中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
28期
5126-5132
,共7页
俞华威%王兆杰%胡小军%赵俊延%齐新文
俞華威%王兆傑%鬍小軍%趙俊延%齊新文
유화위%왕조걸%호소군%조준연%제신문
组织构建%骨组织构建%骨质疏松症%骨折%骨密度%骨代谢%成骨细胞%破骨细胞%生化标志物%老年%病理学检查
組織構建%骨組織構建%骨質疏鬆癥%骨摺%骨密度%骨代謝%成骨細胞%破骨細胞%生化標誌物%老年%病理學檢查
조직구건%골조직구건%골질소송증%골절%골밀도%골대사%성골세포%파골세포%생화표지물%노년%병이학검사
tissue construction%bone tissue construction%osteoporosis%fracture%bone mineral density%bone metabolism%osteoblasts%osteoclasts%biochemical markers%old%pathological examination
背景：目前国际上公认双能 X 射线吸收测定法为诊断骨质疏松症的金标准，但常由于测量部位异位骨化、骨质增生等因素使得测量结果存在误差。目的：探讨骨代谢标志物在老年骨质疏松骨折诊疗中的临床意义以及它与骨密度和骨组织形态病理学改变的相关性。方法：选取50例需行手术治疗的老年骨质疏松骨折患者，行骨生化4项检测，其中抗酒石酸酸性磷酸酶5b(TRACP 5b)检测值明显增高患者25例(标记为抗酒石酸酸性磷酸酶5b 升高组)，骨碱性磷酸酶(BAP)检测值明显升高患者25例(标记为骨碱性磷酸酶升高组)。术中抽取两组各8例患者骨折断端部分骨组织，苏木精-伊红染色普通光镜检查和扫描电镜检查病理学改变。术后，抗酒石酸酸性磷酸酶5b 升高组患者使用鲑鱼降钙素抗骨质疏松治疗，骨碱性磷酸酶升高组患者使用骨肽注射液抗骨质疏松治疗，6个月后再次检测骨密度和骨生化4项。结果与结论：两组患者术前骨密度和骨生化4项检查结果相比较差异无显著性意义(P >0.05)。抗酒石酸酸性磷酸酶5b 升高组患者骨折断端骨组织病理检查示成骨细胞减少、破骨细胞增多；骨碱性磷酸酶升高组患者骨折断端骨组织病理检查示成骨细胞减少；两组骨小梁/骨面积比值均降低，且抗酒石酸酸性磷酸酶5b 升高组较骨碱性磷酸酶升高组降低程度差异有显著性意义(P <0.05)。扫描电镜检查示两组破骨细胞都较正常组活跃，抗酒石酸酸性磷酸酶5b 升高组骨小梁较骨碱性磷酸酶升高组稀松明显，吸收空泡增大。两组于术后使用抗骨质疏松药物治疗，两组治疗前与治疗后骨密度和骨生化4项检测结果差异有显著性意义(P <0.05)。结果显示：①骨代谢标志物检测能明确患者骨组织是以成骨细胞功能和数量减低还是以破骨细胞功能和数量增加为主，以便指导临床针对性使用抗骨质疏松药物。②骨折断端骨组织形态病理学检查能更好地反映患者骨组织内成骨细胞、破骨细胞和骨小梁等状况。骨质疏松患者针对性使用抗骨质疏松药物治疗能提高疗效、降低相关并发症。
揹景：目前國際上公認雙能 X 射線吸收測定法為診斷骨質疏鬆癥的金標準，但常由于測量部位異位骨化、骨質增生等因素使得測量結果存在誤差。目的：探討骨代謝標誌物在老年骨質疏鬆骨摺診療中的臨床意義以及它與骨密度和骨組織形態病理學改變的相關性。方法：選取50例需行手術治療的老年骨質疏鬆骨摺患者，行骨生化4項檢測，其中抗酒石痠痠性燐痠酶5b(TRACP 5b)檢測值明顯增高患者25例(標記為抗酒石痠痠性燐痠酶5b 升高組)，骨堿性燐痠酶(BAP)檢測值明顯升高患者25例(標記為骨堿性燐痠酶升高組)。術中抽取兩組各8例患者骨摺斷耑部分骨組織，囌木精-伊紅染色普通光鏡檢查和掃描電鏡檢查病理學改變。術後，抗酒石痠痠性燐痠酶5b 升高組患者使用鮭魚降鈣素抗骨質疏鬆治療，骨堿性燐痠酶升高組患者使用骨肽註射液抗骨質疏鬆治療，6箇月後再次檢測骨密度和骨生化4項。結果與結論：兩組患者術前骨密度和骨生化4項檢查結果相比較差異無顯著性意義(P >0.05)。抗酒石痠痠性燐痠酶5b 升高組患者骨摺斷耑骨組織病理檢查示成骨細胞減少、破骨細胞增多；骨堿性燐痠酶升高組患者骨摺斷耑骨組織病理檢查示成骨細胞減少；兩組骨小樑/骨麵積比值均降低，且抗酒石痠痠性燐痠酶5b 升高組較骨堿性燐痠酶升高組降低程度差異有顯著性意義(P <0.05)。掃描電鏡檢查示兩組破骨細胞都較正常組活躍，抗酒石痠痠性燐痠酶5b 升高組骨小樑較骨堿性燐痠酶升高組稀鬆明顯，吸收空泡增大。兩組于術後使用抗骨質疏鬆藥物治療，兩組治療前與治療後骨密度和骨生化4項檢測結果差異有顯著性意義(P <0.05)。結果顯示：①骨代謝標誌物檢測能明確患者骨組織是以成骨細胞功能和數量減低還是以破骨細胞功能和數量增加為主，以便指導臨床針對性使用抗骨質疏鬆藥物。②骨摺斷耑骨組織形態病理學檢查能更好地反映患者骨組織內成骨細胞、破骨細胞和骨小樑等狀況。骨質疏鬆患者針對性使用抗骨質疏鬆藥物治療能提高療效、降低相關併髮癥。
배경：목전국제상공인쌍능 X 사선흡수측정법위진단골질소송증적금표준，단상유우측량부위이위골화、골질증생등인소사득측량결과존재오차。목적：탐토골대사표지물재노년골질소송골절진료중적림상의의이급타여골밀도화골조직형태병이학개변적상관성。방법：선취50례수행수술치료적노년골질소송골절환자，행골생화4항검측，기중항주석산산성린산매5b(TRACP 5b)검측치명현증고환자25례(표기위항주석산산성린산매5b 승고조)，골감성린산매(BAP)검측치명현승고환자25례(표기위골감성린산매승고조)。술중추취량조각8례환자골절단단부분골조직，소목정-이홍염색보통광경검사화소묘전경검사병이학개변。술후，항주석산산성린산매5b 승고조환자사용해어강개소항골질소송치료，골감성린산매승고조환자사용골태주사액항골질소송치료，6개월후재차검측골밀도화골생화4항。결과여결론：량조환자술전골밀도화골생화4항검사결과상비교차이무현저성의의(P >0.05)。항주석산산성린산매5b 승고조환자골절단단골조직병리검사시성골세포감소、파골세포증다；골감성린산매승고조환자골절단단골조직병리검사시성골세포감소；량조골소량/골면적비치균강저，차항주석산산성린산매5b 승고조교골감성린산매승고조강저정도차이유현저성의의(P <0.05)。소묘전경검사시량조파골세포도교정상조활약，항주석산산성린산매5b 승고조골소량교골감성린산매승고조희송명현，흡수공포증대。량조우술후사용항골질소송약물치료，량조치료전여치료후골밀도화골생화4항검측결과차이유현저성의의(P <0.05)。결과현시：①골대사표지물검측능명학환자골조직시이성골세포공능화수량감저환시이파골세포공능화수량증가위주，이편지도림상침대성사용항골질소송약물。②골절단단골조직형태병이학검사능경호지반영환자골조직내성골세포、파골세포화골소량등상황。골질소송환자침대성사용항골질소송약물치료능제고료효、강저상관병발증。
