腰椎间盘突出症患者外周血及髓核组织CXCL10/CXCR3和TNF-α及MMP1表达临床意义研究
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摘要
目的腰椎间盘突出症(lumbar disc herniation,LDH)是临床中常见骨科疾病,以腰腿疼痛为主要临床表现。本研究探讨外周血及髓核组织中干扰素诱导型蛋白-10(interferon-inducible protein-10,CXCL10)、CXCL10受体(CXCL10receptor,CXCR3)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、基质金属蛋白酶-1(matrix metalloproteinase1,MMP1)对LDH发病和术后复发风险的预测价值。方法选取2014-08-01-2017-8-31山东医专附属医院及沂水中心医院收治的80例行髓核摘除手术LDH患者为病例组,另选取40例行手术治疗的腰椎骨折患者为对照组。对比外周血和髓核组织中CXCL10、CXCR3、TNF-α和MMP1水平,并采用Pearson相关性分析法分析MMP1与CXCL10、CXCR3和TNF-α相关性。对比术后1年复发组与未复发组患者CXCL10、CXCR3、TNF-α和MMP1水平,并采用Logistic回归分析法确定术后复发的危险因素。结果病例组与对照组相比,外周血及髓核组织CXCL10、CXCR3、TNF-α和MMP1水平均较高,均P<0.05;病例组外周血及髓核组织中MMP1与CXCL10、CXCR3、TNF-α均呈显著正相关,均P<0.05;复发组与未复发组相比,外周血及髓核组织CXCL10、CXCR3、TNF-α和MMP1水平均显著较高,均P<0.05;多因素分析结果显示,年龄≥60岁(OR=3.846,95%CI为2.379～5.313,P<0.001)、病程≥4年(OR=2.433,95%CI为1.225～3.640,P<0.001)、术后早期不适当运动(OR=2.547,95%CI为1.354～3.740,P<0.001)、外周血CXCL10≥326.50pg/mL(OR=2.759,95%CI为1.153～4.366,P=0.005)、CXCR3≥283.61pg/mL(OR=2.319,95%CI为1.159～3.478,P=0.003)、TNF-α≥193.00pg/mL(OR=2.509,95%CI为1.260～3.759,P=0.001)、MMP1≥18.20ng/mL(OR=2.849,95%CI为1.567～4.131,P<0.001)、髓核组织CXCL10≥852.40pg/mL(OR=3.476,95%CI为2.654～4.299,P<0.001)、CXCR3≥423.22pg/mL(OR=3.885,95%CI为2.685～5.084,P<0.001)、TNF-α≥17.21pg/mL(OR=2.575,95%CI为1.371～3.834,P<0.001)、MMP1≥276.54ng/mL(OR=2.497,95%CI为1.117～3.877,P<0.001)均是导致LDH患者术后复发的危险因素。结论 LDH患者外周血及髓核组织中CXCL10、CXCR3和TNF-α水平异常较高,与MMP-1正相关,可能导致术后复发。
OBJECTIVE Lumbar disc herniation(LDH)is a common orthopaedic disease in clinic,with lumbar and leg pain as the main clinical manifestation.The study aims to investigate the predictive value of interferon-inducible protein-10(CXCL10),CXCL10 receptor(CXCR3),tumor necrosis factor-α(TNF-α)and matrix metalloproteinase 1(MMP1)in peripheral blood and nucleus pulposus tissues for the attack of LDH.METHODS A total of 80 patients with LDH who underwent surgery for discectomy received from two hospitals from August 2014 to August 2017 were selected as the case group,and 40 patients who underwent surgical of lumbar vertebrae fractures were set as control group,respectively.The levels of CXCL10,CXCR3,TNF-αand MMP1 of peripheral blood and nucleus pulposus tissues were compared,and Pearson correlation analysis was observed between MMP1 and CXCL10,CXCR3 and TNF-αin peripheral blood and nucleus pulposus tissues.The levels of CXCL10,CXCR3,TNF-αand MMP1 in the recurrence group and the non-recurrence group were compared 1 year after operation.Logistic regression analysis was used to determine the risk factors for postoperative recurrence.RESULTS The levels of CXCL10,CXCR3,TNF-αand MMP1 in peripheral blood and nucleus pulposus tissues in case group were significantly higher than those in the control group,all P<0.05.There were significant positive correlations between MMP1 and CXCL10,CXCR3 and TNF-αin the peripheral blood and nucleus pulposus of the case group,all P<0.05.The levels of CXCL10,CXCR3,TNF-αand MMP1 in peripheral blood and nucleus pulposus were significantly higher in the recurrent group than those in the non-recurrent group,all P<0.05.Logistic regression analysis showed that age≥60 years,duration≥4 years,inappropriate postoperative exercise,peripheral blood CXCL10≥326.50 pg/ml,CXCR3≥283.61 pg/ml,TNF-α≥193.00 pg/ml,MMP1≥18.20 ng/ml,nucleus pulposus tissue CXCL10≥852.40 pg/ml,CXCR3≥4 23.22 pg/ml,TNF-α≥17.21 pg/ml,MMP1≥276.54 ng/ml were risk factors for postoperative recurrence in patients with LDH,all P<0.05.CONCLUSION The levels of CXCL10,CXCR3 and TNF-αin peripheral blood and nucleus pulposus of patients with LDH are abnormally high,which is positively correlated with MMP-1,which may lead to postoperative recurrence.
