不同病变类型的腰椎髓核CD68表达及其与临床意义

Expression of CD68 in lumbar nucleus pulposus tissue from different type of lesions and its clinical significance

[目的]观察比较突出型和脱垂游离型腰椎间盘突出症(lumbar disc herniation,LDH)手术摘除的髓核组织CD68表达与相关临床表现。[方法]收集2014年9月~2017年1月在延边大学附属医院脊柱外科住院的55例LDH患者髓核标本,施行手术摘除突出型患者(突出组,30例)和脱垂游离型患者(游离组,25例),全部标本采用HE染色观察及免疫组化方法检测髓核组织中CD68的阳性表达率,观察两种突出类型在组织学上的差异并分析CD68的阳性表达率与术前疼痛程度之间的关系。[结果]HE染色观察下游离型组失去正常的髓核组织结构,可见肉芽组织生成及炎性细胞浸润,而突出型组则无此现象。游离组CD68的阳性表达率显著高于突出组(P<0.05)。游离组术前的VAS评分、ODI评分高于突出组(P<0.05)。髓核组织中CD68的阳性表达率与疼痛程度呈正相关。[结论]与突出型髓核相比,脱垂游离型髓核表现为更明显的肉芽形成和炎细胞浸润,伴有更高的CD68阳性表达率。由于其阳性表达率与术前临床疼痛程度评分呈正相关,CD68有可能与腰椎间盘突出症疼痛的产生有关。

[Objective] To compared CD68 expression in the nucleus pulposus tissue removed surgically and relative clini- cal manifestation between the protrusion-type and sequestration-type lumbar disc herniation. [Method] From September 2014 to January 2017, the nucleus pulposus specimens, harvested surgically from 55 patients who received surgical treatment at the Affiliated Hospital of YaMbian University, were pathologically studied by HE staining and CD68 immunohistochemical staining. In term of lesion type, 30 patients proved protrusion-type lesion （the protrusion group）, while the remaining 25 patients were se- questration-type lesion （the sequestration group） . The positive expression rate of CD68, prominent differences in histology and the relationship between the positive expression rate of CD68 and the degree of preoperative pain were evaluated and compared between the two groups. [Results] Compared with the protrusion group in which normal nucleus pulposus structure could be seen, HE staining showed that no normal nucleus pulposus structure was noted in the sequestration group, replaced with great amount of the granulation tissue formation with inflammatory cell infiltration. The positive expression rate of CD68 in the seques- tration group was statistically higher than the protrusion group （P〈0.05） . In addition, the VAS score and ODI score in the se- questration group before operation were significantly higher than the protrusion group （P〈0.05） . There was a positive correla- tion between the positive expression rate of CD68 in nucleus pulposus and the extent of pain before operation. [Conclusion] Compared with the protrusion-type lesion, the sequestration-type nucleus pulposus present much significantly granulation for- mation with inflammatory infiltration, and higher expression of CD68. Because its expression levels is positively correlated with the extent of pain before operation, the CD68 is probably involved in the painfulness of lumbar disc herniation.