环氧化酶2与血管内皮生长因子在突出腰椎间盘中的表达及意义

Expression and clinical significance of cyclooxygenase-2 and vascular endothelial growth factor in lumbar disc herniation

目的:探讨环氧化酶2(COX-2)、血管内皮生长因子(VEGF)在突出腰椎间盘中的表达及其意义。方法:62个突出椎间盘标本取自58例腰椎间盘突出症手术患者,包括突起型22个,破裂型20个,游离型20个。取材部位分别为突出组织或游离组织(A部位)和椎间隙残余髓核组织(B部位)。对照组取自4例新鲜年轻尸体的L3/4、L4/5及L5/S1椎间盘组织共12个标本,取材部位为椎间盘边缘(A部位)和中央髓核(B部位);应用免疫组化法对各组标本中COX-2和VEGF的表达进行检测;应用图像分析系统测量标本中COX-2和VEGF表达量的平均光密度值。结果:在腰椎间盘突出组,特别是破裂型和游离型组的突出组织中存在富含新生血管的肉芽组织,COX-2和VEGF染色阳性细胞主要表达于肉芽组织中及突出组织的椎间盘细胞中,对照组未见阳性染色细胞。在突出组的A部位从突起型、破裂型到游离型COX-2和VEGF的表达均逐渐增高,差异有显著性(P<0.01)。突出组的A部位COX-2和VEGF的表达明显高于B部位(P<0.01)。腰椎间盘组织中COX-2和VEGF的表达存在明显相关性(r=0.855,P<0.01)。结论:COX-2、VEGF参与腰椎间盘退变、突出的发病过程;随着腰椎间盘退变突出的进展,COX-2、VEGF的表达均逐渐增高;COX-2与VEGF表达密切相关。

Objective：To investigate the expression of cyclooxygenase-2 （COX-2） and vascular endothelial growth factor（VEGF） in lumbar disc herniation and explore their significance in the pathogenesis of intervertebral disc degeneration and relationship between lumbar protrusion types.Method：62 discs from patients with lumbar disc herination（22 inflation type,20 extrusion type,20 sequestration type） were collected.The disc herniation were obtained from two zone of disc：zone A was hernia tissue or separate fragment,zone B was the remainder nucleus pulpous of lumbar intervertebral disc.In control group, 12 normal discs were harvested from 4 young fresh specimens obtained from two zone of disc：zone A was the margin of lumbar intervertebral disc,zone B was the center nucleus pulpous of lumbar intervertebral disc.The expression of COX-2 and VEGF were evaluated immunohistochemically,and their average optical density were assayed by image analysis system.Result：COX-2 and VEGF were overexpressed in LDH group especially in extrusion and sequestration type.There were no expression in control group.The expression of COX-2 and VEGF gradually raised from inflation,extrusion to sequestration type at zone A in LDH group（P〈0.01）.The expression of COX-2 and VEGF were higher at zone A than at zone B in LDH group （P〈0.01）.A positive correlation was found between the expression of COX-2 and VEGF in LDH group （r=0.855,P〈0.01）.Conclusion：COX-2 and VEGF are involved in the pathogenesis of lumbar disc degeneration and lumbar disc herniation.COX-2 and VEGF play critical role in the development of lumbar disc degeneration and herniation.The inhibition of COX-2 and VEGF should be promising in dealing with early disc degeneration.