Article(id=1203033495254819242, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203033494428541350, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2023.05.0552, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1649260800000, receivedDateStr=2022-04-07, revisedDate=null, revisedDateStr=null, acceptedDate=1654704000000, acceptedDateStr=2022-06-09, onlineDate=1764755136549, onlineDateStr=2025-12-03, pubDate=1685203200000, pubDateStr=2023-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764755136549, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764755136549, creator=13701087609, updateTime=1764755136549, updator=13701087609, issue=Issue{id=1203033494428541350, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='5', pageStart='489', pageEnd='626', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764755136353, creator=13701087609, updateTime=1764756085669, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1203037476202967229, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203033494428541350, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1203037476202967230, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203033494428541350, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=552, endPage=559, ext={EN=ArticleExt(id=1203033495510671790, articleId=1203033495254819242, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Effects of differences in intestinal flora on steroid-induced osteonecrosis of the femoral head in SD rats, columnId=1190310110212751762, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Basic Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the differences in the intestinal flora between the glucocorticoid-associated osteonecrosis of the femoral head (GA-ONFH) rat model and its effect on the modeling results of GA-ONFH. Methods Forty SD rats were randomly divided into four groups (n=10 for each group): control group, antibiotic (ABX) group, GA-ONFH model group, and ABX+GA-ONFH group. The ABX group and ABX+GA-ONFH group were continuously treated with an antibiotic solution to elute intestinal microorganisms for one week. One week later, the GA-ONFH model group and ABX+GA-ONFH group were intraperitoneally injected with lipopolysaccharide and dexamethasone to create an early GA-ONFH model; while the control group and ABX group received an equal volume of normal saline for six weeks. After six weeks, to evaluate correlation between intestinal flora and GA-ONFH modeling, the following experiments were conducted and analyzed from intestinal contents and femur samples: 1) the composition and abundance of fecal flora based on 16S rDNA amplicon sequencing technology; 2) Micro-CT and HE staining to observe the modeling results of early GA-ONFH. Results Compared with control group, the abundance of intestinal flora in GA-ONFH model group changed, and the abundance of Bacteroidetes was significantly down-regulated and Firmicutes was significantly up-regulated, with statistical significance (P<0.05); at the family level, the abundance of Prevotellaceae, Clostridia-UCG-014, Peptococcaceae, Rikenellaceae, and Christensenellaceae were significantly down-regulated, the abundance of Staphylococcaceae was significantly up-regulated, and the differences were statistically significant (P<0.05); at the genus level, the abundance of Alistipes, UCG-005, Clostridia_UCG-014, Alloprevotella, and Prevotellaceae_UCG-001 were significantly down-regulated, the abundance of Staphylococcus and Frisingicoccus were significantly up-regulated, with statistical significance (P<0.05).Micro-CT tomography showed subchondral trabecular sclerosis in both the GA-ONFH model group and ABX+GA-ONFH group after modeling. HE staining showed that trabecular bone fracture occurred earlier in the ABX+GA-ONFH group than in the GA-ONFH model group. After the gut microbial abundance was removed, the rat GA-ONFH modeling effect was more significant. Conclusion The intestinal flora of GA-ONFH model rats changed, and the change of intestinal flora may affect the occurrence of early GA-ONFH.

