腰椎间盘突出症的免疫病理学研究

The immunopathological observation of lumbar disc herniation

目的从免疫组织化学角度研究破碎型和完整型腰椎间盘突出症的病理机制和病理过程，比较其差异，探讨腰椎间盘突出症的不同病理学分型。方法选取40例腰椎间盘突出症患者的椎间盘手术标本，依术中所见分为两组：（1）破碎型腰椎间盘突出组（切开突出病变部浅层后纵韧带及纤维环可见破碎椎间盘组织与椎间盘母体分离，突出病变质软，自行溢出或较易钳出）。（2）完整型腰椎间盘突出组（切开突出病变部浅层后纵韧带及纤维环无破碎椎间盘组织溢出，突出病变质硬，必须以器械切除）。所获得的椎间盘标本均行常规HE染色；以鼠抗人CD43RO、CD20单克隆抗体进行免疫组织化学标记，双盲法半定量计数阳性细胞，Ridit等级分析；以FITC标记的兔抗人IgM、IgG抗体进行免疫荧光标记，双盲法半定量计数荧光量，Ridit等级分析。结果两组形态学有显著差异：（1）HE染色可见破碎组标本边缘灶性炎性细胞浸润，血管化；完整组髓核面积减少，纤维环增厚，软骨基质增生；（2）破碎组标本CD。sRO免疫组织化学阳性反应与完整组比较差异有统计学意义（P〈0．05）；（3）破碎组标本IgG和kM免疫荧光阳性反应与完整组比较差异有统计学意义（P〈0．01）。结论（1）破碎型腰椎间盘突出症标本中有T淋巴细胞浸润和免疫球蛋白IgG、IgM沉积，因而其病理机制可能是在损伤基础上的自免疫炎症反席过程。（2）完整犁腰椎间鼎突出以髓核很蛮、软骨某质及纤维环增牛为丰兽表现．

Objective To differentiate the differences between ruptured lumbar disc herniation （RDH） and degenerative lumbar disc herniation （DDH） by the immunopathological study. Methods Fourty cases of confirmed lumbar disc herniation were chosen and divided into 2 groups by the operational findings： 1） RDH： that the herniated disc tissue could be easily removed when the superficial posterior longitudinal ligament and annulus fibrosis were opened during operation; 2） DDH： when the superficial posterior longitu- dinal ligament and annulus fibrosis were opened, no herniated chip of the lumber disc was escaped, herniated material couldn＇t be taken out unless the discs were resected by instruments. The disc tissues were processed in following methods： 1） HE stain; 2） Immunocytochemical protocols using monoclonal antibodies to CD45Ro and CD20 molecule; 3） Immunofluorescence protocols using monoclonal antibodies to IgG and IgM marked with FITC. Results Significant morphologic differences were found between two groups： 1） Routine morphologic observation： focal infiltration of inflammatory cells and neovascularation could be seen at the edge of the RDH samples. There were decreased area of nucleus pulposus, increased annulus fibrosus and chondrocytes in the DDH. 2） In 16 of 24 （66.7%） RDH specimens, CD45RO positive cells were observed, there was significant differences compared with the group of DDH （P〈0.05）; No CD20 positive cells were found in both groups. 3） In 18 of 24 （75%） and 12 of 24 （50%） RDH specimens, IgG and IgM deposit were observed and compared with the DDH group, there were significant differences （P〈 0.01 and P〈 0.05）. Conclusion 1） Different type of lumbar disc herniation （LDH） has its own pathological course. 2） Infiltration of T lymphocytes and deposit of immunoglobulins proved that RDH could be an autoimmunity course. 3） The DDH should be a pathologically proliferative course during the adjustment to the mechanical environments.