OBJECTIVE Lumbar disc herniation(LDH)is a common orthopaedic disease in clinic,with lumbar and leg pain as the main clinical manifestation.The study aims to investigate the predictive value of interferon-inducible protein-10(CXCL10),CXCL10 receptor(CXCR3),tumor necrosis factor-α(TNF-α)and matrix metalloproteinase 1(MMP1)in peripheral blood and nucleus pulposus tissues for the attack of LDH.METHODS A total of 80 patients with LDH who underwent surgery for discectomy received from two hospitals from August 2014 to August 2017 were selected as the case group,and 40 patients who underwent surgical of lumbar vertebrae fractures were set as control group,respectively.The levels of CXCL10,CXCR3,TNF-αand MMP1 of peripheral blood and nucleus pulposus tissues were compared,and Pearson correlation analysis was observed between MMP1 and CXCL10,CXCR3 and TNF-αin peripheral blood and nucleus pulposus tissues.The levels of CXCL10,CXCR3,TNF-αand MMP1 in the recurrence group and the non-recurrence group were compared 1 year after operation.Logistic regression analysis was used to determine the risk factors for postoperative recurrence.RESULTS The levels of CXCL10,CXCR3,TNF-αand MMP1 in peripheral blood and nucleus pulposus tissues in case group were significantly higher than those in the control group,all P<0.05.There were significant positive correlations between MMP1 and CXCL10,CXCR3 and TNF-αin the peripheral blood and nucleus pulposus of the case group,all P<0.05.The levels of CXCL10,CXCR3,TNF-αand MMP1 in peripheral blood and nucleus pulposus were significantly higher in the recurrent group than those in the non-recurrent group,all P<0.05.Logistic regression analysis showed that age≥60 years,duration≥4 years,inappropriate postoperative exercise,peripheral blood CXCL10≥326.50 pg/ml,CXCR3≥283.61 pg/ml,TNF-α≥193.00 pg/ml,MMP1≥18.20 ng/ml,nucleus pulposus tissue CXCL10≥852.40 pg/ml,CXCR3≥4 23.22 pg/ml,TNF-α≥17.21 pg/ml,MMP1≥276.54 ng/ml were risk factors for postoperative recurrence in patients with LDH,all P<0.05.CONCLUSION The levels of CXCL10,CXCR3 and TNF-αin peripheral blood and nucleus pulposus of patients with LDH are abnormally high,which is positively correlated with MMP-1,which may lead to postoperative recurrence.
引文
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[8]施栋梁,林青.趋化因子CXCL9、CXCL10、CXCL11与狼疮肾炎相关性研究进展[J].免疫学杂志,2016,32(7):630-633.
[9]肖艳辉,刘高勤,陈志刚,等.重组干扰素诱导蛋白-10对视网膜血管内皮细胞增生、迁移及管腔形成的影响[J].中华眼底病杂志,2013,29(1):58-61.
[10]刘龙庆,陈志伟,易世杰.MMP1基因在头颈部鳞状细胞癌的表达及预后相关性[J].临床耳鼻咽喉头颈外科杂志,2018,32(4):287-291.
[11]邓斌,王叶新,孟纯阳.椎间盘退变患者血清及髓核组织中基质金属蛋白酶1及抑制剂1的表达[J].中国组织工程研究,2016,20(29):4303-4310.
[12]Chang HK,Chang HC,Wu JC,et al.Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy[J].J Neurosurg Spine,2016,24(4):586-591.