, correspAuthors=Xin Liu, Bin Du, authorNote=null, correspAuthorsNote=
Liu Xin, E-mail:
Du Bin, E-mail:
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目的 探究激素性股骨头坏死(GA-ONFH)模型大鼠的肠道菌群变化及其对造模效果的影响。方法 40只雄性SD大鼠随机分为空白对照组、抗生素组(ABX组)、激素性股骨头坏死模型组(GA-ONFH模型组)、抗生素+激素性股骨头坏死模型组(ABX+GA-ONFH组),每组10只。ABX组和ABX+GA-ONFH组持续给予抗生素溶液洗脱肠道微生物1周。1周后GA-ONFH模型组和ABX+GA-ONFH组给予脂多糖(LPS)+地塞米松腹腔注射建立早期GA-ONFH模型,空白对照组和ABX组腹腔注射等量生理盐水,连续注射6周。收集大鼠粪便和股骨头样本,基于16S rDNA扩增子测序分析大鼠肠道菌群的构成及丰度,使用micro-CT和HE染色观察早期GA-ONFH造模效果,评估肠道菌群对GA-ONFH造模效果的影响。结果 与空白对照组比较,GA-ONFH模型组大鼠肠道菌群丰度发生改变,其中拟杆菌门丰度明显下调,而厚壁菌门丰度明显上调,差异有统计学意义(P<0.05);在科水平上,普雷沃菌科、梭状芽胞杆菌科、消化球菌科、理研菌科和克里斯滕森菌科的丰度明显下调,而葡萄球菌科的丰度明显上调,差异有统计学意义(P<0.05);在属水平上,另枝菌属、UCG-005、梭状芽胞杆菌属、拟普雷沃菌属和普雷沃菌属的丰度明显下调,而葡萄球菌属和Frisingicoccus的丰度明显上调,差异有统计学意义(P<0.05)。Micro-CT断层扫描显示,GA-ONFH模型组和ABX+GA-ONFH组均出现软骨下骨小梁硬化;HE染色显示,ABX+GA-ONFH组较GA-ONFH模型组更早出现骨小梁断裂,表明抗生素洗脱肠道微生物后,大鼠GA-ONFH造模效果更加显著。结论 GA-ONFH模型大鼠的肠道菌群发生了明显变化,且该变化可能影响早期GA-ONFH的发生。

, correspAuthors=刘锌, 杜斌, authorNote=null, correspAuthorsNote=
刘锌,E-mail:
杜斌,E-mail:
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何帅,硕士研究生,主要从事中西医结合治疗股骨头坏死方面的研究

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何帅,硕士研究生,主要从事中西医结合治疗股骨头坏死方面的研究

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ABX. 抗生素;GA-ONFH. 激素性股骨头坏死;LPS. 脂多糖

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Box diagram of cumulative Alpha diversity

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GA-ONFH. 激素性股骨头坏死;与空白对照组比较,(1)P<0.05,(2)P<0.01

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ABX. 抗生素;GA-ONFH. 激素性股骨头坏死;与空白对照组比较,(1)P<0.05;与GA-ONFH模型组比较,(2)P<0.05

, figureFileSmall=GnQob1HLWOYodIT+PcyaaA==, figureFileBig=jlg6DNfgr0wXB/n5Gw5YgQ==, tableContent=null), ArticleFig(id=1203033502011843275, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033495254819242, language=EN, label=Fig. 5, caption=Micro-CT and HE staining observation of the femoral head, figureFileSmall=hZNnMP3QCyABMi9dTpPksg==, figureFileBig=xObotgR+c/Sn4PqsynMWOw==, tableContent=null), ArticleFig(id=1203033502125089488, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033495254819242, language=CN, label=图5, caption=股骨头micro-CT和HE染色观察

红色箭头示软骨下硬化带;绿色箭头示骨陷窝增大、核固缩;黄色箭头示空骨陷窝;ABX. 抗生素;GA-ONFH. 激素性股骨头坏死;A. 空白对照组;B. ABX组;C. GA-ONFH模型组;D. ABX+GA-ONFH组

, figureFileSmall=hZNnMP3QCyABMi9dTpPksg==, figureFileBig=xObotgR+c/Sn4PqsynMWOw==, tableContent=null), ArticleFig(id=1203033502221558485, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033495254819242, language=EN, label=Tab. 1, caption=

Comparison of the empty lacuna rate and proportion of fat follicles area in each group (%, $\bar{x}±s$, n=9)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别空骨陷窝率脂肪滤泡面积占比
空白对照组5.15±0.950.54±0.06
ABX组5.46±1.920.51±0.04
GA-ONFH模型组15.79±2.06(1)(2)8.82±0.99(1)(2)
ABX+GA-ONFH组20.80±3.76(1)(2)(3)14.29±1.38(1)(2)(3)
), ArticleFig(id=1203033503395963611, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033495254819242, language=CN, label=表1, caption=