BACKGROUND: Now, dual-energy X-ray absorptiometry is international y recognized as gold standard for the diagnosis of osteoporosis, but the errors can be found in the measurement results due to the heterotopic ossification and bone hyperplasia exists in the measurement part. OBJECTIVE: To investigate the clinical significance of bone metabolic markers in the diagnosis and treatment of elderly patients with osteoporotic fractures, and to research its correlation with the changes of pathological histology and bone mineral density. METHODS: Four bone biochemical markers in 50 elderly patients with osteoporosic fractures were measured preoperatively. According to the results, 25 patients had significantly increased tartrate-resistant acid phosphatase 5b (considered as the increased tartrate-resistant acid phosphatase 5b group), and 25 patients had increased bone alkaline phosphatase (considered as the increased bone alkaline phosphatase group). During operation, the bone tissues of eight patients in each group were treated with hematoxylin-eosin staining and electron microscopy scanning in order to detect the pathological changes. After operation, the patients in the increased tartrate-resistant acid phosphatase 5b group received salmon calcitonin anti-osteoporosis treatment, and the patients in the increased bone alkaline phosphatase group received the anti-osteoporosis treatment of bone peptide injection. The bone mineral density and the four bone biochemical markers were detected again at 6 months after treatment. RESULTS AND CONCLUSION: There were no significant differences in the preoperative bone mineral density and four biomechanical markers between two groups (P > 0.05). The pathological examination results of bone tissue on the fracture site showed that the number of osteoblasts was reduced and the number of oeteoclasts was increased in the increased tartrate-resistant acid phosphatase 5b group; while in the increased bone alkaline phosphatase group, the pathological examination results showed the number of osteoblasts was reduced; the trabecular bone/bone area ratio was decreased in two groups, and there was a significant difference in the decrease degree between two groups (P < 0.05). The electron microscope scanning showed that the osteoclasts of two groups were more active than that of the normal group. The sloppy of trabecular bone in the increased tartrate-resistant acid phosphatase 5b group was more obvious than that in the increased bone alkaline phosphatase group, and the absorption vacuoles were increased. There were significant differences in the bone mineral density and four biomechanical markers between two groups before and after anti-osteoporosis treatment (P < 0.05). The detection of bone metabolic markers could help us to make it clearly that the main function of osteoblast reduce or osteoclast increase in bone tissue of patients, and guide us to use anti-osteoporosis drugs in target. Pathological histology examination can better reflect the condition of osteoblasts, osteoclasts and trabecular bone in bone tissue on the fracture site. Target application of anti-osteoporosis drugs in the osteoporosis patients can effectively improve the efficacy and reduce the relative complications.
