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| 维持性血液透析患者骨质疏松与腰椎间盘退变：氧化应激的潜在作用 |
| Association of osteoporosis with lumbar intervertebral disc degeneration in maintenance hemodialysis patients: a potential role for oxidative stress |
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| DOI：10.3969/j.issn.1006-7108.2026.05.013 |
| 中文关键词: 维持性血液透析 骨质疏松 腰椎间盘退变 氧化应激 骨密度 |
| 英文关键词:maintenance hemodialysis osteoporosis lumbar disc degeneration oxidative stress bone mineral density |
| 基金项目:国家自然科学基金青年项目（82104614）；北京市自然科学基金项目（7204268） |
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| 中文摘要: |
| 目的 探讨维持性血液透析（maintenance hemodialysis，MHD）患者骨质疏松与腰椎间盘退变的关系，并评估氧化应激的潜在作用。方法 纳入2022年1月至2024年12月于首都医科大学附属复兴医院行MHD的患者70例，按双能X线吸收法（DXA）T值分为骨量正常组、骨量减少组和骨质疏松组。腰椎MRI采用Pfirrmann分级并测定髓核T2 mapping值评估椎间盘退变；对部分因临床需要接受腰椎手术的患者获取退变椎间盘组织，行组织学染色及Western blot检测；体外以过氧化氢（H2O2）构建氧化应激模型，并以N-乙酰半胱氨酸（NAC）干预验证可逆性。结果 与骨量正常组相比，骨量减少组及骨质疏松组患者腰椎间盘髓核T2值显著降低，且T2值与骨量指标呈正相关。椎间盘髓核组织学染色显示骨质疏松组蛋白聚糖含量减少并伴纤维化改变。Western blot结果示骨质疏松组髓核中Ⅱ型胶原和Aggrecan表达下降，MMP-13表达上调，抗氧化相关Nrf2和HO-1蛋白水平降低。体外实验中，H2O2可诱导髓核细胞ROS大量积累并显著升高细胞凋亡率，伴随Ⅱ型胶原和Aggrecan下调、MMP-13上调；NAC预处理可明显降低ROS与凋亡水平，部分恢复Ⅱ型胶原和Aggrecan表达并抑制MMP-13上调。结论 MHD患者骨质疏松与腰椎间盘退变相关，氧化应激可能参与其发生发展。 |
| 英文摘要: |
| Objective To investigate the association between osteoporosis in maintenance hemodialysis (MHD) patients and lumbar intervertebral disc degeneration, and to evaluate the potential role of oxidative stress. Methods Seventy patients receiving maintenance hemodialysis at Fuxing Hospital, Capital Medical University, from January 2022 to December 2024 were enrolled and stratified by DXA T-scores into normal bone mass, osteopenia, and osteoporosis groups. Lumbar MRI was performed for Pfirrmann grading and quantitative T2 mapping of the nucleus pulposus (NP). Degenerated disc tissues were obtained from a subset of patients who underwent lumbar surgery for clinical indications and were subjected to histological staining and Western blotting. Primary NP cells were exposed to H2O2 to establish an in vitro oxidative stress model, and N-acetyl-L-cysteine (NAC) was used for antioxidant intervention. Results Compared with the normal bone mass group, NP T2 values were significantly lower in the osteopenia and osteoporosis groups, and NP T2 values were positively correlated with bone mass indices. Histology of NP tissues from osteoporotic patients showed reduced proteoglycan staining with fibrotic changes. Western blotting revealed decreased Collagen II and Aggrecan, increased MMP-13, and reduced antioxidant proteins Nrf2 and HO-1 in the osteoporosis group. In vitro, H2O2 induced marked ROS accumulation and apoptosis in NP cells, accompanied by down-regulation of Collagen II and Aggrecan and up-regulation of MMP-13; NAC pretreatment significantly reduced ROS overproduction and apoptosis and partially restored ECM-related protein expression. Conclusion Osteoporosis in MHD patients is closely associated with lumbar disc degeneration, and oxidative stress may contribute to its progression. |
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