各组空骨陷窝率、脂肪滤泡面积占比比较(%,$\bar{x}±s$,n=9)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别空骨陷窝率脂肪滤泡面积占比
空白对照组5.15±0.950.54±0.06
ABX组5.46±1.920.51±0.04
GA-ONFH模型组15.79±2.06(1)(2)8.82±0.99(1)(2)
ABX+GA-ONFH组20.80±3.76(1)(2)(3)14.29±1.38(1)(2)(3)
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肠道菌群变化对大鼠激素性股骨头坏死造模效果的影响
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何帅 , 刘锌 * , 杜斌 * , 孙光权 , 高飞飞 , 陈阳
解放军医学杂志 | 基础研究 2023,48(5): 552-559
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解放军医学杂志 | 基础研究 2023, 48(5): 552-559
肠道菌群变化对大鼠激素性股骨头坏死造模效果的影响
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何帅, 刘锌* , 杜斌* , 孙光权, 高飞飞, 陈阳
作者信息
  • 南京中医药大学附属医院/江苏省中医院骨伤科,江苏南京 210029
  • 何帅,硕士研究生,主要从事中西医结合治疗股骨头坏死方面的研究

通讯作者:

刘锌,E-mail:
杜斌,E-mail:
Effects of differences in intestinal flora on steroid-induced osteonecrosis of the femoral head in SD rats
Shuai He, Xin Liu* , Bin Du* , Guang-Quan Sun, Fei-Fei Gao, Yang Chen
Affiliations
  • Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, China
出版时间: 2023-05-28 doi: 10.11855/j.issn.0577-7402.2023.05.0552
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目的 探究激素性股骨头坏死(GA-ONFH)模型大鼠的肠道菌群变化及其对造模效果的影响。方法 40只雄性SD大鼠随机分为空白对照组、抗生素组(ABX组)、激素性股骨头坏死模型组(GA-ONFH模型组)、抗生素+激素性股骨头坏死模型组(ABX+GA-ONFH组),每组10只。ABX组和ABX+GA-ONFH组持续给予抗生素溶液洗脱肠道微生物1周。1周后GA-ONFH模型组和ABX+GA-ONFH组给予脂多糖(LPS)+地塞米松腹腔注射建立早期GA-ONFH模型,空白对照组和ABX组腹腔注射等量生理盐水,连续注射6周。收集大鼠粪便和股骨头样本,基于16S rDNA扩增子测序分析大鼠肠道菌群的构成及丰度,使用micro-CT和HE染色观察早期GA-ONFH造模效果,评估肠道菌群对GA-ONFH造模效果的影响。结果 与空白对照组比较,GA-ONFH模型组大鼠肠道菌群丰度发生改变,其中拟杆菌门丰度明显下调,而厚壁菌门丰度明显上调,差异有统计学意义(P<0.05);在科水平上,普雷沃菌科、梭状芽胞杆菌科、消化球菌科、理研菌科和克里斯滕森菌科的丰度明显下调,而葡萄球菌科的丰度明显上调,差异有统计学意义(P<0.05);在属水平上,另枝菌属、UCG-005、梭状芽胞杆菌属、拟普雷沃菌属和普雷沃菌属的丰度明显下调,而葡萄球菌属和Frisingicoccus的丰度明显上调,差异有统计学意义(P<0.05)。Micro-CT断层扫描显示,GA-ONFH模型组和ABX+GA-ONFH组均出现软骨下骨小梁硬化;HE染色显示,ABX+GA-ONFH组较GA-ONFH模型组更早出现骨小梁断裂,表明抗生素洗脱肠道微生物后,大鼠GA-ONFH造模效果更加显著。结论 GA-ONFH模型大鼠的肠道菌群发生了明显变化,且该变化可能影响早期GA-ONFH的发生。

