摘要目的 观察体外冲击波(extracorporeal shock wave,ESW)对早中期股骨头坏死(osteonecrosis of the femoral head,ONFH)患者骨髓间质干细胞(mesenchymal stem cells,MSCs)成骨及成脂相关基因表达的影响.方法 取ONFH患者自愿捐赠的骨髓.体外分离并传代培养MSCs.将P_3代MSCs分为A组(干预组)和B组(对照组);细胞计数试剂盒检测P_3代MSCs不同时间点增殖差异;酶细胞化学和茜素红染色检测P_3代MSCs碱性磷酸酶(alkaline phosphatase,ALP)含量和P_7代MSCs胞外基质矿化程度的差异;RT-PCR检测不同时间点骨钙素(osteocalcin,OC)、核心结合因子α1(core-binding factor alpha 1,Cbfα1)、过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptor γ,PPARγ)表达量的差异.结果 A组各时间点(不含第1天)细胞增殖速度均明显强于B组;ALP含量(不含第3天)A组总体水平明显高于B组;茜素红染色示A组矿化结节数为(6.0±1.0)个/视野,B组始终为阴性;Cbfα1在成骨分化的整个过程中均持续表达,A组在各时间点(不含第3天)均明显强于B组;A组OC在各时间点(不舍第3、6天)均明显强于B组;PPARγ在成骨分化的整个过程中均持续表达.A组在各时间点(不含第3天)均明显弱于B组.结论 适当强度的ESW能够促进MSCs增殖,诱导MSCs向成骨细胞方向分化并抑制MSCs向成脂细胞方向分化是其治疗ONFH的有效机制.

abstractsObjective To investigate the effect of extracorporeal shock wave (ESW) on osteogenesisrelated and adipogenic-related genes of mesenchymal stem cells (MSCs) of patients with early or moderate osteonecrosis of the femoral head (ONFH).Methods MSCs obtained from ONFH patients were divided into Group A and Group B.The proliferation was detected and compared.as well the content of alkaline phosphatase (ALP) in P_3,extracellular matrix mineralization in P_7,the expression of core-binding factor alpha 1 (Cbfα1),osteocalcin (OC) and peroxisome proliferator-activated receptor γ (PPARγ) between two groups at different time points.Results The proliferation of Group A was better than Group B significantly (except the 1st day);the ALP) content of Group A were higher than that of Group B significantly (except the 3rd day).The mineralized nodules was (6.0±1.0)/field in Group A,but negative in Group B.Cbfα 1 sustained expression in the whole process of ESW induced osteoblast differentiation,Group A was significantly stronger than the Group B every day (except the 3rd day);the OC expression of Group A was significantly earlier and stronger than that of Group B every day (except the 3rd,lay and 6th day).The PPARγ sustained expression in the whole process of ESW induced osteoblast differentiation,and that in Group A was significant stronger than that in Group B every day (exeept the 3rd day).Conclusion The appropriate intensity ESW can promote MSCs'proliferation,induce MSCs'differentiation into osteoblastic and inhibit MSCs'differentiate into fat cells,which may be an effective way of treating ONFH.