CAJ | 학술논문

目的通过研究椎旁肌细胞凋亡因子Bax、Bcl-2于后颅窝减压术(posterior fossa decompression,PFD)前后表达的差异,探讨PFD术对Chiari畸形/脊髓空洞伴脊柱侧凸患者椎旁肌失神经支配的改善效果.方法前瞻性选取2011年7月至2012年7月,接受PFD及二期脊柱侧凸矫形手术的14例Chiari畸形伴脊髓空洞患者,于PFD及矫形术中分别切取颈胸段脊柱两侧椎旁肌中的部分竖脊肌组织.通过蛋白免疫印迹检测椎旁肌细胞Bax与Bcl-2的表达,测定灰度值并对其PFD前后表达差异进行定量分析.结果 14例患者接受PFD时年龄为(16.0±3.3)岁,主弯Cobb角为63.8°±18.3°,PFD与侧凸矫形术间隔(7.6±2.6)个月.Bax净灰度、阳性灰度积和阳性比于PFD术前分别为106.2±30.9、12.6× 104±9.4× 104和0.75±0.13,术后改善为73.9±38.5 (P=0.021)、5.6×104±6.1×104(p=0.013)和0.28±0.15 (P＜ 0.001).Bcl-2净灰度、阳性灰度积和阳性比于PFD术前分别为84.4±35.8、10.6×104±6.1×104和0.40±0.17,术后改善为101.6±33.3(P=0.197)、21.3×104±9.2×104 (P=0.001)和0.85±0.19(P＜ 0.001).结论 Chiari畸形/脊髓空洞伴脊柱侧凸患者椎旁肌的失神经支配可于PFD术后获得改善,提示此类患者的脊髓功能损害可能是一种可逆的病理过程.
목적 통과연구추방기세포조망인자Bax、Bcl-2우후로와감압술(posterior fossa decompression,PFD)전후표체적차이,탐토PFD술대Chiari기형/척수공동반척주측철환자추방기실신경지배적개선효과.방법 전첨성선취2011년7월지2012년7월,접수PFD급이기척주측철교형수술적14례Chiari기형반척수공동환자,우PFD급교형술중분별절취경흉단척주량측추방기중적부분수척기조직.통과단백면역인적검측추방기세포Bax여Bcl-2적표체,측정회도치병대기PFD전후표체차이진행정량분석.결과 14례환자접수PFD시년령위(16.0±3.3)세,주만Cobb각위63.8°±18.3°,PFD여측철교형술간격(7.6±2.6)개월.Bax정회도、양성회도적화양성비우PFD술전분별위106.2±30.9、12.6× 104±9.4× 104화0.75±0.13,술후개선위73.9±38.5 (P=0.021)、5.6×104±6.1×104(p=0.013)화0.28±0.15 (P＜ 0.001).Bcl-2정회도、양성회도적화양성비우PFD술전분별위84.4±35.8、10.6×104±6.1×104화0.40±0.17,술후개선위101.6±33.3(P=0.197)、21.3×104±9.2×104 (P=0.001)화0.85±0.19(P＜ 0.001).결론 Chiari기형/척수공동반척주측철환자추방기적실신경지배가우PFD술후획득개선,제시차류환자적척수공능손해가능시일충가역적병리과정.
Objective To investigate the influence of posterior fossa decompression (PFD) on denervation of the paraspinal muscles in patients with scoliosis secondary to Chiari malformation and syringomyelia through evaluating the alterations in expression of Bax and Bcl-2.Methods Fourteen patients with scoliosis secondary to Chiari malformation and syringomyelia treated between July 2011 and July 2012 were prospectively enrolled.Bilateral biopsy of paraspinal muscles was performed during PFD and subsequent scoliosis surgery.Bax and Bcl-2 protein levels were examined by Western blotting and then quantitatively assessed using a scanning densitometer.Results The initial age and primary curve magnitude were 16.0±3.3 years and 63.8°± 18.3°,respectively.At 7.6±2.6 months post-PFD,net gray value,positive area and positive ratio for the 20×103 Bax protein were 73.9±38.5,5.6× 104±6.1 × 104 and 0.28±0.15,respectively,representing a significant decrease when compared with those observed at the time of PFD (106.2±30.9,P=0.021; 12.6×104±9.4 ×l04,P=0.013; 0.75±0.13,P＜ 0.001).The 25×103 Bcl-2 protein,in contrast,appeared to be enriched over the same period in protein lysates from paraspinal muscles.Specifically,the positive area and positive ratio changed from 10.6×104±6.1×104 and 0.40±0.17 to 21.3×104±9.2×104 (P=0.001) and 0.85±0.19 (P＜ 0.001).Concerning the net gray value,a similar upward trend was demonstrated though not reaching statistical significance (84.4±35.8 versus 101.6±33.3,P =0.197).Conclusion Improvement in denervation of the paraspinal muscles was demonstrated following PFD,indicating that the impairment of spinal cord function may be reversible in patients with Chiari malformation and syringomyelia.