[13]刘志恒,霍军丽,刘光华,等.破裂型颈椎间盘突出症患者脱出髓核组织自发吸收1例报告[J].中国脊柱脊髓杂志,2018,28(1):88-90.
[14]尚玉攀,吴昊,曾晓丽,等.从脊柱内镜手术摘除组织中分离髓核间充质干细胞及其生物学特征鉴定[J].中国病理生理杂志,2017,33(6):1147-1152.
[15]冉博.腰椎间盘突出后重吸收的研究现状及进展[J].检验医学与临床,2016,13(5):706-708.
[16]马海珍,祝华,陈娟,等.腰椎间盘突出对绝经后妇女骨密度的影响分析[J].中国骨质疏松杂志,2017,23(11):1420-1424.
[17]Elkan P,Sten-Linder M,Hedlund R,et al.Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation:A prospective study on 177patients[J].Eur Spine J,2016,25(1):186-191.
[18]罗海杰,柯松坚,林彩娜,等.运动训练对椎间盘退变模型大鼠疼痛及细胞外基质合成的影响[J].中国组织工程研究,2017,21(20):3176-3182.
[2]Jiang H,Deng Y,Wang T,et al.Interleukin-23may contribute to the pathogenesis of lumbar disc herniation through the IL-23/IL-17pathway[J].J Orthop Surg Res,2016,11(1):12-19.
[3]宫相翠,管慧,刘杰.幼年特发性关节炎患儿关节滑膜组织中趋化因子CXCL10及其受体CXCR3的表达及意义[J].解剖学报,2017,48(5):590-594.
[4]Eser B,Eser O,Yuksel Y,et al.Effects of MMP-1and MMP-3gene polymorphisms on gene expression and protein level in lumbar disc herniation[J].Genet Mol Res,2016,15(3):159-165.
[5]孔庆奎,谢元忠,万大兰,等.CT多平面重建对腰椎间盘突出症的诊断[J].中华骨科杂志,2001,21(8):508-509.
[6]陆新泉,邹海鹏,张桂琴.按动疗法治疗腰椎间盘突出症下肢疼痛的临床观察[J].中国中西医结合杂志,2016,36(2):239-241.
[7]Nagata K,Yamamoto S,Miyoshi K,et al.A diagnostic algorithm for eosinophilic granulomatosis with polyangiitis initially diagnosed as lumbar disc hernia or lumbar spinal stenosis:Personal experience and review of the literature[J].Acta Med Okayama,2016,70(4):261-268.
[8]施栋梁,林青.趋化因子CXCL9、CXCL10、CXCL11与狼疮肾炎相关性研究进展[J].免疫学杂志,2016,32(7):630-633.
[9]肖艳辉,刘高勤,陈志刚,等.重组干扰素诱导蛋白-10对视网膜血管内皮细胞增生、迁移及管腔形成的影响[J].中华眼底病杂志,2013,29(1):58-61.
[10]刘龙庆,陈志伟,易世杰.MMP1基因在头颈部鳞状细胞癌的表达及预后相关性[J].临床耳鼻咽喉头颈外科杂志,2018,32(4):287-291.
[11]邓斌,王叶新,孟纯阳.椎间盘退变患者血清及髓核组织中基质金属蛋白酶1及抑制剂1的表达[J].中国组织工程研究,2016,20(29):4303-4310.
[12]Chang HK,Chang HC,Wu JC,et al.Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy[J].J Neurosurg Spine,2016,24(4):586-591.
[13]刘志恒,霍军丽,刘光华,等.破裂型颈椎间盘突出症患者脱出髓核组织自发吸收1例报告[J].中国脊柱脊髓杂志,2018,28(1):88-90.
[14]尚玉攀,吴昊,曾晓丽,等.从脊柱内镜手术摘除组织中分离髓核间充质干细胞及其生物学特征鉴定[J].中国病理生理杂志,2017,33(6):1147-1152.
[15]冉博.腰椎间盘突出后重吸收的研究现状及进展[J].检验医学与临床,2016,13(5):706-708.
[16]马海珍,祝华,陈娟,等.腰椎间盘突出对绝经后妇女骨密度的影响分析[J].中国骨质疏松杂志,2017,23(11):1420-1424.
[17]Elkan P,Sten-Linder M,Hedlund R,et al.Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation:A prospective study on 177patients[J].Eur Spine J,2016,25(1):186-191.
[18]罗海杰,柯松坚,林彩娜,等.运动训练对椎间盘退变模型大鼠疼痛及细胞外基质合成的影响[J].中国组织工程研究,2017,21(20):3176-3182.