Experimental And Clinical Study On Lipid Etabolism Of Alcohol-Related Osteonecrosis Of Femoral Head

Objective: To ascertain the relationship between alcohol- induced avascular necrosis of femoral head(AIANFH)and lipid metabolism.In this study,by pouring into stomach,a high dose of stong wine was administered to rabbits to produce alcoholism- induced ANFH animal's model.Besides,clinical study of lipids in blood is undertaken.Series abnomal changes of experimental animals and patients were observed to reveal the pathogen- nesis,which would give a science basis to clinically prevent and treat alcoholism-induced ANFH.Methods: On experimental study:60 New Zealand rabbits were randomly divided in to experimental group and control group,there being 30 animals in each one respectively.By pouring into stomach,the experimental group were adiministered 10ml/kg/d wine,which contains 55% ethanol,and the control group were given the same dose of normal-sodium(NS).The animals from two groups were sacrificed in batches in the 1st,2nd,3rd and 6th monthes periodically after treatment.The changes of serology and histology of the femoral head were studied.On clinical study:40 patients of AIANFH diagnosed by CT or MRI were chosen as experimental group,and 40 patients of Non-AIANFH excluded by CT or MRI were chosen as control group at the same time, Summarizing and analyzing the lipids in blood with statistical analysis.Results: On experimental study:(1)The changes of serology: Compared with the changes of control group in the same time, the experimental group showed elevated serum levels of GGT in the 2nd month,AST in the 3rd month,and ALT in the 6th month were observed.Serum TG increased in the 2nd month,and CHO in the 3rd month in the experimental group.There is an obvious difference of serum level between two groups(p<0.05).(2)The changes of ECT:Degraded radioaction signal was observed in the center of the femoral head in the experimental group and increased radioaction signal in the ambitus of the femoral head in the 6th month,with"frying-bread collar"change emerging.The same changes was not observed in the control group.(3)The histological changes:In subchondral district,by light microscope examination,the blood-cell forming tissue tapered,and adipose tissue multed and degenerated,forming bone rarefaction.Adipose degeneration was observed in osteocyte of the femoral head with vacuous bone lacuna.Decreased chondrocyte and necrosis were observed in the 2rd month.Bone trabecula became thin and sparse,and the nucleus was compressed to one side of osteocyte and became pyknosis,with osteocyte ranging in disorder form- ing"peripheralization"phenomenon,in the third month.Bone tra- becula became thin and sparse and collapsed with nuclus of osteocyte pyknosis,resorption,and vanished with the percentage of empty osteocyte lacuna elevating,and necrosis focus emerged at last,and the bone marrow had adipose degeneration and necrosis in the 6th month.In the 3rd and 6th month,the average diameter of the fat cell enlarged obviously in marrow in the experimental group, and there is an obvious difference between two groups(p<0.05,p<0.01).Besides,In the 3rd and 6th month, the percentage of empty osteocyte lacuna elevated in the experimental group,and there is an obvious difference between two groups(p<0.05,p<0.01).On clinical study:The TG,LDL and Apo-B in experimental group is higher than control group,and there is an obvious difference of serum level between two groups(p<0.01).The Apo-A1 in experimental group is lower than control group,and there is an obvious difference of serum level between two groups(p <0.01).Conclusion: 1 There are disorders of lipid metabolism in both the animal models and the patients of alcohol-related osteonecrosis of the femoral head,and alcohol may lead to the osteonecrosis in femoral head.2 alcoholism poroduces hyperli- pemia and fatty metamophorsis and fat degeneration of the subchondral osteocyte,which aggravates the aberration metabo- lism of lipid.3 alcoholism can poroduce hypertrophic fat cell in bone marrow of femoral head and abnormally elevated iop (intraosseous pressure),which decreases priming volume,and then lead to thin and sparse trabecular and osteopenia.The last,cell death.4 Due to these synthesis effect,ANFH would be resulted in at last.5 The inhibition of bone-marrow adipogenesis and the concomitant enhancement of osteogenesis may provide a novel approach to the prevention or treatment of osteonecrosis and osteoporosis.