不同病变类型的腰椎髓核CD68表达及其与临床意义
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摘要
[目的]观察比较突出型和脱垂游离型腰椎间盘突出症(lumbar disc herniation,LDH)手术摘除的髓核组织CD68表达与相关临床表现。[方法]收集2014年9月~2017年1月在延边大学附属医院脊柱外科住院的55例LDH患者髓核标本,施行手术摘除突出型患者(突出组,30例)和脱垂游离型患者(游离组,25例),全部标本采用HE染色观察及免疫组化方法检测髓核组织中CD68的阳性表达率,观察两种突出类型在组织学上的差异并分析CD68的阳性表达率与术前疼痛程度之间的关系。[结果]HE染色观察下游离型组失去正常的髓核组织结构,可见肉芽组织生成及炎性细胞浸润,而突出型组则无此现象。游离组CD68的阳性表达率显著高于突出组(P<0.05)。游离组术前的VAS评分、ODI评分高于突出组(P<0.05)。髓核组织中CD68的阳性表达率与疼痛程度呈正相关。[结论]与突出型髓核相比,脱垂游离型髓核表现为更明显的肉芽形成和炎细胞浸润,伴有更高的CD68阳性表达率。由于其阳性表达率与术前临床疼痛程度评分呈正相关,CD68有可能与腰椎间盘突出症疼痛的产生有关。
[Objective] To compared CD68 expression in the nucleus pulposus tissue removed surgically and relative clinical manifestation between the protrusion-type and sequestration-type lumbar disc herniation. [Method] From September 2014 to January 2017, the nucleus pulposus specimens, harvested surgically from 55 patients who received surgical treatment at the Affiliated Hospital of Yanbian University, were pathologically studied by HE staining and CD68 immunohistochemical staining.In term of lesion type, 30 patients proved protrusion-type lesion(the protrusion group), while the remaining 25 patients were sequestration-type lesion(the sequestration group). The positive expression rate of CD68, prominent differences in histology and the relationship between the positive expression rate of CD68 and the degree of preoperative pain were evaluated and compared between the two groups. [Results] Compared with the protrusion group in which normal nucleus pulposus structure could be seen, HE staining showed that no normal nucleus pulposus structure was noted in the sequestration group, replaced with great amount of the granulation tissue formation with inflammatory cell infiltration. The positive expression rate of CD68 in the sequestration group was statistically higher than the protrusion group(P<0.05). In addition, the VAS score and ODI score in the sequestration group before operation were significantly higher than the protrusion group(P<0.05). There was a positive correlation between the positive expression rate of CD68 in nucleus pulposus and the extent of pain before operation. [Conclusion]Compared with the protrusion-type lesion, the sequestration-type nucleus pulposus present much significantly granulation formation with inflammatory infiltration, and higher expression of CD68. Because its expression levels is positively correlated with the extent of pain before operation, the CD68 is probably involved in the painfulness of lumbar disc herniation.
[Objective] To compared CD68 expression in the nucleus pulposus tissue removed surgically and relative clinical manifestation between the protrusion-type and sequestration-type lumbar disc herniation. [Method] From September 2014 to January 2017, the nucleus pulposus specimens, harvested surgically from 55 patients who received surgical treatment at the Affiliated Hospital of Yanbian University, were pathologically studied by HE staining and CD68 immunohistochemical staining.In term of lesion type, 30 patients proved protrusion-type lesion(the protrusion group), while the remaining 25 patients were sequestration-type lesion(the sequestration group). The positive expression rate of CD68, prominent differences in histology and the relationship between the positive expression rate of CD68 and the degree of preoperative pain were evaluated and compared between the two groups. [Results] Compared with the protrusion group in which normal nucleus pulposus structure could be seen, HE staining showed that no normal nucleus pulposus structure was noted in the sequestration group, replaced with great amount of the granulation tissue formation with inflammatory cell infiltration. The positive expression rate of CD68 in the sequestration group was statistically higher than the protrusion group(P<0.05). In addition, the VAS score and ODI score in the sequestration group before operation were significantly higher than the protrusion group(P<0.05). There was a positive correlation between the positive expression rate of CD68 in nucleus pulposus and the extent of pain before operation. [Conclusion]Compared with the protrusion-type lesion, the sequestration-type nucleus pulposus present much significantly granulation formation with inflammatory infiltration, and higher expression of CD68. Because its expression levels is positively correlated with the extent of pain before operation, the CD68 is probably involved in the painfulness of lumbar disc herniation.
引文
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[6]蒋尧传,肖胜军,肖荣驰,等.巨噬细胞及免疫复合物在腰椎间盘突出组织中的表达及其意义[J].华夏医学,2010,23(5):536-538
[7]马力军,王钢.腰椎间盘突出症的发病机制研究进展[J].湖南中医杂志,2013,29(3):125-127
[8]马信龙,王涛,马剑雄.自免疫椎间盘炎动物模型构建及其免疫反应[J].中国组织工程研究与临床康复,2009,13(11):2105-2109.
[9]金晓娜,张党锋.腰椎间盘突出症的发病机制及健康教育[J].医学理论与实践,2011,24(10):1152-1154.
[10]王志伟,元虎.新西兰大白兔髓核组织在自身椎管内巨噬细胞浸润的动态变化及其意义[J].中国矫形外科杂志,2011,19(9):774-778.
[11]Yoichi K,Miwa U,Shoichi K,et al.Angiogenesis and inflammatory cell infiltration in lumbar disc herniation[J].Spine,2003,28(17):1928-1933.
[2]鲁玉来,张喜善,范锡海.腰椎间盘突出症诊疗中的问题及对策[J].中国矫形外科杂志,2012,20(21):2011-2013
[3]Shin KH.Revisional percutaneous full endoscopic disc surgery for recurrent herniation of previous open lumbar discectomy[J].Asian Spine J,2011,5(1):1-9
[4]Shiri R.Obesity as a risk factor for sciatica:a meta-analysis[J].Am J Epidemiol,2014,179(8):929-937.
[5]贺宝荣,郝定均,许正伟,等.腰椎间盘突出症髓核的超微结构与临床对照研究[J].骨科,2010,1(1):33-36
[6]蒋尧传,肖胜军,肖荣驰,等.巨噬细胞及免疫复合物在腰椎间盘突出组织中的表达及其意义[J].华夏医学,2010,23(5):536-538
[7]马力军,王钢.腰椎间盘突出症的发病机制研究进展[J].湖南中医杂志,2013,29(3):125-127
[8]马信龙,王涛,马剑雄.自免疫椎间盘炎动物模型构建及其免疫反应[J].中国组织工程研究与临床康复,2009,13(11):2105-2109.
[9]金晓娜,张党锋.腰椎间盘突出症的发病机制及健康教育[J].医学理论与实践,2011,24(10):1152-1154.
[10]王志伟,元虎.新西兰大白兔髓核组织在自身椎管内巨噬细胞浸润的动态变化及其意义[J].中国矫形外科杂志,2011,19(9):774-778.
[11]Yoichi K,Miwa U,Shoichi K,et al.Angiogenesis and inflammatory cell infiltration in lumbar disc herniation[J].Spine,2003,28(17):1928-1933.