激素性股骨头坏死  /  造模  /  肠道菌群  /  16S rDNA测序

Objective To explore the differences in the intestinal flora between the glucocorticoid-associated osteonecrosis of the femoral head (GA-ONFH) rat model and its effect on the modeling results of GA-ONFH. Methods Forty SD rats were randomly divided into four groups (n=10 for each group): control group, antibiotic (ABX) group, GA-ONFH model group, and ABX+GA-ONFH group. The ABX group and ABX+GA-ONFH group were continuously treated with an antibiotic solution to elute intestinal microorganisms for one week. One week later, the GA-ONFH model group and ABX+GA-ONFH group were intraperitoneally injected with lipopolysaccharide and dexamethasone to create an early GA-ONFH model; while the control group and ABX group received an equal volume of normal saline for six weeks. After six weeks, to evaluate correlation between intestinal flora and GA-ONFH modeling, the following experiments were conducted and analyzed from intestinal contents and femur samples: 1) the composition and abundance of fecal flora based on 16S rDNA amplicon sequencing technology; 2) Micro-CT and HE staining to observe the modeling results of early GA-ONFH. Results Compared with control group, the abundance of intestinal flora in GA-ONFH model group changed, and the abundance of Bacteroidetes was significantly down-regulated and Firmicutes was significantly up-regulated, with statistical significance (P<0.05); at the family level, the abundance of Prevotellaceae, Clostridia-UCG-014, Peptococcaceae, Rikenellaceae, and Christensenellaceae were significantly down-regulated, the abundance of Staphylococcaceae was significantly up-regulated, and the differences were statistically significant (P<0.05); at the genus level, the abundance of Alistipes, UCG-005, Clostridia_UCG-014, Alloprevotella, and Prevotellaceae_UCG-001 were significantly down-regulated, the abundance of Staphylococcus and Frisingicoccus were significantly up-regulated, with statistical significance (P<0.05).Micro-CT tomography showed subchondral trabecular sclerosis in both the GA-ONFH model group and ABX+GA-ONFH group after modeling. HE staining showed that trabecular bone fracture occurred earlier in the ABX+GA-ONFH group than in the GA-ONFH model group. After the gut microbial abundance was removed, the rat GA-ONFH modeling effect was more significant. Conclusion The intestinal flora of GA-ONFH model rats changed, and the change of intestinal flora may affect the occurrence of early GA-ONFH.

