青少年特发性脊柱侧凸椎体软骨终板核心蛋白和细胞因子的变化

The changes of core protein of proteoglycan and cytokines in the vertebral cartilage endplate of adolescent idiopathic scoliosis

目的了解青少年特发性脊柱侧凸患者顶端椎凸、凹侧椎体软骨终板内核心蛋白、TGFβ1及bFGF的变化,探讨其在特发性脊柱侧凸发病中的作用。方法12例患者,男4例,女8例;年龄12～20岁,平均14.9岁;侧凸Cobb角43°～102°,平均65.1°。所有患者均经X线、CTM和(或)MR检查排除先天性、神经肌肉性等原因所导致的侧凸。对前路手术取下的顶椎和端椎的软骨终板进行S-P法免疫组化染色,染色结果采用北京航空航天大学图像中心医学彩色病理图像分析系统进行分析。结果经非参数Wilcoxon秩和检验,侧凸顶椎和端椎凹侧终板软骨细胞内TGFβ1表达的面密度和数密度高于凸侧及顶椎凸侧表达的数密度高于端椎均有统计学意义(P<0.05);侧凸顶椎和端椎凹侧bFGF表达的面密度和数密度高于凸侧亦有统计学意义(P<0.05);顶椎及端椎凸侧蛋白多糖核心蛋白的面密度和数密度高于凹侧,但无统计学意义(P>0.05)。TGFβ1及bFGF及核心蛋白在侧凸顶椎的表达较端椎表达略高,但无统计学意义(P>0.05)。结论青少年特发性脊柱侧凸患者凹侧TGFβ1、bFGF高表达和核心蛋白低表达,表明细胞因子和核心蛋白的表达异常可能是脊柱侧凸的发病原因或继发于侧凸的变化。

Objective To observe the expression of the transforming growth factor beta 1, the basic fibroblast growth factor and the core protein of proteoglycan on the convex and concave sides of apex and end vertebral cartilagnous endplate in adolescent idiopathic scoliosis. Methods There were 12 cases in the study group. There were 4 males and 8 females. The age of patients at the surgery ranged from 12 to 20 years （with an average of 14.9 years）. The Cobb angle ranged 43° to 102° （mean, 65.1°） preoperatively. The diagnosis of idiopathic scolisis was made based on radiography, CTM and/or MRI to rule out congenital, neuromyeputhic and other scolisis. All patients underwent anterior correction procedures. The sections of the convex and concave side of the resected apex and end vertebral cartilage endplate were examined with S-P immunohistochemistry and the results were analyzed with image analysis system. Results The transforming growth factor beta 1, the basic： fibroblast growth factor and the core protein of proteoglycan were all expressed in the cytoplasm of chondrocytes in the cartilaginous endplate. With non-parameter Wilcoxon rank test, the area density and quantity density of the transforming growth factor beta 1, the basic fibroblast growth factor on the concave curve of the apex and end vertebrae are expressed in a significantly higher level than those of the convex curve at the apex and end vertebrae （P〈0.05）. The expression of the core protein of proteoglycan on the convex curve of the apex and end vertebrae is higher than that on the concave curve of the apex and end vertebrae （P〉0.05）. Conclusion There was a significantly higher expression of TGFβ1 and bFGF, while a lower expression of the core protein on the concave side, which suggest a possible aetiological factor or a secondary change in the development of AIS.