邓爽 彭昊

    [摘要] 糖皮质激素应用是股骨头坏死最常见的非创伤性原因，研究认为其发生机制包含直接和间接两重作用。直接作用包括：成骨细胞与破骨细胞前体生成抑制，成骨细胞与骨细胞凋亡，破骨细胞寿命延长，内皮细胞凋亡；间接作用包括：促进凝血活性，干扰血管再生，影响骨修复，调节局部血管收缩，诱导骨髓脂肪生成，增高髓内压。多种途径的激活使股骨头血供减少，从而导致坏死发生。此外，激素性股骨头坏死的发生还存在个体敏感性差异及其他的潜在机制，其患病模型为多重命中理论，风险因素越多则患病概率越大。应更深入地认识糖皮质激素的详细作用机制，从而为临床治疗提供更好的选择。

    [关键词] 糖皮质激素；股骨头坏死；成骨细胞；破骨细胞；骨细胞；内皮细胞；凋亡

    [中图分类号] R684 [文献标识码] A [文章编号] 1673-7210(2017)12(a)-0029-04

    [Abstract] The use of glucocorticoids is the most common non-traumatic cause of osteonecrosis of the femoral head. Studies have shown that glucocorticoids can act directly or indirectly. Direct effects include inhibition of osteoblast and osteoclast precursor formation， apoptosis of osteoblasts and osteocytes， prolongation of osteoclast lifespan and apoptosis of endothelial cells. Indirect effects include increasing the risk of clot formation， inhibiting angiogenesis， interfering with bone repair， causing local vessel contraction， promoting lipogenesis in the bone marrow and increasing intramedullary pressure. Multiple pathway activation leads to the decrease of blood supply of the femoral head ......