glucocorticoid-associated osteonecrosis of the femoral head  /  mold  /  intestinal flora  /  16s rDNA sequencing
何帅, 刘锌, 杜斌, 孙光权, 高飞飞, 陈阳. 肠道菌群变化对大鼠激素性股骨头坏死造模效果的影响. 解放军医学杂志, 2023 , 48 (5) : 552 -559 . DOI: 10.11855/j.issn.0577-7402.2023.05.0552
Shuai He, Xin Liu, Bin Du, Guang-Quan Sun, Fei-Fei Gao, Yang Chen. Effects of differences in intestinal flora on steroid-induced osteonecrosis of the femoral head in SD rats[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (5) : 552 -559 . DOI: 10.11855/j.issn.0577-7402.2023.05.0552
激素性股骨头坏死(glucocorticoid-associated osteonecrosis of the femoral head,GA-ONFH)是一种骨科常见的难治性可致残疾病。由于临床上糖皮质激素(glucocorticoid,GC)的广泛应用,自1957年报告第1例由于激素使用导致的股骨头坏死以来,GA-ONFH的发病率呈逐年上升趋势[1]。目前,长期或大量应用GC已成为非创伤性股骨头坏死的首要诱因。研究发现,大剂量GC可导致股骨头血液供应受损及骨细胞凋亡[2],进而导致股骨头结构改变,引起股骨头塌陷和髋关节功能障碍。然而,有部分患者接受大剂量GC冲击治疗却未发生GA-ONFH,其患病因素目前尚无定论。GA-ONFH的病理机制较为复杂,目前主要有脂代谢紊乱学说、血管损伤学说、细胞自噬学说、骨质疏松学说等[3-4]。近年来,肠道菌群与骨代谢的关系已成为医学研究的热点,有研究表明,肠道菌群与骨代谢及骨质疏松症存在潜在的相关性[5-10]。然而探究肠道菌群对GA-ONFH影响的相关报道鲜少。本研究初步探讨了肠道菌群在GA-ONFH动物模型中的变化及其对GA-ONFH造模效果的影响。
万古霉素(希腊Vianex S.A.公司);氨苄青霉素(上海吉至生化有限公司);硫酸新霉素(上海源叶生物科技有限公司);甲硝唑(武汉远大医药有限公司);脂多糖(lipopolysaccharide,LPS;美国Sigma-Aldrich公司);地塞米松磷酸钠注射液(济宁辰欣药业股份有限公司);HE染色试剂盒(北京索莱宝科技有限公司);TruSeq DNA PCR-Free Library Preparation Kit建库试剂盒(美国Illumina公司);胶回收试剂盒(德国Qiagen公司);High-Fidelity PCR Master Mix with GC Buffer(美国New England Biolabs公司)。Bio-Rad T100梯度PCR仪(美国Bio-Rad公司);Skyscan 1276 Micro-CT Instrument (Bruker MicroCT;比利时Kontich公司);硬组织切片机、分层脱水机(德国Leica公司);石蜡包埋机(北京中科亚光科技有限公司);正置白场显微镜(Eclipse Ni-U;日本Nikon公司)。
8周龄雄性SD大鼠40只,由杭州医学院实验动物中心提供(实验动物合格证号:20211116Aazz0100000258)。实验前将大鼠置于SPF级恒温(20~24 ℃)、恒湿(45%~60%)的环境控制室中,按标准光/暗循环12 h/12 h适应性饲养7 d。本研究经南京中医药大学动物伦理委员会批准(202111A002),实验过程符合国家和单位有关实验动物的管理和使用规定。
