椎间盘退变模型的研究进展

椎间盘退变疾病发病率越来越高,但退变的机制尚不明确.椎间盘退变模型是现今研究椎间盘退变疾病的主要方式,退变模型主要分为体内退变模型和体外退变模型两大类.两种退变模型从不同角度研究椎间盘退变的病理生理过程,为揭示退变机制及预防、治疗椎间盘退变疾病起着重要作用.本文就目前国内外关于两种不同椎间盘退变模型研究的进展作一综述.     

兔椎间盘退变与修复模型的研究现状*

椎间盘退变模型是研究椎间盘退变疾病的基础和关键之一。兔退变椎间盘模型具有操作简单、可重复性好等特点被国内外学者广泛应用。兔椎间盘退变模型包括体内模型、体外模型等。体内模型根据损伤类别包括:机械损伤模型、化学损伤模型、异常应力模型、脊柱不稳模型、脊柱融合模型等;体外模型包括椎间盘细胞模型、椎间盘组织模型等。本文根据近年兔腰椎间盘各种退变模型与修复的研究现状与进展作一综述。     

关节突关节失稳致兔椎间盘退变的分子生物学评价

目的探讨新西兰大白兔腰椎关节突关节失稳诱发椎间盘退变(IVDD)的蛋白多糖和Ⅰ、Ⅱ型胶原基因的表达。方法30只新西兰大白兔。随机分为骨性手术组和软组织手术组。软组织手术组仅骨膜下剥离L3~L7的椎旁肌肉;骨性手术组完整切除L4、L5双侧下关节突、L5棘突,保留L5、L6上关节突。骨性手术组L4-5、L5-6椎间盘为实验组椎间盘,上下相邻的L3-4、L6-7为自身对照组椎间盘;软组织手术组L4-5、L5-6椎间盘为实验对照组椎间盘。术后1、2、4及8个月处死实验动物,RT-PCR检测椎间盘中蛋白多糖和Ⅰ、Ⅱ型胶原基因表达,并用磷酸甘油醛脱氢酶(GAPDH)做内参照行半定量。结果随着术后时间的延长,各组蛋白多糖、Ⅱ型胶原表达量逐渐下降,Ⅰ型胶原表达量逐渐上升。相同时间段,蛋白多糖、Ⅱ型胶原实验组最低,实验对照组最高(P<0.01);Ⅰ型胶原实验组最高,实验对照组最低(P<0.01)。结论椎间失稳后可以诱发出IVDD。蛋白多糖、Ⅰ、Ⅱ型胶原基因表达能够较早反映出IVDD。     

Fas配体与椎间盘免疫赦免及退行性变的研究

椎间盘退变是一个复杂的病生理过程,Fas配体被认为是快速传递细胞凋亡的死亡信号。研究者提出椎间盘免疫赦免特性归结于椎间盘在局部所表达的Fas配体,而且Fas配体介导的细胞凋亡可能是椎间盘退变的一个病因。近年有关Fas配体及细胞凋亡在椎间盘免疫赦免及退行性变的发生及发展中所起的作用越来越受到重视。     

低温等离子消融术建立兔椎间盘退变模型的实验研究

目的　探讨低温等离子消融术建立兔椎间盘退变模型的方法与可行性。 方法　新西兰大白兔24只,随机分为实验组12只,对照组12只。两组均穿刺L3/4～L5/6椎间隙,实验组采用消融30s建模,对照组单纯以穿刺针穿刺建模。分别于术前及术后4、8、12周行CR、MRI检查及病理学检查。 结果　实验组DR及MR检查至术后12周均可见退变逐步加重的征象,如椎间隙高度的丢失及T2信号逐步降低。对照组DR及MR检查4周后无明显的退变加重迹象。两组病理学检查均未见早期的髓核缺失,实验组12周可见髓核正常结构消失,椎间盘内结构紊乱。 结论　低温等离子消融术比传统单纯穿刺更易及快速建立椎间盘退变的动物模型,采用此方法建立兔椎间盘退变模型是可靠可行的。     

