椎体终板软骨细胞凋亡与椎间盘退变的相关性研究

目的 探讨椎体软骨终板内软骨细胞凋亡和椎间盘退变之间的关系.方法 40只成年新西兰白兔,随机平均分为实验组和对照组.实验组采用阻断椎体软骨终板营养途径的方法制作椎间盘退变模型,对照组不做任何处理.术后4周和8周,每组各处死10只动物,切取软骨终板和相应的椎间盘组织.TUNEL法检测终板软骨细胞的凋亡数,免疫组织化学方法检测椎间盘内Ⅱ型胶原阳性细胞数,并对两组数据进行相关性分析.结果 实验组软骨终板内凋亡的软骨细胞在4周、8周时分别为9.9±O.88个/视野和12.4±0.71个/视野,较对照组明显增加,4周、8周组间比较差异有统计学意义(P＜0.05).相关分析显示,术后4周和8周终板软骨细胞凋亡与Ⅱ型胶原表达之间有高度的相关性,相关系数分别为0.86和0.82(均P＜0.05),表明椎体终板软骨细胞凋亡与椎间盘退变之间存在有高度的相关性.结论 阻断椎体软骨终板营养途径可导致椎间盘退变的发生,椎体终板软骨细胞凋亡增加可导致椎问盘内Ⅱ型胶原表达进一步减少.     

围绝经期妇女腰椎体骨密度与腰椎间盘退变程度的相关性分析

目的研究围绝经期妇女中腰椎体骨密度与腰椎间盘退变程度的相关性,探讨骨质疏松对腰椎间盘退变程度的影响。材料和方法收集年龄为45-55岁的围绝经期妇女,进行常规腰椎体CT螺旋扫描及定量CT(QCT)骨密度检查,重组腰椎间盘矢状位及轴位图像,同时使用骨密度测量软件测量腰椎体平均BMD值及平均T值。结果纳入研究对象348例,平均年龄48.6岁,平均SMD值为127.4,平均T值-1.18;腰椎体骨密度与腰椎间盘退变程度有相关性(X2=34.72,r=0.28,P0.05)。腰椎体骨密度与发生退变腰椎间盘个数有相关性(X2=49.15,r=0.35,P0.05)。结论围绝经期妇女腰椎体骨质疏松可以促进腰椎间盘退变的发生。     

骨形态发生蛋白-7对椎间盘细胞Sox9和Ⅱ型胶原基因的调节作用

目的探讨骨形态发生蛋白-7（BMP-7）对椎间盘细胞Sox9和Ⅱ型胶原基因表达的调节作用。方法应用逆转录聚合酶链反应检测不同浓度BMP-7对培养的人椎间盘细胞中软骨特异性基因Sox9和Ⅱ型胶原基因表达的影响。结果在10ng/ml、100ng/ml、1000ng/mlBMP-7作用下,其对椎间盘细胞Sox9和Ⅱ型胶原基因mRNA可起到显著的正向调控作用。结论BMP-7可以按照剂量依赖方式正向调节椎间盘细胞Sox9和Ⅱ型胶原基因的表达。提示BMP-7对退变早期的椎间盘具有一定的修复功能。     

Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

Background  Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.

Methods  From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.

Results  In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001). The vertebral body height on the convex side was greater than the height on the concave side (P=0.016). There was a significant difference between the scoliosis group and the control group (P=0.003), and between T-value and the rate of osteoporosis between the two groups (both P <0.001). Results were verified using multiple linear regression analysis.

Conclusions  Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.

     

L1~4椎间盘ADC值、腰动脉血供与椎间盘退变程度的相关性分析

目的分析可疑腰椎病变患者L1~4椎间盘ADC值、腰动脉血供与相应平面椎间盘退变程度的相关性,评价ADC值对椎间盘退变的可能诊断价值,并探讨椎间盘退变的血供因素。方法可疑腰椎病变患者65例,年龄16~76岁,平均(52.3±28.5)岁;其中下腰痛并坐骨神经痛11例,下腰痛无坐骨神经痛16例,坐骨神经痛无下腰痛33例,跛行5例;病程1~57周,平均(13.4±6.3)周。对所有患者采用椎间盘弥散成像测定L1~4椎间盘ADC值,采用腰动脉MRA进行腰动脉成像,分析椎间盘ADC值、腰动脉血供与相应平面椎间盘退变程度的相关性。结果L1~4平面ADC值与各自平面椎间盘退变分级明显相关(P<0.05),退变程度越大,椎间盘ADC值越小。L1、L2、L3平面腰动脉血供分级与各自平面(L1~2、L2~3、L3~4)椎间盘退变程度分级明显相关(rs=0.823,P=0.016 3;rs=0.791,P=0.019 2;rs=0.835,P=0.010 3);L4平面腰动脉血供分级与L4~5椎间盘退变程度分级无明显相关(rs=0.306,P=0.209 2)。结论MR弥散成像测得的腰椎间盘ADC值能反映L1~4腰椎退变程度;血供...     