将大鼠称重编号后分为空白对照组、抗生素组(ABX组)、激素性股骨头坏死模型组(GA-ONFH模型组)、抗生素+激素性股骨头坏死模型组(ABX+GA-ONFH组),适应性喂养1周。按氨苄西林1 g、甲硝唑1 g、万古霉素0.5 g、硫酸新霉素0.5 g加入1 L双蒸水的比例,充分混匀制备抗生素溶液。ABX组和ABX+GA-ONFH组持续给予抗生素溶液1周以建立低菌鼠模型(微生物洗脱实验)[5,11],空白对照组和GA-ONFH模型组SPF环境常规维持饲料和无菌水喂养。第3周,GA-ONFH模型组和ABX+GA-ONFH组给予LPS+地塞米松腹腔注射构建早期GA-ONFH模型,空白对照组和ABX组腹腔注射等量生理盐水。GA-ONFH模型组和ABX+GA-ONFH组给药剂量和频次:腹腔注射25 μg/ml LPS 4 ml/kg,1次/d,连续2 d;末次注射后24 h,腹腔注射5 mg/ml醋酸地塞米松4 ml/kg,每周3次,连续注射6周。动物实验流程如图1所示。
抗生素溶液饲喂结束后,收集大鼠粪便,置于–80 ℃保存备检。末次给药后麻醉大鼠,腹主动脉采血休克死亡后,剖开腹腔后在回盲部做V形切口,用无菌镊子夹取肠内容物(肠道内未排出粪便),置于冻存管中于–80 ℃保存备检。剥离大鼠双侧股骨头,剔除周围软组织,大体观察后将左侧股骨头用生理盐水浸泡过的纱布包裹,–80 ℃保存,右侧股骨头用10%多聚甲醛溶液固定。
采用十六烷基三甲基溴化铵(CTAB)提取大鼠粪便中的微生物基因组DNA,然后使用琼脂糖凝胶电泳检测DNA的纯度和浓度;取适量DNA于离心管中,用无菌水稀释至1 ng/μl。检测DNA浓度和质量合格后,以稀释后的基因组DNA为模板,进行16S rDNA基因V3~V4(341F—806R)区域的PCR扩增,引物序列如下。341F:5'-CCTAYGGGRBGCASCAG-3';806R:5'-GGACTACNNGGGTATCTAAT-3'。采用2%琼脂糖凝胶电泳检测PCR产物,并根据其浓度进行等量混样,充分混匀后再次行2%琼脂糖凝胶电泳检测,使用胶回收试剂盒回收目的条带。纯化后的PCR产物使用TruSeq DNA PCR-Free Library Preparation Kit建库试剂盒进行文库构建,构建好的文库经过Qubit定量和文库检测合格后,使用NovaSeq6000进行测序,并对测序结果进行Alpha多样性指数差异分析和组间相似性分析(ANOSIM分析)。
取右侧股骨头样本,使用micro-CT进行扫描。扫描条件:电压100 kV,电流200 mA,扫描层厚度20 μm。扫描数据使用CTAn和CTvol软件进行分析。
Micro-CT扫描结束后,将大鼠股骨头浸泡于体积分数为5%的硝酸脱钙液中脱钙1周,直至股骨头软化可用针刺入为止,流水冲洗后,经常规脱水、透明、浸蜡、包埋、切片,行苏木精-伊红染色(HE染色),分别在30、100、400倍光镜下观察股骨头骨小梁结构、骨髓腔脂肪形态及滤泡数目、空骨陷窝情况并扫描拍照。
按照病理学诊断标准对早期GA-ONFH造模效果进行评估[11-12]。GA-ONFH诊断标准:骨小梁出现弥漫性空骨陷窝,骨细胞核固缩,周围组织可见骨髓细胞坏死。高倍镜下分析各组标本切片,每例标本选取2张玻片,每张玻片在400倍视野下随机选取3个视野,统计空骨陷窝数量、骨陷窝数量及脂肪滤泡面积,计算空骨陷窝率及脂肪滤泡面积占比。空骨陷窝率(%)=空骨陷窝数量/骨陷窝数量×100%;脂肪滤泡面积占比(%)=脂肪滤泡面积/骨髓腔面积×100%。
应用SPSS 25.0软件进行统计分析。计量资料以$\bar{x}±s$表示,符合正态分布且方差齐,多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。P<0.05为差异有统计学意义。
对实验第8周末收集的大鼠粪便样本进行16S rDNA扩增子测序,结果显示,GA-ONFH模型组与空白对照组门、科、属水平的肠道菌群丰度差异有统计学意义(P<0.05)。Alpha多样性物种累积箱形图趋于平缓(图2),提示16S rDNA扩增子测序中检测到的物种并不会随着样本量的增加而增多,本实验采集的样本量充分。
与空白对照组比较,GA-ONFH模型组大鼠的肠道菌群相对丰度发生了变化。在门(Phylum)水平上,GA-ONFH模型组和空白对照组大鼠肠道菌群主要由4个菌门组成,包括拟杆菌门(Bacteroidota)、厚壁菌门(Firmicutes)、变形菌门(Proteobacteria)和疣微菌门(Verrucomicrobiota),这4个菌门序列总和均占各组大鼠肠道菌群中序列总数的99%以上。与空白对照组比较,GA-ONFH模型组肠道菌群中拟杆菌门(Bacteroidota)丰度明显下调,而厚壁菌门(Firmicutes)丰度明显上调,差异均有统计学意义(P<0.05,图3A)。
