腰椎间盘突出症患者外周血及髓核组织CXCL10/CXCR3和TNF-α及MMP1表达临床意义研究

Clinical significance of expression of CXCL10/CXCR3,TNF-alpha and MMP1in peripheral blood and nucleus pulposus of patients with lumbar disc herniation

目的腰椎间盘突出症(lumbar disc herniation,LDH)是临床中常见骨科疾病,以腰腿疼痛为主要临床表现。本研究探讨外周血及髓核组织中干扰素诱导型蛋白-10(interferon-inducible protein-10,CXCL10)、CXCL10受体(CXCL10receptor,CXCR3)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、基质金属蛋白酶-1(matrix metalloproteinase1,MMP1)对LDH发病和术后复发风险的预测价值。方法选取2014-08-01-2017-8-31山东医专附属医院及沂水中心医院收治的80例行髓核摘除手术LDH患者为病例组,另选取40例行手术治疗的腰椎骨折患者为对照组。对比外周血和髓核组织中CXCL10、CXCR3、TNF-α和MMP1水平,并采用Pearson相关性分析法分析MMP1与CXCL10、CXCR3和TNF-α相关性。对比术后1年复发组与未复发组患者CXCL10、CXCR3、TNF-α和MMP1水平,并采用Logistic回归分析法确定术后复发的危险因素。结果病例组与对照组相比,外周血及髓核组织CXCL10、CXCR3、TNF-α和MMP1水平均较高,均P<0.05;病例组外周血及髓核组织中MMP1与CXCL10、CXCR3、TNF-α均呈显著正相关,均P<0.05;复发组与未复发组相比,外周血及髓核组织CXCL10、CXCR3、TNF-α和MMP1水平均显著较高,均P<0.05;多因素分析结果显示,年龄≥60岁(OR=3.846,95%CI为2.379～5.313,P<0.001)、病程≥4年(OR=2.433,95%CI为1.225～3.640,P<0.001)、术后早期不适当运动(OR=2.547,95%CI为1.354～3.740,P<0.001)、外周血CXCL10≥326.50pg/mL(OR=2.759,95%CI为1.153～4.366,P=0.005)、CXCR3≥283.61pg/mL(OR=2.319,95%CI为1.159～3.478,P=0.003)、TNF-α≥193.00pg/mL(OR=2.509,95%CI为1.260～3.759,P=0.001)、MMP1≥18.20ng/mL(OR=2.849,95%CI为1.567～4.131,P<0.001)、髓核组织CXCL10≥852.40pg/mL(OR=3.476,95%CI为2.654～4.299,P<0.001)、CXCR3≥423.22pg/mL(OR=3.885,95%CI为2.685～5.084,P<0.001)、TNF-α≥17.21pg/mL(OR=2.575,95%CI为1.371～3.834,P<0.001)、MMP1≥276.54ng/mL(OR=2.497,95%CI为1.117～3.877,P<0.001)均是导致LDH患者术后复发的危险因素。结论 LDH患者外周血及髓核组织中CXCL10、CXCR3和TNF-α水平异常较高,与MMP-1正相关,可能导致术后复发。

OBJECTIVE Lumbar disc herniation(LDH)is a common orthopaedic disease in clinic,with lumbar and leg pain as the main clinical manifestation.The study aims to investigate the predictive value of interferon-inducible protein-10(CXCL10),CXCL10 receptor(CXCR3),tumor necrosis factor-α(TNF-α)and matrix metalloproteinase 1(MMP1)in peripheral blood and nucleus pulposus tissues for the attack of LDH.METHODS A total of 80 patients with LDH who underwent surgery for discectomy received from two hospitals from August 2014 to August 2017 were selected as the case group,and 40 patients who underwent surgical of lumbar vertebrae fractures were set as control group,respectively.The levels of CXCL10,CXCR3,TNF-αand MMP1 of peripheral blood and nucleus pulposus tissues were compared,and Pearson correlation analysis was observed between MMP1 and CXCL10,CXCR3 and TNF-αin peripheral blood and nucleus pulposus tissues.The levels of CXCL10,CXCR3,TNF-αand MMP1 in the recurrence group and the non-recurrence group were compared 1 year after operation.Logistic regression analysis was used to determine the risk factors for postoperative recurrence.RESULTS The levels of CXCL10,CXCR3,TNF-αand MMP1 in peripheral blood and nucleus pulposus tissues in case group were significantly higher than those in the control group,all P<0.05.There were significant positive correlations between MMP1 and CXCL10,CXCR3 and TNF-αin the peripheral blood and nucleus pulposus of the case group,all P<0.05.The levels of CXCL10,CXCR3,TNF-αand MMP1 in peripheral blood and nucleus pulposus were significantly higher in the recurrent group than those in the non-recurrent group,all P<0.05.Logistic regression analysis showed that age≥60 years,duration≥4 years,inappropriate postoperative exercise,peripheral blood CXCL10≥326.50 pg/ml,CXCR3≥283.61 pg/ml,TNF-α≥193.00 pg/ml,MMP1≥18.20 ng/ml,nucleus pulposus tissue CXCL10≥852.40 pg/ml,CXCR3≥4 23.22 pg/ml,TNF-α≥17.21 pg/ml,MMP1≥276.54 ng/ml were risk factors for postoperative recurrence in patients with LDH,all P<0.05.CONCLUSION The levels of CXCL10,CXCR3 and TNF-αin peripheral blood and nucleus pulposus of patients with LDH are abnormally high,which is positively correlated with MMP-1,which may lead to postoperative recurrence.