CAJ | 학술논문

目的观察白细胞介素17 (interleukin- 17,IL-17)在腰椎间盘突出症(lumbar disc herniation,LDH)损伤疝出型和退变突出型椎间盘组织中表达的差异,以及LDH病变节段Modic改变的情况,探讨Modic改变与突出类型的相关性及可能的病理机制.方法选取2009年2月至10月确诊并手术治疗的单节段LDH患者50例.根据临床诊断标准、影像学(CT及MR)检查结果以及手术所见将病例分为损伤疝出组35例,退变突出组15例.根据MRI将病例分为Modic改变组14例,非Modic改变组36例.收集椎间盘标本,采用HE染色、免疫组织化学染色和实时荧光定量PCR检测观察椎间盘组织病理变化及IL-17的表达.结果 (1)损伤疝出组中肉芽组织、新生血管化明显高于退变突出组.(2)损伤疝出组标本中IL-17阳性细胞数明显高于退变突出组,Modic改变组IL-17阳性细胞数明显高于非Modic改变组,差异均有统计学意义.(3)损伤疝出组椎间盘组织中IL-17 mRNA的表达量与退变突出组的比值为6.7701,Modic改变组与非Modic改变组的比值为4.2836.(4)损伤疝出型LDH与Modic改变之间的相关性分析显示两者存在相关性.结论 (1)损伤疝出型椎间盘髓核组织可以引起更为明显的局部炎性反应；(2)IL-17在损伤疝出型椎间盘表达明显,提示IL-17介导了椎间盘神经根微环境的免疫炎症变化；(3)自身免疫反应参与了Modic改变的病理生理机制,并且很可能发挥重要作用.
목적 관찰백세포개소17 (interleukin- 17,IL-17)재요추간반돌출증(lumbar disc herniation,LDH)손상산출형화퇴변돌출형추간반조직중표체적차이,이급LDH병변절단Modic개변적정황,탐토Modic개변여돌출류형적상관성급가능적병리궤제.방법 선취2009년2월지10월학진병수술치료적단절단LDH환자50례.근거림상진단표준、영상학(CT급MR)검사결과이급수술소견장병례분위손상산출조35례,퇴변돌출조15례.근거MRI장병례분위Modic개변조14례,비Modic개변조36례.수집추간반표본,채용HE염색、면역조직화학염색화실시형광정량PCR검측관찰추간반조직병리변화급IL-17적표체.결과 (1)손상산출조중육아조직、신생혈관화명현고우퇴변돌출조.(2)손상산출조표본중IL-17양성세포수명현고우퇴변돌출조,Modic개변조IL-17양성세포수명현고우비Modic개변조,차이균유통계학의의.(3)손상산출조추간반조직중IL-17 mRNA적표체량여퇴변돌출조적비치위6.7701,Modic개변조여비Modic개변조적비치위4.2836.(4)손상산출형LDH여Modic개변지간적상관성분석현시량자존재상관성.결론 (1)손상산출형추간반수핵조직가이인기경위명현적국부염성반응；(2)IL-17재손상산출형추간반표체명현,제시IL-17개도료추간반신경근미배경적면역염증변화；(3)자신면역반응삼여료Modic개변적병리생리궤제,병차흔가능발휘중요작용.
Objective To observe the expression of Interleukin-17 (IL-17) in different types of herniated disc tissue,and to investigate Modic changes in corresponding injured segment and relationship between Modic changes and herniated types.Methods Fifty patients with single level disc herniation were enrolled in this study.According to clinical diagnosis criteria,imaging (CT and MR) examination results,and the view in surgery process the patients were divided into 2 groups:herniation group(35 patients),degeneration group(15 patients).According to MRI,patients were divided into 2 groups:Modic changes group(14 patients),non-Modic changes group (36 patients).The disc tissues were observed by HE staining and immunohistochemical staining,and the expression of IL-17 was detected by using real-time quantitative PCR.Results Pathological examination revealed that there were more granulation tissue and neovascularization in herniation group than in degeneration group.Immunohistochemical result showed that there were more IL-17-positive cells in herniation group than in degeneration group; there were more IL-17-postive cells in Modic changes group than in non-Modic changes group.The expression of IL-17 mRNA in herniation group was 6.7701 times more than that in degeneration group.The expression of IL-17mRNA in Modic changes group was 4.2836 times more than that in non-Modic changes group. Conclusion The herniated disc nucleus pulposus can cause more prominent local inflammation.Autoimmune responses maybe play an important role in pathophysiological mechanisms of Modic changes.