椎间盘退变相关危险因素的研究进展

Research progress of associated risk factors in intervertebral disc degeneration

下腰痛是导致全球范围内人群致残的重要原因,发病率极高,给患者家庭和社会均带来了沉重的负担。目前,广泛认为椎间盘退变(intervertebral disc degeneration,IDD)是引起下腰痛的主要原因之一,也是引起椎间盘突出症、椎管狭窄症等椎间盘退行性疾病的病理学基础。然而,导致椎间盘退变的病因复杂多样,其危险因素和具体的作用机制尚不完全明确,其中部分学术观点也一直存在争议。既往严重的椎间盘疾病常采取手术治疗,而早、中期的椎间盘退变尚无确切、有效的治疗手段。深入探究椎间盘退变的分子生物学机制及其危险因素,将对椎间盘退行性疾病的预防、诊断、早期治疗和后期康复均有重要意义。因此,结合近10年的文献报道,从衰老、遗传、机械负荷、低毒力感染、生物节律、烟草吸食、代谢性疾病、雌激素、营养等方面,对椎间盘退变相关危险因素的最新研究进展进行综述。研究结果显示椎间盘退变可受多种危险因素影响,这些危险因素之间相互交织、互相作用,并通过不同的作用机制引起椎间盘细胞数量减少、表型转化、代谢紊乱,引起细胞外基质减少、微环境失衡,最终导致椎间盘组织结构完整性丧失和椎间盘退变。保持良好的生活作息规律、控制体重和血糖水平、获得充足营养、减少烟草吸食、调控激素水平、适度锻炼、避免外伤以及严格医疗无菌操作,均将有益于改善椎间盘的退变进程。

Low back pain is an important cause of disability worldwide.It has a high incidence rate and brings a huge burden to families and society.Intervertebral disc degeneration(IDD)is one of the leading factors causing low back pain and the pathological basis of degenerative disc diseases,such as intervertebral disc herniation and spinal stenosis.However,the etiology of IDD is complex,and the risk factors and specific mechanisms behind remain unclear.Some controversial views have also been observed.Surgery is often considered for patients with severe intervertebral disc diseases,but there is no effective treatment for IDD at the early and middle stages.It will be of great significance to in-depth explore the molecular biological mechanisms and related risk factors,which can bring benefits to the prevention,accurate diagnosis,early treatment,and rehabilitation of degenerative disc diseases.Refer to the literatures published in the past ten years,this paper describes the latest research progress on risk factors related to IDD in terms of aging,genetics,mechanical loading,low-grade infection,biological rhythms,smoking,metabolic disease,estrogen,and nutrition.The results show that IDD is affected by multiple risk factors.These factors can interact with each other,and lead to death,phenotypic transformation,and metabolic disorder of disc cells,leading to a reduction of extracellular matrix and an unbalanced microenvironment and eventually loss of structural integrity of intervertebral disc tissue and IDD.A good body clock,a controlled weight,an appropriate blood glucose level,adequate nutrition,no smoking,a good hormone level,moderate exercise,avoiding injury,and strict aseptic techniques in the clinic will bring benefits to the progress of IDD.