在科(Family)水平上,与空白对照组比较,GA-ONFH模型组肠道菌群中葡萄球菌科(Staphylococcaceae)的丰度明显上调,而普雷沃菌科(Prevotellaceae)、梭状芽胞杆菌科(Clostridia-UCG-014)、消化球菌科(Peptococcaceae)、理研菌科(Rikenellaceae)和克里斯滕森菌科(Christensenellaceae)的丰度明显下调,差异有统计学意义(P<0.05,图3B)。
在属(Genus)水平上,与空白对照组比较,GA-ONFH模型组肠道菌群中另枝菌属(Alistipes)、UCG-005、梭状芽胞杆菌属(Clostridia_UCG-014)、拟普雷沃菌属(Alloprevotella)和普雷沃菌属(Prevotellaceae_UCG-001)的丰度明显下调,而葡萄球菌属(Staphylococcus)和Frisingicoccus的丰度明显上调,差异均有统计学意义(P<0.05,图3C)。
ANOSIM分析结果显示,GA-ONFH模型组与空白对照组大鼠肠道菌群的群落结构明显不同(R=0.355,P<0.05)。
对实验第2周收集的大鼠粪便样本进行16S rDNA扩增子测序,结果显示,抗生素洗脱后,ABX组和ABX+GA-ONFH组大鼠肠道微生物群落的多样性和丰富度较空白对照组和GA-ONFH模型组明显降低(P<0.05,图4),表明抗生素洗脱有效。
Micro-CT扫描和HE染色结果显示,空白对照组与ABX组未出现股骨头坏死相关改变;与空白对照组比较,GA-ONFH模型组和ABX+GA-ONFH组出现软骨下硬化区,在micro-CT连续断层扫描片中表现为软骨下骨密度增高,在HE染色中表现为软骨下骨小梁粗大融合的硬化带,且软骨均有不同程度的钙化(图5)。
HE染色结果显示,ABX组、空白对照组高倍镜下均可见股骨头软骨较厚,软骨下骨小梁排列规则整齐、致密饱满,髓腔内未见脂肪细胞增生及肥大,各种造血细胞丰富,红细胞清晰可见,表明股骨头血液供应正常。与空白对照组比较,GA-ONFH模型组、ABX+GA-ONFH组高倍镜下可见软骨下骨小梁间隙之间存在新生骨组织与原骨小梁交织融合的硬化区,其结构紊乱、小梁间隙变窄、髓腔面积减小,骨小梁中骨细胞减少,骨陷窝增大、核固缩,空骨陷窝增多,骨细胞排列无序,骨髓内造血细胞明显减少,骨髓细胞大量坏死,红细胞消失,提示股骨头血液供应受阻;髓内脂肪面积明显增大,部分肥大融合成囊状。GA-ONFH模型组和ABX+GA-ONFH组均有软骨下骨小梁粗大融合、结构紊乱,但GA-ONFH模型组骨小梁仍保存其基本的连续性,未见断裂缺损,而ABX+GA-ONFH组除上述改变外,还有不同程度的骨小梁断裂缺损,甚至出现大面积坏死骨片。
按照病理学诊断标准,在HE染色400倍视野下计算空骨陷窝率和脂肪滤泡面积占比,结果如表1所示。ABX组与空白对照组空骨陷窝率、脂肪滤泡面积占比差异无统计学意义(P>0.05);GA-ONFH模型组、ABX+GA-ONFH组空骨陷窝率、脂肪滤泡面积占比均高于空白对照组和ABX组,且ABX+GA-ONFH组高于GA-ONFH模型组,差异有统计学意义(P<0.05)。
GA-ONFH一旦发展到股骨头塌陷期则只能进行人工髋关节置换治疗,严重降低了患者的生活质量,也给社会经济带来了巨大压力。如何筛选大剂量使用GC的高危人群,从而预防和预警GA-ONFH的发生是目前研究的热点和难点。已有学者尝试寻找各种潜在的GC干预后的变量,用于预测GA-ONFH的发生。肠道菌群是人体消化道内重要的生态系统,被视作体内的一个多细胞器官,其发生微生态紊乱时可引发机体免疫系统和(或)内分泌系统紊乱,从而引发一系列疾病[12-14]。近年来,肠道菌群与各种疾病的关系已成为医学研究的热点。在骨代谢方面,有研究表明,肠道菌群与骨质疏松症的发生发展有关,益生菌可通过调节宿主肠道菌群、降低炎性因子的表达、促进钙吸收等多种途径来改善骨质代谢[15-16]。此外,肠道菌群中的一些细菌可分泌血清素和多巴胺等影响宿主激素水平,进一步调节骨骼重塑;而肠道菌群失调时,雌激素再吸收能力下降,会加重骨质疏松[17]。然而,从肠道菌群方面探讨GA-ONFH发生机制的研究鲜见。