转染hIGF-1基因增强兔退变椎间盘蛋白多糖的表达

目的 探讨人胰岛素样生长因子(hlGF-1)基因在退变椎间盘中的表达及对椎间盘中蛋白多糖(agglecan)的影响.方法 制备新西兰大白兔腰椎间盘退变(IDD)模型24只,随机分为Ad/CMV.hlGF-1、hlGF.1生长因子及PBS组,每组8只.IA-5、L5-6椎间盘中分别注射第2代Ad/CMV-hlGF-1(8×108PFU)、hlGF-1生长因子(100μg/L)、PBS均25μL.注射后1、2.4和8周,Western blot检测hlGF-1蛋白表达;RT-PCR检测aggrecan mRNA的表达.结果 hlGF-1蛋白带出现在7.6×103ku.Ad/CMV-hlGF-1组hIGF-I蛋白表达持续达4周以上,hIGF-1组表达持续约2周;PBS注射组无hIGF-1蛋白表达.aggrecan电泳条带出现在200～300 bp;在注射后1～4周,Ad/CMV-hlGF-I组内aggrecan mRNA相对表达量进行性增加,8周轻度下降,4个时期总的比较(F=8.51,P<0.05),注射后1～8周,hlGF-1组、PBS组aggrecan mRNA相对表达量进行性下降.结论 hlGF-1能够增强椎间盘aggrecan的表达.     

纤维环损伤诱导兔椎间盘退变模型

目的:探讨纤维环刺伤法诱导腰椎间盘退变建立动物模型的可行性.方法:普通级新西兰大白兔(雄性,体质量约3.5 kg,1岁龄).分为正常对照组及模型组,以腰4～5椎问盘为正常对照组,以每只兔的腰2～3椎间盘为模型组.用16号穿刺针于腰2～3椎间盘纤维环前外侧刺入,分别于术前及术后4、8、16周对模型组及正常对照组椎问盘进行磁共振(MRI)检查,动物处死取材后行组织学及免疫组织化学观察.结果:术后4～16周,模型组椎间盘髓核MRI T<,2>W<,1>信号呈逐渐减弱趋势,组织学观察髓核脊索细胞逐渐减少,免疫组织化学观察到髓核中Ⅰ型胶原表达较正常对照组逐渐增多,而Ⅱ型胶原表达较对照组逐渐减少.结论:本实验可为椎间盘退变的进一步研究提供动物模型.     

颈椎间盘退变的形态学观察和生物力学研究

目的:观察长时间异常应力环境下兔颈椎间盘的组织形态和生物力学性能变化,为防治颈椎病的研究提供实验依据.方法:选取30只家兔,随机分为对照组、模型组,造模家兔颈椎处于低头屈曲45°位异常应力环境下5小时/次·天.动物处死后,光镜和电镜下观察颈椎间盘组织形态学变化;功能节段生物力学性能测试.比较各组间存在的差异.结果:对照组颈椎间盘组织形态及生物力学性能无明显变化;模型组颈椎间盘发生软骨细胞变性、坏死,髓核皱缩,软骨终板钙化、断裂等组织形态学改变;椎间盘压缩、扭转生物力学性能下降,并随着异常应力作用时间的延长而表现更为显著.结论:长时间处于异常应力环境下能使兔颈椎间盘组织形态和生物力学性能均发生明显退行性改变.     

人退变椎间盘组织的基因表达谱

目的：研究人类退变椎间盘的基因表达谱,分析人退变椎间盘基因表达水平的变化。方法：按条件优化的一步法抽提人退变及正常椎间盘组织的总RNA各3例,分别用cy3,cy5荧光标记,获得2组椎间盘cDNA的探针,与含有4096条人类全长基因的cDNA表达谱芯片杂交,扫描芯片荧光信号图像,对所获得的基因进行生物信息学分析。结果：在4096条基因中,有差异表达的基因706条,358条基因表达量明显下降,298条基因表达量明显上升。在有差异表达的基因中,细胞凋亡相关类蛋白8条,其中上皮细胞膜蛋白(EMP-1)基因的表达上调明显。结论：退变椎间盘的基因表达发生变化,细胞凋亡增加可能是椎间盘退变发生和发展的因素之一。     

椎间盘退变模型的研究现状及进展

目的：探讨椎间盘退变模型的研究现状及进展。方法：在Pubmed、中国知网查阅有关椎间盘退变模型研究的文献,进行汇总分析。结果：椎间盘退变模型可以通过体外和体内两种方法构建,前者包括椎间盘细胞模型和椎间盘组织模型,后者包括诱发性椎间盘退变模型和自发性椎间盘退变模型。体外模型适用面较广,但培养要求较高,不能全面模拟体内环境;体内培养干预技术较容易实现,但适用面较窄。结论：人椎间盘退变的影响因素繁多,目前的椎间盘退变模型往往具有一定的局限性,无法全面地模拟出人的椎间盘退变情况。无创、微创构建椎间盘退变模型将是未来的发展趋势。     

腰痹舒干预腰椎间盘退变模型兔髓核组织水通道蛋白1、水通道蛋白3的表达

BACKGROUND: The aging and lesions of the intervertebral disc are closely related to the lack of nutritional blood supply to the disc. Aquaporin plays an important role in the nutritional supply to the intervertebral discs, but the specific mechanism has not been fully defined.     