Transplantation of gene-modified nucleus pulposus cells reverses rabbit intervertebral disc degeneration

Background  Intervertebral disc degeneration is the main cause of low back pain. The purpose of this study was to explore potential methods for reversing the degeneration of lumbar intervertebral discs by transplantation of gene-modified nucleus pulposus cells into rabbit degenerative lumbar intervertebral discs after transfecting rabbit nucleus pulposus cells with adeno-associated virus 2 (AAV2)-mediated connective tissue growth factor (CTGF) and tissue inhibitor of metalloproteinases 1 (TIMP1) genes in vitro.

Methods  Computer tomography (CT)-guided percutaneous annulus fibrosus injury was performed to build degenerative lumbar intervertebral disc models in 60 New Zealand white rabbits. rAAV2-CTGF-IRES-TIMP1-transfected rabbit nucleus pulposus cells were transplanted into degenerative lumbar intervertebral discs (transplantation group), phosphate-buffered saline (PBS) was injected into degenerative lumbar intervertebral discs (degeneration control group) and normal lumbar intervertebral discs served as a blank control group. After 6, 10 and 14 weeks, the disc height index (DHI) and signal intensity in intervertebral discs were observed by X-ray and magnetic resonance imaging (MRI) analysis. The expression of CTGF and TIMP1 in nucleus pulposus tissue was determined by Western blotting analysis, the synthesis efficiency of proteoglycan was determined by a ³⁵S-sulfate incorporation assay, and the mRNA expression of type II collagen and proteoglycan was detected by RT-PCR.

Results  MRI confirmed that degenerative intervertebral discs appeared two weeks after percutaneous puncture. Transgenic nucleus pulposus cell transplantation could retard the rapid deterioration of the DHI. MRI indicated that degenerative intervertebral discs were relieved in the transplantation group compared with the degeneration control group. The expression of collagen II mRNA and proteoglycan mRNA was significantly higher in the transplantation group and the blank control group compared with the degeneration control group (P <0.05).

Conclusions  CT-guided percutaneous puncture can successfully build rabbit degenerative intervertebral disc models. Both CTGF and TIMP1-transfected cell transplantation helps to maintain disc height, and promotes the biosynthesis of type II collagen and proteoglycan in intervertebral discs, reversing the degeneration of intervertebral discs.

     

骨质疏松性椎体骨折患者血清破骨细胞生成抑制因子和破骨细胞分化因子的表达及意义

目的 探讨骨质疏松性椎体骨折患者血清破骨细胞生成抑制因子(osteoclast suppressor,OCIF)和破骨细胞分化因子(osteoclast differentiation factor,ODF)的表达及意义。 方法 选择衢州市人民医院2013年1月—2016年12月符合标准的骨质疏松性椎体骨折患者70例为骨质疏松组,非骨质疏松性椎体骨折患者70例为对照组。采用双抗体夹心酶联免疫吸附实验(Double antibody sandwich enzyme-linked immunosorbent assay,ELISA)法测定血清OCIF和ODF水平。采用双能X线骨密度仪测量腰椎正位总体L_1-4骨密度及左侧股骨颈骨密度。采用SPSS20.0统计软件对数据进行分析。 结果 骨质疏松组血清OCIF和ODF水平均高于对照组(均P<0.05)。骨质疏松组腰椎正位骨密度和股骨颈骨密度均低于对照组(均P<0.05)。骨质疏松患者血清OCIF、ODF水平与腰椎正位骨密度、股骨颈骨密度均呈负相关(均P<0.05)。骨质疏松患者血清OCIF、ODF水平与骨折程度无显著相关性(均P>0.05)。 结论 骨质疏松性椎体骨折患者血清OCIF、ODF水平升高,血清OCIF、ODF水平与骨质疏松性椎体骨折患者的骨密度关系密切,与骨折的严重程度关系不大。      

