腰椎间盘突出症自身免疫因素的研究  

Study on autoimmune factors in lumbar disc herniation

作　　者：马信龙[1] 徐云强[1] 张义修[1] 王沛[1] 郑永发[1] 冯世庆[1] 

机构地区：[1]天津医科大学总医院骨科,300052

出　　处：《中国现代神经疾病杂志》2004年第5期291-296,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市自然科学基金资助项目(033606911)

摘　　要：目的探讨自身免疫因素在腰椎间盘突出症(尤其是破碎型)发生中的机制。方法选择已经确诊并接受手术治疗的腰椎间盘突出症患者19例,按照术中所见分为2组:破碎或游离型椎间盘突出组(9例)和退变型椎间盘突出组(10例)。以CD68和CD4、CD8单克隆抗体对手术切除标本进行免疫组化染色,并测定外周血免疫球蛋白IgM、IgG、IgA以及补体C3和循环免疫复合物的水平。比较了两组数据间的差异。结果(1)组织病理学变化:破碎型腰椎间盘突出组有6例标本近边缘细胞浸润区可见CD68阳性反应细胞,并且阳性细胞有沿血管样组织分布的趋势;4例标本见CD4阳性反应细胞浸润;2例标本CD8染色可见阳性反应细胞。退变型腰椎间盘突出组有3例标本边缘可见CD68阳性反应细胞,但细胞数较少。CD4和CD8免疫染色均未见阳性细胞。两组相比,CD68细胞阳性率差异有显著性意义(P<0.05);破碎组CD4和CD8细胞阳性率略高于退变组,但差异无显著性意义(P>0.05)。(2)免疫学检测结果:破碎型腰椎间盘突出症组患者外周血免疫球蛋白IgG和IgM水平高于退变型组,差异具有显著性意义(P<0.05);而两组IgA以及补体C3和循环免疫复合物水平比较差异无显著性意义(P>0.05)。结论(1)腰椎间盘突出症按照其病理实质可分为破碎型和退变型,二者有不同的发病机制,应加以区分。(2)破碎?Objective To study the role of autoimmune factors in the pathogenesis and development of lumbar disc herniation, especially in ruptured lumbar disc herniation (RDH). Methods A total of 19 cases definitely diagnosed patients with lumbar disc herniation were selected and divided into 2 groups through the operative findings: group 1 RDH 9 cases, and group 2 degenerative lumbar disc herniation (DDH) 10 cases. The surgical specimen of disc tissues were examinated by immunohistochemical staining with monoclonal antibodies CD68, CD4 and CD8. The levels of IgA, IgG, IgM and C3 and circulatory immune complex (CIC) in peripheral blood were determined. The difference of data between RDH and DDH groups was compared. Results (1) Histopathological change: In RDH patients the CD68 positive cells were seen in 6 cases, there was the tendancy of distributing these cells along the angioid tissue; infiltration of CD4 positive cells were seen in 4 cases; positive cells were found in 2 cases with CD8 staining. In DDH group, there were CD68 positive cells in 3 cases but cell amount was rather small; but positive cell was not found in CD4 and CD8 immunological staining. Compared CD68 cell positive rate in RDH group and DDH group, the difference was significant (P < 0.05); the CD4 and CD8 cell positive rate were slightly higher in RDH group than that in DDH group, but no significant difference (P > 0.05). (2) Immunological determination: The peripheral IgG and IgM levels in RDH group were higher than those in DDH group with significant difference (P < 0.05), but the difference was not significant (P >.05) in levels of IgA, C3 and CIC between the two group patients. Conclusion (1) The lumbar disc herniation can be divided into two different types according to its pathological essence: RDH and DDH. The pathogenesis is quite different in the 2 types, thus they should be differentiated from each other. (2) There are infiltration of macrophage and T lymph cells in the disc samples of RDH; while a few macrophages are seen in specim

关 键 词：腰椎间盘突出症 自身免疫 病理学 免疫球蛋白 免疫组织化学 

分 类 号：R681.5[医药卫生—骨科学]