本研究首先探索了GA-ONFH模型大鼠与空白对照大鼠肠道菌群的差异,发现GA-ONFH造模后大鼠肠道菌群的丰度发生改变,在属水平,GA-ONFH模型组大鼠肠道菌群中另枝菌属(Alistipes)、UCG-005、梭状芽胞杆菌属(Clostridia_UCG-014)、拟普雷沃菌属(Alloprevotella)和普雷沃菌属(Prevotellaceae_UCG-001)的丰度明显降低,而葡萄球菌属(Staphylococcus)和Frisingicoccus的丰度明显增高。另枝菌属是新近被识别的菌属,目前研究较少。从生态学角度来看,另枝菌属主要存在于健康人的肠道中,在肠道菌群中的占比较低,但研究发现其与肠道菌群生态失调和炎症性疾病高度相关,如另枝菌属在包括血液、阑尾、直肠周围和脑脓肿组织在内的临床标本中均可被分离出来,其在人类疾病中具有潜在的条件致病作用[18]。普雷沃菌可通过与其他细菌相互影响而发挥“益生菌”的作用。例如,体外研究发现,普雷沃菌可通过调节NF-κB/MAPK通路的信号转导,抑制铜绿假单胞菌中Toll样受体4(TLR-4)的表达和IL-6、IL-8的释放,从而减轻炎症反应[19]。本研究中,除公认的致病菌葡萄球菌和Frisingicoccus外,GA-ONFH模型组大鼠的肠道菌群多样性主要表现为下降趋势,下降的菌属包括多种益生菌,由此推测,潜在有益菌丰度降低和(或)条件致病菌丰度升高可能与早期GA-ONFH的发生发展存在一定关系。
本研究进一步探究了肠道菌群差异对GA-ONFH造模效果的影响。在建立早期GA-ONFH大鼠模型前,先用广谱抗生素溶液代替无菌水喂养ABX组和ABX+GA-ONFH组大鼠1周以建立低菌鼠模型。实验第2周收集大鼠粪便样本进行16S rDNA扩增子测序,结果表明抗生素洗脱有效。进一步观察发现,抗生素洗脱肠道微生物后造模大鼠较直接激素造模大鼠更早出现了骨小梁断裂缺损,空骨陷窝率和脂肪滤泡面积占比也较单纯激素造模组明显增高,而仅用抗生素处理的大鼠micro-CT断层扫描和HE染色结果均未出现股骨头坏死的相关改变,可以排除抗生素本身的干预作用。该结果表明,抗生素洗脱肠道微生物后,对股骨头有保护作用的有益菌被明显下调,从而使SD大鼠GA-ONFH的造模效果更加显著。由此推测,肠道内的部分有益菌被洗脱后,其产生的具有骨保护作用的代谢产物下调,导致激素更容易诱导GA-ONFH的发生。
综上所述,本研究结果表明,肠道菌群变化可能影响早期GA-ONFH的发生,该结果为GA-ONFH的发病因素和易患性研究提示了新的方向。尽管本研究观察到GA-ONFH造模改变了大鼠肠道菌群的丰度,抗生素洗脱肠道微生物后大鼠GA-ONFH造模效果更加显著,但二者之间的具体联系尚不明确,具体机制和菌群补充的效果有待后续进一步研究。
  • 国家自然科学基金青年基金(81804117)
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2023年第48卷第5期
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doi: 10.11855/j.issn.0577-7402.2023.05.0552
  • 接收时间:2022-04-07
  • 首发时间:2025-12-03
  • 出版时间:2023-05-28
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  • 收稿日期:2022-04-07
  • 录用日期:2022-06-09
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National Natural Science Foundation of China Youth Fund(81804117)
国家自然科学基金青年基金(81804117)
作者信息
    南京中医药大学附属医院/江苏省中医院骨伤科,江苏南京 210029

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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