外源性粒-巨噬细胞集落刺激因子在硬脊膜损伤修复中的实验研究

目的探讨外源性粒-巨噬细胞集落刺激因子(GM-CSF)在实验性硬脊膜损伤修复中的应用价值。方法新西兰大白兔27只分为3组,即自体筋膜组(A组)、0.9%氯化钠注射液+脊柱膜组(B组)、GM-CSF+脊柱膜组(C组),每组9只,制造L2-L3硬脊膜损伤脑脊液漏模型,分别于术后1、2、4周处死,取标本,行肉眼大体观察,苏木素-伊红(HE)染色形态学观察和免疫组织化学检测白细胞介素(IL)-1、IL-6在修复组织中的表达。结果肉眼观察发现药物作用组能够起到诱发炎症反应的目的 ,与其他2组比较,局部应用GM-CSF能增强修复部位外周肉芽组织的生长,起到物理加压效果,加快创面愈合;组织学观察A组与B组未见明显差异(P>0.05),C组硬脊膜修复时间明显缩短(P<0.05),1周时已达到修复目的 ;免疫组织化学结果显示修复过程中处理因素间存在差异,其中以药物作用效应为主;作用时间之间未见明显差异。结论外源性GM-CSF在硬脊膜损伤修复过程中通过趋化增殖修复部位细胞成分、增加细胞因子表达实现促进硬脊膜修复的作用。

The value of exogenous GM-CSF in repair of dural mater injury: an experimental study

Objective To explore the value of exogenous granulocyte-macrophage colony stimulating factor （GM-CSF） in repair of dural mater injury. Methods Twenty-seven New Zealand white rabbits were randomly divided into three groups including autologous fascia group （A group）, saline＋ spinal membrane group （B group）, GM-CSF ＋ spinal membrane group （C group） （n=9 each） for establishment of L2-L3 cerebrospinal leak models of dural mater injury. The rabbits were then sacrificed for collection of samples at 1 week, 2 week and 4 week after surgery. The general macroscopic observation and HE staining morphologic observation were performed, and immunohistochemistry was used to detect the expressions of IL-1 and IL-6 in tissue repair. Results Macroscopic observation found that drug effection group could induce the irdlammation. In drug effection group, the local application of GM-CSF could enhance the growth of peripheral granulation tissues in repair region as compared with other two groups, which could lead to the physical pressure effects and fasten the wound healing. Histology observation showed no obvious difference be- tween A and B groups （P〉0.05） and significantly shorter repair time of spinal dura mater in C group （P〈0.05） within 1 week. Immunohistochemistry staining results demonstrated the differences between the treatment factors, especially the drug effects. Nevertheless, there was no significant diffcrence between different effection time spots. Conclution Exogenous GM-CSF could achieve the promotion of repair of spinal dura mater by chemotaxis and proliferation of cells in repair region, and increase the expressions of cell factors.