椎间盘的免疫反应及治疗的研究进展  

Recent progress in intervertebral disc immune responses and therapeutic strategies

作　　者：张蒯祥 刘曼 易靖博 张文睿 浦飞飞 李记天 Zhang Kuaixiang;Liu Man;Yi Jingbo;Zhang Wenrui;Pu Feifei;Li Jitian(Laboratory of Molecular Biology,Luoyang Orthopaedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopaedic Hospital),Zhengzhou 450000,China;Henan University of Chinese Medicine,Zhengzhou 450000,China;Department of Orthopaedics,Wuhan Hospital of Traditional Chinese and Western Medicine(Wuhan No.1 Hopital),Wuhan 430000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)分子生物学实验室,郑州450000 [2]河南中医药大学,郑州450000 [3]武汉市第一医院(武汉市中西医结合院)骨科,武汉430000

出　　处：《中华骨科杂志》2025年第7期446-453,共8页Chinese Journal of Orthopaedics

基　　金：河南省中原医学科技创新发展基金会科学研究项目(ZYYC2023ZD)。

摘　　要：椎间盘由中心髓核组织、外周纤维环及上下方软骨终板组成,这种独特的结构将髓核与宿主的免疫系统隔离开来。椎间盘中表达的某些物质对免疫细胞和细胞因子浸润具有抑制作用,因此椎间盘被认为是一个免疫赦免组织。然而,椎间盘退变过程中,其物理屏障受损,髓核可能会被识别为免疫系统的外来抗原;同时,退变椎间盘中炎症细胞因子会招募大量免疫细胞,使髓核原有的免疫平衡被破坏,导致椎间盘退变进展。近年研究证实,退变椎间盘内存在巨噬细胞及肥大细胞等免疫细胞浸润,且免疫细胞的表型特征与数量变化与椎间盘退变进程密切相关。在治疗策略方面,针对退变椎间盘免疫微环境调控的间充质干细胞疗法、基因治疗及生长因子等生物制剂已进入动物实验阶段,小分子药物在重建椎间盘免疫赦免状态方面也展现出独特的调控潜力。The intervertebral disc is a complex structure composed of the central nucleus pulposus,the peripheral annulus fibrosus,and the cartilaginous endplates located at the top and bottom.This unique arrangement effectively isolates the nucleus pulposus from the host’s immune system.Additionally,specific substances within the intervertebral disc exhibit inhibitory effects on the infiltration of immune cells and cytokines,which has led to the recognition of the intervertebral disc as an immune-privileged tissue.However,during intervertebral disc degeneration(IDD),the physical barriers that maintain this immune privilege are compromised.As a result,the nucleus pulposus may be perceived as a foreign antigen by the immune system.Simultaneously,inflammatory cytokines released by the degenerating disc attract a significant influx of immune cells,disrupting the delicate immunological balance within the nucleus pulposus and exacerbating the progression of IDD.Recent studies have confirmed the infiltration of immune cells such as macrophages and mast cells into the degenerative intervertebral disc,and the phenotypic characteristics and quantitative changes of these immune cells are closely related to the process of IDD.In terms of treatment strategies,biological agents such as mesenchymal stem cell therapy,gene therapy and growth factors that regulate the immune microenvironment of degenerative intervertebral discs have entered the stage of animal experiments.At the same time,small molecule drugs have shown unique regulatory potential in restoring the immune-privileged status of intervertebral discs.

关 键 词：椎间盘退行性变 免疫 细胞 免疫赦免 炎症 

分 类 号：R681.5[医药卫生—骨科学]