大鼠肾虚型颈椎病模型的建立

目的：采用病、证模型复合的方法建立大鼠肾亏型颈椎病动物模型。方法：选择3月龄雌性SPF级SD大鼠30只,随机分为正常组、颈椎病模型组和肾虚型颈椎病模型组,每组10只。采用动静力失衡性大鼠颈椎间盘退变模型复合去卵巢肾虚亏模型的方法建立肾虚型颈椎病模型。通过检测大鼠子宫及附件形态和质量、血清雌二醇（estradiol,E2）含量验证肾虚证;通过颈椎间盘组织病理学、Ⅱ型和Ⅹ型胶原的免疫组化检测及聚集蛋白聚糖（aggrecan-1,Agc1）、Ⅱ型前胶原基因（typeⅡprocolla-gen gene,Col2a1）、基质金属蛋白酶-13（matrix metalloproteinase-13,MMP-13）和基质金属蛋白酶抑制剂-1（tissue inhibitor of metalloproteinases-1,TI MP-1）的基因表达情况评判椎间盘退变。结果：与正常组和颈椎病模型组相比,肾虚型颈椎病模型组动物子宫及附件形态萎缩、质量减轻,血清雌二醇含量降低,颈椎间盘组织病理学退变更加明显,Ⅱ型胶原蛋白表达减少,Ⅹ型胶原表达增高,Agc1和Col2a1基因表达降低,MMP-13基因表达增高。结论：通过病、证模型复合的方式建立了肾虚型颈椎病模型,肾虚可以加重颈椎间盘的退变。     

Pathological changes in the lumbar spine of pigs: gross findings

The lumbar vertebral columns from 60 sows and 30 slaughter weight pigs were examined grossly for pathological changes. Asymmetry of lumbar articular facets and minor periarticular osteophytes were seen in the slaughter weight group. Degeneration of intervertebral discs or vertebral osteophytes were not present. In contrast, 38% of 60 sows had vertebral osteophytes and 40% had degeneration of intervertebral discs. Extensive ankylosing spondylosis was present in two sows. Other vertebral lesions observed in sows include asymmetry and arthrosis of articular facets, fissures and areas of cavitation in the annulus fibrosus and vertebral end plate, and vertebral osteomyelitis and/or vertebral fracture. Extravertebral skeletal lesions, some of which could be related to a clinical history of lameness or posterior paralysis, include sacroiliac arthrosis, pelvic deformity, polyarthritis, femoral osteomyelitis, sacroiliac dislocation and epiphyseolysis involving the femoral head or tuber ischii.     

颈椎软骨终板Ank表达的变化

目的 观察ANK/ANKH(ANK/ANKH)在正常颈椎软骨终板和退变软骨终板中的表达变化,探讨软骨终板中ANK/ANKH的表达与椎间盘退变的相关性.方法 选择2007年11月至2009年2月45例颈椎骨折、脱位及颈椎病患者术中取出的颈椎软骨终板,其中实验组28例,男17例,女11例;对照组17例,男10例,女7例.对照组术前MRI检查软骨终板均为Miller分级0级,术后病理证实椎间盘无明显退变或Thompson椎间盘退变病理分级1级;实验组Miller分级1～3级,Thompson病理分级3～5级.VON KOSSA染色观察标本的钙化情况,免疫组织化学SABC染色法、逆行聚合酶链反应和免疫印迹方法检测ANK的表达.结果 VON KOSSA染色显示实验组可见较多的矿化结节,对照组出现少量或无矿化结节.免疫组织化学染色显示终板软骨细胞有Ankh蛋白表达,主要定位于细胞膜.实验组ankh基因mRNA表达(0.682±0.154)低于对照组(0.805±0.171),差异有统计学意义(P＜0.05).实验组Ankh蛋白表达(0.172±0.030)低于对照组(0.196±0.028),差异有统计学意义(P＜0.05).结论 伴随软骨终板的退变,ANK/ANKH的表达明显降低且与椎间盘的退变程度呈正比,提示调节ANK在终板软骨细胞中的表达有可能会阻止椎间盘的退变.     