降钙素治疗延缓卵巢切除大鼠腰椎间盘退变

目的:观察降钙素对卵巢切除大鼠腰椎骨量及椎间盘退变的影响。方法:SD大鼠分为基线对照组、假手术组、卵巢切除组及降钙素治疗组,进行腰椎节段骨密度和骨形态计量学分析,观察椎间盘的组织形态学改变。结果:卵巢切除组骨量较对照组和降钙素治疗组显著下降,骨转化指标明显提高。降钙素治疗组的腰椎间盘组织学评分较卵巢切除组显著下降。结论:卵巢切除大鼠椎间盘退变可能是骨量减少引起的脊柱力学改变所致,降钙素治疗可以预防骨量丢失并延缓其腰椎间盘退变。     

脊柱椎间盘退变与高尿酸血症的相关性

背景:高尿酸血症是常见的代谢性疾病,高尿酸血症患者以尿酸结晶形成导致痛风为主要临床表现。既往研究仅报道了尿酸结晶会导致脊柱椎间盘的退变,但关于高尿酸血症与脊柱椎间盘退变的相关性研究较少。目的:回顾性分析高尿酸血症患者脊柱椎间盘的退变特点以及血尿酸浓度与脊柱椎间盘退变的相关性。方法:回顾性分析2021年1月至2022年12月在西南医科大学附属医院骨科就诊并被诊断为脊柱椎间盘退变的所有患者,纳入97例高尿酸血症患者作为高尿酸血症组,然后根据性别、年龄按照1∶2进行匹配,将194例非高尿酸血症患者作为对照组。收集两组患者的血尿酸检验结果,并在全脊柱MRI图像上对两组患者的椎间盘退变程度进行Pfirrmann评分。比较两组患者椎间盘退变程度的差异,分析血尿酸浓度与椎间盘退变程度的相关性。结果与结论:①高尿酸血症组的椎间盘退变程度Pfirrmann评分大于对照组,且高尿酸血症组的椎间盘退变总数大于对照组,差异均有显著性意义(P<0.05);②Spearman相关分析显示,在高尿酸血症组内的多个节段,男性患者的椎间盘退变程度与血尿酸浓度呈正相关(C_(3/4):r=0.317,C_(4/5):r=0.333,C_(5/6):r=0.309,L_(2/3):r=0.443;P<0.05);女性患者的椎间盘退变程度也与血尿酸浓度呈正相关(C_(3/4):r=0.354,C_(4/5):r=0.388,C_(6/7):r=0.312,T_(7/8):r=0.282,T_(9/10):r=0.305,T_(11/12):r=0.277,L_(4/5):r=0.319,L_(5)-S_(1):r=0.367,P<0.05);③在对照组中,男性和女性患者的椎间盘退变程度与血尿酸浓度无明显相关性(P>0.05);④结果提示:在高尿酸血症患者中,血尿酸浓度越高,椎间盘退变程度越严重。因此,高尿酸血症是导致椎间盘退变的危险因素之一。     

Clarifying the nomenclature of intervertebral disc degeneration and displacement: from bench to bedside

As a significant determinant of low back pain, intervertebral disc degeneration (IDD) has attracted more and more attention of both investigators and physicians. Disc herniation, termed as intervertebral disc displacement, is amongst the most prevalent spinal diseases closely linked with IDD. Due to the same origins and similar pathophysiology, the ambiguity regarding the similarity and difference of IDD and intervertebral disc displacement thus remains. The aim of this study was to clarify the nomenclature of IDD and disc herniation in terms of molecular etiology, pathophysiology, nature history and clinical outcomes. Collectively, IDD is a type of multifaceted, progressive spinal disease with or without clinical symptoms as back pain, characterized by extracellular matrix and the integrity of NP and AF lost, fissures formation. Disc herniation (termed as intervertebral disc displacement) is a type of spinal disease based on IDD or not, with local pain and/or sciatica due to mechanical compression and autoimmune cascades upon the corresponding nerve roots. Clarifying the nomenclature of intervertebral disc degeneration and displacement has important implications both for investigators and for physicians.     

