腰椎间盘突出症和椎间盘源性疼痛的免疫病理学研究  

Immunopthological observation of lumbar disc herniation and discogenic pain

作　　者：刘振刚[1] 卢一生[1] 施建东[1] 黄波[1] 张宝英[1] 

机构地区：[1]解放军第117医院骨科中心,浙江杭州310013

出　　处：《颈腰痛杂志》2016年第4期272-275,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的通过对突出腰椎间盘组织中免疫因子的测定,进一步探讨腰椎间盘突出症与椎间盘源性疼痛在免疫病理学改变的异同点。方法收集标本:腰椎间盘突出症(A组)30例,椎间盘源性疼痛(B组)30例,确诊后两组均行腰椎后路减压植骨融合术,腰椎爆裂骨折(C组)10例,都行前路手术,共70例椎间盘髓核标本。对各组髓核组织进行组织学观察,通过免疫组化方法对髓核中CD25+T细胞和CD68阳性巨噬细胞进行检测及数据统计分析。结果病理学观察:C组髓核组织细胞形态一致,匀称分布,细胞质无明显退变,无明显炎症细胞浸润;其他两组均见髓核细胞空泡样变、形态不一致,胞质分布不均;A组髓核组织周围能见较多炎症细胞、局部见毛细血管增生;B组髓核细胞质退变明显,髓核组织周围能见少量炎症细胞,无明显毛细血管增生。免疫组化检测:CD68阳性率,B组(50%)>A组(33.3%)>C组(0%),各组间差异有统计学意义(P<0.05)。A组中CD25+T细胞均表现在CD68阳性巨噬细胞相同位置,B组与C组为阴性。结论腰椎间盘突出症髓核周围有显著的自身免疫反应与炎症反应;椎间盘源性疼痛髓核周围有少量炎症细胞与较多巨噬细胞,但未见明显的毛细血管与T淋巴细胞增生,表明周围有炎症反应,但自身免疫反应没有腰椎间盘突出症典型。Objective To evaluate and compare the immunopathological changes of lumbar disc herniation and discogenic pain. Methods Seventy lumbar disc nucleuses were collected in- tra-operation, and they were divided into three groups. Group A specimens： 30 cases of lumbar disc prolapse, intervertebral disc source sex pain （group B）, 30 cases diagnosed lumbar posterior decompression and interbody fusion in the two groups, 10 cases of lumbar spine burst fracture （group C）, received anterior surgery. A total of 50 cases of intervertebral disc nucleus pulposus specimens. For each group the histological change was observed, CD25＋T cells in the nucleus pulposus and CD68 positive macrophages were tested by immunohistochemical method, and the data were analyzed. Results Pathology observation： group C nucleus pulposus tissue cell morphology, symmetrical distribution, the cytoplasm had no obvious degeneration, no obvious inflammatory cells infiltration; Other groups have seen nucleus pulposus cell cavity change, shape, cytoplasmic distribution; Group A around the nucleus pulposus could see more inflammatory cells, local blood capillary hyperplasia; Group B cytoplasm degeneration of nucleus pulposus, I could see more inflammatory cells around the nucleus pulposus, no obvious blood capillary hyperplasia. Immunohistochemical detection：CD68 positive rate, group B （50%）〉group A （33.3%）〉group C （0%）, the difference between groups was statistically significant（P〈0.05）. CD25＋T cells in group A was at the same position of CD68 positive macrophages, those in group B and group C were negative. Conclusion The nucleus of herniated disc has evident inflammatory and autoimmunity reaction. The nucleus of discogenic pain is infiltrated with diffuse inflammatory cells and some macrophages, without T lymphocyte and neovascularization, so the autoimmunity course is not evident.

关 键 词：腰椎椎间盘突出症 椎间盘退变 腰痛 免疫病理学 

分 类 号：R681.53[医药卫生—骨科学] R392.3[医药卫生—外科学]