腫瘤坏死因子α拮抗剂对应力屏蔽导致的跟腱挛缩形态学影响.doc

肿瘤坏死因子α拮抗剂对应力屏蔽导致的跟腱挛缩形态学影响*★ 李 萍，赵华昆，马燕红(上海交通大学附属第六人民医院康复科，上海市 200233) 文章亮点： 跟腱应力屏蔽后肿瘤坏死因子α明显升高，重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(益赛普)作为目前常用的肿瘤坏死因子α免疫调节剂能特异性阻断肿瘤坏死因子α与细胞表面受体结合，现已运用到多种慢性炎症性疾病的临床治疗。实验通过对肌腱的形态学改变的研究来观察重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白对挛缩肌腱的影响，探讨在肌腱挛缩中肿瘤坏死因子α的变化及其级联作用，初步研究用肿瘤坏死因子α拮抗剂预防肌腱挛缩。 α拮抗剂；肌腱挛缩；其他基金 主题词： 肌腱病；跟腱；挛缩；肿瘤坏死因子α；重组融合蛋白质类；应力, 物理 基金资助： 上海交通大学医学院自然科学基金资助(YZ1061)* 摘要 背景：跟腱应力屏蔽后肿瘤坏死因子α明显升高，应用肿瘤坏死因子α拮抗剂干预肿瘤坏死因子α的作用是否会干预跟腱挛缩尚不清楚。 目的：通过观察重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)干预应力屏蔽后大鼠跟腱形态学变化，了解肿瘤坏死因子α在肌腱挛缩中的影响及肿瘤坏死因子α拮抗剂对肌腱挛缩的干预作用。 方法：20只健康雄性SD大鼠左后肢行跟腱应力屏蔽后随机数字表法均分为实验组和模型组，两组中随机各抽取5只大鼠以右后肢为正常对照组。建模后即刻实验组大鼠使用0.6 mg/kg重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白、模型组使用1 mL磷酸缓冲盐溶液于大鼠皮下注射，后根据重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白半衰期两组分别再注射3次，干预2周时大体下及透射电镜下观察跟腱形态学改变。 结果与结论：大体观察实验组跟腱明显比模型组细小、光滑，但较正常对照组粗。电镜下模型组胶原纤维束较实验组组疏松、紊乱；实验组横切面和纵切面均与正常对照组差异无显著性意义。说明，在2周时，肿瘤坏死因子α拮抗剂能明显预防应力屏蔽所致的肌腱挛缩。 Effects of tumor necrosis factor alpha antagonist on the morphological change of Achilles tendon contracture induced by stress shielding Li Ping, Zhao Hua-kun, Ma Yan-hong (Department of Rehabilitation, Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China) Abstract BACKGROUND: Stress shielding in the Achilles tendons induces over-expression of tumor necrosis factor-α. The degree of tendon contracture remains unclear after the intervention with tumor necrosis factor inhibitor. OBJECTIVE: To investigate the effects of tumor necrosis factor-α on tendon contracture and the preventive effects of tumor necrosis factor inhibitor (etanercept) on tendon contracture by observing the morphological changes of the stress-shielded Achilles tendons after the intervention with etanercept. METHODS: A total of 20 healthy male Sprague-Dawley rats were randomly divided into experimental and model groups after stress shielding in Achilles tendons of rat left hind limb. Five rats from either group were randomly selected, and their right hind limbs were considered as normal controls. Immediately after model induction,