原发性骨质疏松性椎体及股骨颈骨折病人血清基质金属蛋白酶-1与骨转换生化指标的关系

目的探讨原发性骨质疏松性椎体及股骨颈骨折病人血清基质金属蛋白酶-1（MMP-1）与骨转换生化指标血清碱性磷酸酶（ALP）及Ⅰ型胶原氨基末端肽（NTX）的关系。方法用酶联免疫吸附试验（ELISA）测定34名骨质疏松椎体及股骨颈骨折病人的血清MMP-1、血清ALP和血清Ⅰ型胶原氨基末端肽（sNTX）水平。结果原发性骨质疏松性椎体及股骨颈骨折患者血清MMP-1与ALP及NTX无相关性;患者血清NTX水平较年龄匹配的骨质疏松组增高（P〈0.0 5）,血清MMP-1水平高于年龄匹配的正常对照组及骨质疏松组（P〈0.05）。结论血清NTX水平增高可能为骨折的危险因素。原发性骨质疏松性椎体及股骨颈骨折患者血清MMP-1水平升高,可能为高骨代谢转换过程中的一种生化表现。     

腰椎间盘组织中MMP-7的表达及意义

目的 检测突出间盘组及对照组腰椎间盘中基质金属蛋白酶-7(MMP-7)的表达情况，探讨MMP-7在腰椎间盘退变突出中的作用。方法 应用免疫组化链霉素亲生物素-过氧化物酶法(S-P)对实验组32例腰椎间盘突出标本及对照组11例非突出间盘标本分别进行抗MMP-7蛋白单克隆抗体染色。实验组按术中病理分型分为突出、脱出、游离型。显微图象分析系统采集灰度值，数据进行统计学分析。结果 实验组MMP-7蛋白表达高于对照组，实验组中游离型及脱出型的MMP-7蛋白表达均比突出型高，游离型和脱出型之间MMP-7蛋白表达无差异。结论 腰间盘组织中MMP-7蛋白表达情况与腰椎间盘退变突出有关，MMP-7蛋白表达增加可能是导致腰间盘退变突出的原因之-。     

Combined expression of CTGF and tissue inhibitor of metalloprotease-1 promotes synthesis of proteoglycan and collagen type II in rhesus monkey lumbar intervertebral disc cells in vitro

Background Low back pain has emerged as a widespread disease often caused by intervertebral disc degeneration.This study aimed to establish an in vitro cell culture model of rhesus monkey lumbar intervertebral discs and to investigate the effect of combined connective tissue growth factor （CTGF） and tissue inhibitor of metalloprotease-1（TIMP-1） expression mediated by adeno-associated virus （AAV） on collagen type Ⅱ and proteoglycan levels.The purpose of these investigations was to explore potential methods for relieving the degeneration of lumbar intervertebral disc cells.Methods Rhesus monkey lumbar intervertebral disc nucleus pulposus cells （NPCs） were isolated by enzyme digestion,cultured, and transduced with rAAV2-CTGF-IRES-TIMP-1, rAAV2-CTGF, or rAAV2-TIMP-1 at a multiplicity of infection （MOl） of 106.The expression of collagen type Ⅱ and proteoglycan was measured using RT-PCR and Western blotting.The synthetic rate of proteoglycan was measured using 35S incorporation.Results Rhesus monkey lumbar intervertebral disc NPCs were transduced with rAAV2-CTGF-IRES-TIMP-1,rAAV2-CTGF, and rAAV2-TIMP-1 and the transduced genes were expressed and detected.Compared to the control,CTGF promoted the synthesis of collagen type Ⅱ and proteoglycan.TIMP-1 showed an enhancing effect on the expression of proteoglycan but no effect on collagen type Ⅱ.Expression of both genes in rhesus monkey lumbar intervertebral disc NPCs significantly enhances the synthesis of proteoglycan and collagen type Ⅱ.Conclusions Single gene transduction of CTGF or TIMP-1 can enhanced synthesis of proteoglycan.CTGF expression can also enhance collagen type Ⅱ protein synthesis.Combined transduction of both CTGF and TIMP1 can significantly promote the expression of proteoglycan and collagen type Ⅱ to levels greater than transduction of a single gene alone.Our study provides a good basis for multi-gene therapy to treat lumbar intervertebral disc degeneration.     

