腰间盘HIZ与TNF-α表达的相关性研究及其在椎间盘内破裂症中的诊断价值

The Correlation of Lumbar Disc HIZ and TNF-α Expression and Its Diagnostic Value in the Rupture Disc Herniation

目的:观察腰间盘信号改变与间盘组织TNF-α表达的关系,分析研究HIZ在椎间盘内破裂症中的诊断价值。方法:38例经椎间盘造影诊断为IDD的患者,行腰椎MRI检查和Pfirrmann分级及VAS评分,根据VAS评分结果分为轻度疼痛A组、中度疼痛B组及重度疼痛C组;根据Pfirrmann分级标准将Ⅲ级归入轻度退变D组,Ⅳ级为中重度退变F组。取手术切除的HIZ及非HIZ间盘组织行TNF-α免疫组化染色观察和TNF-α含量检测,同时以5例脊柱骨折患者手术时取出的间盘组织作为对照。结果:(1)间盘信号与年龄间的直线相关系数R值0.6111,信号与年龄呈负相关;信号与间盘内TNF-α表达量呈负相关,R值为-0.8710。(2)随着疼痛症状加重,间盘信号逐渐减弱,A、B、C组间盘信号改变与对照组比较差异均有统计学意义(P<0.05)。(3)间盘退变程度与间盘信号改变及TNF-α表达量相关,D组、F组比较差异有统计学意义(P<0.05)。(4)IDD患者HIZ间盘组织局部炎性反应明显,TNF-α免疫组化染色阳性;HIZ组TNF-α表达量明显强于非HIZ组和对照组(P<0.05)。结论:(1)间盘信号与年龄、TNF-α表达量及VAS评分负相关。(2)IDD患者HIZ中TNF-α阳性表达明显,表明HIZ可作为IDD诊断的一个特异性影像改变。

Objective：To investigate the relationship between the signal changes with TNF-α expression in the lumbar disc tissues and the diagnostic value of HIZ in the ruptured intervertebral disc herniation.Method：38 IDD patients following discography were subjected to lumbar MRI,Pfirrmann grading and VAS scoring.Based on mild pain VAS scores,those cases were divided into group A,group B group with moderate pain and severe pain in Group C.According to Pfirrmann grading standards,cases were classified as class Ⅲ mild degeneration in group D,Ⅳ level was moderate to severe degenerative group F.TNF-α immunohistochemical staining and HE staining were performed in disc tissues of patients with HIZ and non-HIZ,and 5 cases of intervertebral disc tissues removed during surgery in patients with spinal fractures were used as control.Result：The linear correlation on between the disc signal and the age were negatively correlated,R value was-0.6111,signal and intradiscal TNF-α expression were negatively correlated,R value was-0.871 and the linear correlation coefficient.With pain symptoms,disc signal gradually weakened,group A,group B,group C disc signal change compared with the control group were significant differences（P〈0.05）.Disc degeneration and disc signal changes and the expression of TNF-α,group D than the group F were statistically significant（P〈0.05）.DD patients HIZ disc tissue between local inflammatory response significantly,TNF-α immunohistochemical staining were positive;TNF-α expression of HIZ group were significantly stronger than the non-HIZ group and the control group（P〈0.05）.Conclusion：Disc signal and age,TNF-α expression and VAS scores negatively correlated significantly when the back pain increase with time HIZ disc signal decreased significantly.IDD patients with positive expression of TNF-α significantly HIZ,and HIZ can be used as a specific image of the IDD.