转化生长因子β1基因509C/T多态性与腰椎间盘突出症血瘀证及椎间盘退变程度的关联研究

Associations of transforming growth factor beta 1-509C/T site gene polymorphism with blood stasis syndrome of lumbar intervertebral disc protrusion and intervertebral disc degeneration

背景:腰椎间盘突出症在中医临床以血瘀证多见,但目前仍缺少理想的防治手段。既往研究已报道了转化生长因子β1基因509C/T多态性可能与椎间盘退变的发生和发展相关。目的:探讨广西地区汉族人腰椎间盘突出症血瘀证及椎间盘退变与转化生长因子β1基因509C/T多态性的关联性。方法:纳入2008-01/2009-12在广西中医学院第一附属医院骨科临床确诊为腰椎间盘突出症患者,其中中医辨证为血瘀证的共60例,同期相匹配的非血瘀证患者60例,均进行转化生长因子β1基因509C/T多态性检测,并观测患者的椎间盘退变等指标。采用非条件Logistic回归Forward(LR)法分析椎间盘退变和转化生长因子β1基因509C/T多态性的交互作用与腰椎间盘突出症中医证型的关联性。腰椎椎间盘退行性变的程度根据磁共振成像检测结果分为轻度、中度及重度。结果与结论:腰椎间盘突出症转化生长因子β1基因509C/T基因型者的腰椎间盘的退变程度较CC和TT基因型高,血瘀证组患者椎间盘退变程度比非血瘀证患者更严重(P<0.05)。重度椎间盘退变者患腰椎间盘突出症血瘀证的风险是轻中度椎间盘退变者的1.818倍(OR=1.818,95%CI:1.275～2.931,P<0.05)。转化生长因子β1基因509C/T多态性与重度椎间盘退变的累积暴露发生腰椎间盘突出症血瘀证的风险是其中某单一因素的2.038倍(OR=2.038,95%CI:1.379～3.423,P<0.05)。实验结果提示重度椎间盘退变很可能是广西壮族自治区汉族人腰椎间盘突出症血瘀证的潜在危险因素之一,携带转化生长因子β1基因CT基因型的患者在引发椎间盘退变加重相关因素的作用下,患血瘀型腰椎间盘突出症的可能性更大。

BACKGROUND：Blood stasis syndrome is common in lumbar intervertebral disk protrusion（LIDP） in traditional Chinese medical clinical practice,which lacks of ideal preventing and treating methods.Previous studies have reported that transforming growth factor β1（TGF-β1）-509C/T site gene polymorphism may correlate to intervertebral disc degeneration（IDD）.OBJECTIVE：To investigate the relationship among the blood stasis syndrome in LIDP,IDD and TGF-β1-509C/T site gene polymorphisms.METHODS：Totally 120 LIDP patients who received treatments in Department of Orthopedics of First Affiliated Hospital of Guangxi Traditional Chinese Medical College from January 2008 to December 2009 were selected,including 60 blood stasis syndrome and 60 non-blood stasis syndrome.The TGF-β1-509C/T site gene polymorphisms were detected and the IDD indexes were observed.The relationships between TGF-β1-509C/T site gene polymorphisms and the blood stasis syndrome of LIDP were analyzed by logistic regression Forward methods.The grade of intervertebral disc degeneration consisted of mild,middle and severe according to nuclear magnetic resonance.RESULTS AND CONCLUSION：The degenerative degree of lumbar intervertebral disk with TGF-β1 gene-509 CT was higher than CC and TT in LIDP patients,the blood stasis syndrome group was severer than the non-blood stasis syndrome group（P 0.05）.It was showed that the risk of syndrome of blood stasis of LIDP in patients with severe IDD was 1.818 folds of that in patients with mild and middle IDD（OR =1.818,95%CI：1.275-2.931,P 0.05）,and the risk further increased 2.038 folds after accumulating with TGF-β1-509C/T site gene polymorphisms（OR = 2.038,95%CI：1.379-3.423,P 0.05）.Severe IDD may be one of the risk factors of syndrome of blood stasis of LIDP in Han ethnic population from Guangxi.Patients with TGF-β1 gene-509 adiponectin CT genotype and combined with severe IDD are susceptible to syndrome of blood stasis of LIDP.