子生物学层面研究，结果表明激素性股骨头坏死的部分生物学基础是骨细胞成脂分化异常，激素引起成脂分化因子的变化进而导致骨髓基质干细胞成脂分化，但是激素的作用于多个分化因子，单纯从某个因子来衡量激素性股骨头坏死病理机制可能有较大误差，激素使用过度是股骨头坏死核心原因。目前对激素性股骨头坏死病理机制及治疗方案的研究仍不深入。