Localization of degradative enzymes and their inhibitors in the degenerate human intervertebral disc

The histological and biochemical changes that occur in the extracellular matrix of the intervertebral disc (IVD) during ageing and degeneration have been investigated extensively. However, the mechanisms behind these changes are not fully understood. A number of studies have suggested the involvement of matrix metalloproteinases (MMPs) and ADAMTS in IVD degeneration, but few have localized the site of production of these enzymes to the cells of the degenerate disc. This study uses immunohistochemical techniques to localize and quantify the production of degrading enzymes (MMPs 1, 3, and 13, and ADAMTS 4) and their inhibitors (TIMPS 1, 2, and 3) within non-degenerate and degenerate discs of varying severity of degeneration. In all discs investigated, the cells that produced the enzymes and their inhibitors were the chondrocyte-like cells of the nucleus pulposus and inner annulus fibrosus (AF), with little immunopositivity in the outer AF. Non-degenerate discs showed low numbers of cells expressing the degradative enzymes MMP 1 and ADAMTS 4, suggesting a role for these enzymes in normal homeostasis. No MMP 3 or MMP 13 immunopositivity was observed in non-degenerate discs. In degenerate discs, the number of cells immunopositive for MMPs 1, 3, 13 and ADAMTS 4 increased with the severity of degeneration. This increase in degrading enzymes was also accompanied by increases in the number of cells immunopositive for TIMPs 1 and 2 but not TIMP 3. This study highlights that although the expression of a number of MMPs increases with degeneration, this is accompanied by an increase in their inhibitors. However, the increase in the number of cells immunoreactive for ADAMTS 4 with increasing degeneration was not paralleled by a rise in its inhibitor TIMP 3. This finding indicates that the aggrecanases, rather then the MMPs, are a possible therapeutic target for the inhibition of disc degeneration.     

兔腰椎间盘退变模型的建立及影像学分析

目的：建立腰椎间盘退变的动物模型并进行CR和MRI观察.方法：选用新西兰兔20只,沿右腹直肌外缘做15 cm长切口,钝性剥离腹膜至腰椎横突前外侧,咬除右侧L5、L6横突,显露上述节段椎间盘,斜形切开纤维环约1.5 mm,未伤及髓核,然后逐层缝合.所有动物在标准条件下饲养,分别于术后2、4、8、20、40周行腰椎计算机x线摄影术（CR）和核磁共振成像（MRI）以检测终板下骨及髓核的变化.结果：术后作为自体对照组的L1、2、L2、3椎间盘未见异常,而手术组L4、5、L5、6椎间盘则相继出现T2加权像低信号、腰椎不稳畸形,终板下骨质硬化,椎体边缘骨赘增生,椎间隙变窄,椎间盘后突和硬膜囊受压等改变.对手术节段及其邻近和完全正常节段椎间盘髓核信号值的定量分析显示,手术组椎间盘T2加权像信号值减低在术后4、8、20、40周与正常对照组对比具有统计学意义,而临近椎间盘L3、4、L6、7手术8周后与正常椎间盘对比有显著差异.CR扫描结果显示：手术节段椎间盘终板下信号值减低与对照组相比4周后就开始有显著差异.结论：应用纤维环切开法可获得可靠的新西兰大白兔椎间盘退变模型,可通过MRI及CR在早期加以证实.     

Piperine mediates LPS induced inflammatory and catabolic effects in rat intervertebral disc

Piperine is an exact of the active phenolic component from Black pepper. It has been reported to have many biological activities including anti-oxidant, anti-inflammatory and anti-tumor effects. Intervertebral disc degeneration (IDD) is a degenerative disease closely relate to inflammation of nucleus pulposus (NP) cells. This study aimed to assess the anti-inflammatory and anti-catabolic effects of piperine in rat intervertebral disc using in vitro and ex vivo analyzes. We demonstrated that piperine could inhibit LPS induced expression and production of inflammatory factors and catabolic proteases in NP cells culture model. It significantly inhibited multiple inflammatory factors and oxidative stress-associated genes (IL-1β, TNF-α, IL-6, iNOS), MMPs (MMP-3, MMP-13), ADAMTS (ADAMTS-4, ADAMTS-5) mRNA expression and NO production in a concentration-dependent manner. Moreover, piperine could reverse the LPS-induced inhibition of gene expression of aggrecan and collagen-II. Histologic and dimethylmethylene blue analysis indicated piperine could also against LPS induced proteoglycan (PG) depletion in a rat intervertebral disc culture model. Western blot results showed that piperine inhibited the LPS-mediated phosphorylation of JNK and activation of NF-κB. Finally, our results demonstrated the ability of piperine to antagonize LPS-mediated inflammation of NP cells and suppression of PG in rat intervertebral disc, suggesting a potential agent for treatment of IDD in future.