本文選題：轉(zhuǎn)化生長(zhǎng)因子 + 骨形態(tài)發(fā)生蛋白　； 參考：《河南大學(xué)》2015年碩士論文

【摘要】：目的:研究酒精性股骨頭壞死以及激素性股骨頭壞死兩組非創(chuàng)傷性股骨頭壞死的病理改變與轉(zhuǎn)化生長(zhǎng)因子-β(TGF-β)的活性大小和骨形態(tài)發(fā)生蛋白-2(BMP-2)強(qiáng)弱的不同表達(dá)情況及臨床意義,為臨床治療股骨頭壞死提供參考,以改善治療。方法:選擇2010年1月至2013年1月整三年中,在我醫(yī)院住院期間依據(jù)X線、CT掃描、MRI掃描等影像資料診斷明確的酒精性股骨頭壞死患者以及依據(jù)X線、CT掃描、MRI掃描等影像資料激素性股骨頭壞死者60例作為實(shí)驗(yàn)組,選取新鮮股骨頸骨折30例作為對(duì)照組。股骨頭壞死的病因非常復(fù)雜,根據(jù)具體病因不同,我們的實(shí)驗(yàn)組選擇經(jīng)X線、CT掃描、MRI掃描等影像資料診斷明確的激素性股骨頭壞死患者30例及X線、CT掃描、MRI掃描等影像資料診斷明確的酒精性股骨頭壞死患者30例,將其分為兩組。在肉眼裸視及光鏡放大下,大體觀察所選組織學(xué)標(biāo)本的病變情況,利用免疫組化方法檢測(cè)各組標(biāo)本中的TGF-β與BMP-2的表達(dá)情況,并將二者進(jìn)行比較。結(jié)果:酒精性和激素性股骨頭壞死組,在肉眼裸視及光鏡放大下病理改變大概相似,這兩種股骨頭壞死組的骨陷窩面積與脂肪細(xì)胞長(zhǎng)徑及空骨陷窩率與股骨頸骨折正常組相比明顯增加(P0.05),并且軟骨成骨指數(shù)、血管形成以及新生骨小梁等均比股骨頸骨折組明顯增加(P0.05);兩種股骨頭壞死組間的骨小梁面積、脂肪細(xì)胞長(zhǎng)徑、空骨陷窩率、新生骨小梁面積等,酒精組明顯高與激素組(p0.05);兩種股骨頭壞死組之間軟骨成骨指數(shù)相比較,酒精組明顯低于激素組(p0.05)。通過(guò)免疫組化來(lái)檢測(cè)TGF-β與BMP-2的表達(dá),結(jié)果顯示是酒精性股骨頭壞死組與激素性股骨頭壞死組樣本中的TGF-β與BMP-2的陽(yáng)性面積百分比低于股骨頸骨折組即正常對(duì)照組,股骨頸骨折組即正常對(duì)照組的平均光密度都明顯高于兩實(shí)驗(yàn)組(P0.05);酒精性股骨頭壞死組與激素性股骨頭壞死組,這兩組間標(biāo)本中TGF-β的表達(dá)無(wú)明顯差異(p0.05);兩組之間標(biāo)本進(jìn)行比較,激素性股骨頭壞死組的BMP-2的陽(yáng)性面積百分比低于酒精性股骨頭壞死組,激素性股骨頭壞死組的光密度則明顯高于激素性股骨頭壞死組(P0.05);分析TGF-β與BMP-2這兩者之間表達(dá)的關(guān)系,可以看出,TGF-β與BMP-2這兩者的陽(yáng)性面積百分比呈現(xiàn)正相關(guān)性,同樣,TGF-β與BMP-2這兩者的光密度也呈正相關(guān)性(P0.05)。結(jié)論:1.激素性和酒精性股骨頭壞死的病人,兩組壞死股骨頭的大體外觀及顯微組織學(xué)結(jié)構(gòu)都發(fā)生了部分變化,尤其是骨小梁面積大小比正常組明顯減少,而同源軟骨細(xì)胞數(shù)量更比正常組減少。2.激素性和酒精性股骨頭壞死患者,所選標(biāo)本中的TGF-β與BMP-2表達(dá)水平都接近正常,不同的病因引起股骨頭壞死致其表達(dá)強(qiáng)度有所改變。由此可以推論,適度增加血液中患者病變局部TGF-β與BMP的濃度及數(shù)量可以促進(jìn)壞死股骨頭的修復(fù)。
[Abstract]:Objective: to study the pathological changes and the activity of transforming growth factor- 尾 (TGF- 尾) and the different expression and clinical significance of bone morphogenetic protein (BMP) -2BMP-2 in alcoholic and steroid-induced osteonecrosis of femoral head. To provide a reference for clinical treatment of femoral head necrosis in order to improve the treatment. Methods: for the entire three years from January 2010 to January 2013, In our hospital, 60 cases of steroid-induced osteonecrosis of femoral head were diagnosed according to X-ray CT scan and MRI scan, and 60 cases of steroid-induced femoral head necrosis according to X-ray CT scan and MRI scan were used as experimental group. Thirty cases of fresh femoral neck fracture were selected as control group. The causes of osteonecrosis of the femoral head are very complex, depending on the cause. In our experimental group, 30 cases of steroid-induced necrosis of femoral head and 30 cases of alcoholic necrosis of femoral head were diagnosed by X-ray CT scanning and MRI scanning. Divide it into two groups. The pathological changes of the selected histological specimens were observed under naked vision and magnification with light microscope. The expression of TGF- 尾 and BMP-2 in each group was detected by immunohistochemical method, and the two were compared. Results: the pathological changes of alcoholic and steroid-induced femoral head necrosis groups were similar under naked vision and optical magnification. Compared with the normal femoral neck fracture group, the bone lacunae area, adipocyte long diameter and empty bone lacuna rate in these two femoral head necrotic groups increased significantly (P 0.05), and the cartilage osteogenesis index. The area of trabecular bone, adipocyte length, the rate of empty bone trabeculae, the area of new bone trabeculae, and the area of new bone trabeculae were significantly increased in the two kinds of femoral head necrosis groups compared with the femoral neck fracture group. The osteogenesis index of cartilage in alcohol group was significantly higher than that in hormone group (P 0.05), and the osteogenesis index of cartilage in alcohol group was significantly lower than that in hormone group (P 0.05). The expression of TGF- 尾 and BMP-2 was detected by immunohistochemistry. The results showed that the percentage of positive area of TGF- 尾 and BMP-2 in the samples of alcoholic and steroid-induced femoral head necrosis group was lower than that of femoral neck fracture group or normal control group. The average optical density of femoral neck fracture group (normal control group) was significantly higher than that of the two experimental groups (P 0.05), the expression of TGF- 尾 was not significantly different between the alcoholic femoral head necrosis group and the steroid-induced femoral head necrosis group, and there was no significant difference in the expression of TGF- 尾 between the two groups. The percentage of BMP-2 positive area in steroid-induced femoral head necrosis group was lower than that in alcoholic femoral head necrosis group, and the optical density of steroid-induced femoral head necrosis group was significantly higher than that of steroid-induced femoral head necrosis group (P0.05). It can be seen that the positive area percentage of TGF- 尾 and BMP-2 is positively correlated with the optical density of TGF- 尾 and BMP-2. Conclusion 1. In the patients with steroid-induced and alcoholic femoral head necrosis, the gross appearance and microscopic structure of the necrotic femoral head were partly changed, especially the size of trabecular bone was significantly smaller than that of the normal group. The number of homologous chondrocytes decreased by 2. 2. The expression levels of TGF- 尾 and BMP-2 in the selected specimens were close to normal in the patients with steroid-induced and alcoholic femoral head necrosis, and the expression intensity of TGF- 尾 and BMP-2 was changed due to different etiology of osteonecrosis of femoral head. It can be concluded that moderate increase in the concentration and quantity of TGF- 尾 and BMP can promote the repair of necrotic femoral head.
【學(xué)位授予單位】：河南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R681.8

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