椎间盘退变过程中软骨终板AQP3的表达变化

目的 阐明水通道蛋白3(AQP3)在椎间盘退变时表达变化特点及其与椎间盘退变的相关性.方法 建立大鼠椎间盘退变的动物模型,影像学观察模型建立的可靠性,采用RT-PCR的方法检测AQP3 mRNA表达的变化,Western blot进行AQP3蛋白的检测.结果 成功建立了大鼠椎间盘退变模型,AQP3 mRNA和蛋白的表达...     

大鼠椎间盘软骨终板软骨细胞体外自然退变模型的建立

目的：建立大鼠椎间盘软骨终板软骨细胞体外自然退变模型，为椎间盘退变的机制研究提供载体。方法：酶消化及自然传代法分离培养大鼠椎间盘软骨终板软骨细胞，观察其形态学变化。采用MTT法测定第Ⅲ代软骨细胞的生长曲线。采用免疫细胞化学法检测其特征性Ⅱ型胶原的表达情况，对该模型进行鉴定。结果：大鼠椎间盘软骨终板软骨细胞表达特征性Ⅱ型胶原。第Ⅲ代细胞培养在生长第13天后，细胞分裂能力明显下降，核仁不清，细胞变形明显，以梭形为主，折、旋光性弱，细胞间隙变大，轮廓增强，胞浆内可见空泡、脂滴；Ⅱ型胶原合成明显下降，细胞增殖率显著降低；呈现自然退变过程。结论：建立椎间盘软骨终板软骨细胞体外自然退变模型，为椎间盘退变机制研究提供较好的细胞学基础。     

益气化瘀补肾方对退变椎间盘细胞蛋白聚糖和Ⅹ型胶原mRNA表达的影响

目的：观察益气化瘀补肾方血清对脊髓型颈椎病患者退变椎间盘细胞蛋白聚糖和Ⅹ型胶原mRNA表达的影响。方法：取6例确诊为脊髓型颈椎病的住院患者行颈椎减压融合手术摘除的退变椎间盘组织块,采用组织块法培养原代细胞;SD大鼠10只,灌胃制备大鼠益气化瘀补肾方含药血清。取传代第1代的退变椎间盘细胞,分为益气化瘀补肾方含药血清高浓度组（20%）、中浓度组（10%）、低浓度组（5%）及相应体积比浓度氯化钠溶液血清对照组。MTT法检测不同浓度的益气化瘀补肾方血清对椎间盘细胞增殖的影响,实时荧光定量聚合酶链反应检测不同给药时间点各组椎间盘细胞蛋白聚糖和Ⅹ型胶原mRNA的表达。结果：第1代退变椎间盘细胞传代第6天时细胞增殖达到顶峰,8d后开始下降,故选择细胞传代第6天为给药干预时间点。与对照血清比较,不同浓度的益气化瘀补肾方血清可促进退变椎间盘细胞的增殖（P〈0.01）,提高退变椎间盘细胞蛋白聚糖mRNA的表达（P〈0.01）,并下调Ⅹ型胶原mRNA的表达（P〈0.01）,且以中浓度的作用最为明显（P〈0.05）。结论：益气化瘀补肾方通过调节退变椎间盘的胶原及蛋白多糖的表达而产生有效防治脊髓型颈椎病椎间盘退变的作用。     

纤维环穿刺法建立兔椎间盘退变模型

目的:拟建立一个有效的可重复的椎间盘退变模型.方法:取健康成年新西兰大白兔40只,体质量2.5~3.0 kg,雌雄不限,随机分为纤维环穿刺组和对照组,每组20只.经腹膜外入路暴露L4/5、L5/6两个椎间隙,采用21号针头从椎间隙侧前方刺入L4/5、L5/6椎间盘的纤维环,深度控制在5 mm.对照组仅分离暴露椎间盘,不做任何处理.术后1、2、4、6、8周每组随机选取4只兔子行MRI、HE染色及Ⅱ型胶原免疫组化观察退变椎间盘的变化.结果:MRI观察发现,纤维环穿刺组术后椎间盘T2信号强度呈持续减弱趋势,椎间隙高度也不断下降.从术后2周开始两组差异有统计学意义(P<0.05).HE染色观察发现,随着时间进展,纤维环穿刺组髓核细胞逐渐减少,8周时组髓核组织几乎完全变性,被纤维软骨组织替代.Ⅱ型胶原免疫组化染色示,纤维环穿刺组Ⅱ型胶原表达随时间呈进行性下降,从术后第2周开始两组差异有统计学意义(P<0.05).结论:纤维环穿刺法可以诱导兔椎间盘缓慢退变,为深入研究椎间盘退变机制及治疗手段提供可靠的动物模型.     

猴异体椎间盘移植--组织形态学研究

目的：探索治疗椎间盘病变的较好方法。方法选用恒河猴１２只进行腰椎间盘两两配对移植,观察术后不同时期间盘组织形态学变化。结果移植间盘高度术后１－５ｍｏ呈下降趋势,６－１２ｍｏ基本保持稳定,光镜下纤维环和软骨终板形态结构基本完好,有较度退变表现,未见炎症细胞浸润及骨坏死现象,透射电镜观察到移植组间盘髓核退变细胞较正常对照组增多,髓核基质中胶原原纤维数量较对照组增多,结论猴异体移植间盘在受体能够存活,移     

小鼠腰椎间盘退变与OPG基因的关系研究

目的：比较骨保护素（OPG）基因敲除（OPG-／-）小鼠与正常（WT）小鼠腰椎间盘退变的关系。方法：分别取出生后4、8、12W的OPG-／-小鼠及正常对照组小鼠的L4,5椎间盘,运用番红O-固绿染色法观察L。／5椎间盘形态学变化,测量椎间盘及软骨终板高度。应用免疫组化染色观察椎间盘聚集蛋白聚糖（aggrecan）基因表达量的变化。结果：①小鼠腰椎间盘番红。-固绿染色结果：OPG_／-小鼠的椎间盘软骨终板在第8W及第12W时可观察到退化改变,软骨终板排列不规则,并有骨髓腔组织进入软骨终板及外层纤维环。②免疫组化染色结果显示：各年龄点OPG-／-组小鼠椎间盘aggrecan的蛋白表达均低于同龄WT组小鼠。③OPG-／-小鼠软骨终板及椎间盘高度在4周时较对照组无明显变化,随着年龄的增长,第8周时较对照组降低,第12周时高度下降最明显（P〈0．01）。结论：OPG基因缺失后可导致椎间盘退变,椎间盘正常的结构和功能的维持有赖于OPG基因。     

血清miRNA-494和miRNA-125a表达在腰椎间盘退变疾病中的临床应用

［摘要］ 目的 探讨血清miRNA-494和miRNA-125a表达与腰椎间盘退变程度的相关性。 方法 选择腰椎间盘膨出或突出患者45例为退变组,下腰痛患者42例为对照组,所有患者均行腰椎MRI,通过磁共振弥散加权成像技术分析腰椎间盘退变程度与椎间盘Pfirrmann(PM)分级的关系。 结果 对照组共检查126个椎间盘,其中分级在Ⅰ级和Ⅱ级（正常）99个椎间盘,占78.6%（99/126）, Ⅲ级、Ⅳ级和Ⅴ级27个椎间盘,占21.4%（27/126）;退变组共检查135个椎间盘,其中分级在Ⅰ级和Ⅱ级（正常）17个椎间盘,占12.6%（17/135）,Ⅲ级、Ⅳ级和Ⅴ级118个椎间盘,占87.4%（118/135）。2组PM分级构成比差异有统计学意义（P＜0.05）, 退变组表观弥散系数(apparent diffusion coefficient,ADC）值低于对照组（P＜0.05）。退变组血清miRNA-125a较对照组明显降低,血清miRNA-494水平较对照组明显升高（P＜0.05）。退变组miRNA-125a表达水平与ADC值呈正相关（r=0.853,P＜0.01）,miRNA-494表达水平与ADC值呈负相关（r=-0.897,P＜0.01）。血清miRNA-125a和miRNA-494的ROC曲线分析显示miRNA-125a和miRNA-494的曲线下区域面积分别为0.893（95%CI=0.815～0.971,P＜0.01）、0.852（95%CI=0.762～0.932,P＜0.01）,敏感度分别为87.9%和93.7%,特异度分别为77.0%和67.7%,准确度分别为80.0%和77.7%,阳性预测值分别为92.3%和92.1%,阴性预测值分别为81.8%和76.9%。 结论 血清miRNA-494和miRNA-125a的表达可能与椎间盘退变疾病的发病机制有关,检测其表达水平可为椎间盘退变疾病的早期诊断及治疗提供基因依据。