小儿先天性脊柱侧弯椎体骺板生长因子表达的研究

目的采用免疫组织化学方法研究小儿各年龄组先天性脊柱侧弯椎体骺板中4种生长因子转化生长因子β1、β2（TGF-β1,β2）、碱性成纤维细胞生长因子（bFGF）、骨形态发生蛋白-2（BMP-2）]的表达,探讨先天性脊柱侧弯畸形进展的病理生理学变化规律。方法选择21例2～14岁的先天性脊柱侧弯患儿顶椎椎体骺板标本,采用SABC免疫组织化学法结合图像分析仪测定上述因子的表达积分光密度,结果进行统计分析。结果4种生长因子在顶椎椎体骺板的表达凸侧明显大于凹侧,具有显著性差异（P〈0.05）。bFGF和TGF-β1在不同年龄组中的凸侧表达,0～5岁组高于～10岁组及〉10岁组,具有显著性差异,后两组之间无显著性差异（P〉0.05）。TGF-β2、BMP-2在凸侧的表达及4种生长因子在凹侧的表达各年龄组间无显著性差异（P〉0.05）。4种生长因子间存在多元相关关系,且相关系数r均〉0,表明其相互之间成正相关。结论先天性脊柱侧弯顶椎凸侧骺板成骨能力显著大于凹侧,凸、凹侧的不平衡生长成为侧弯畸形发生和进展的关键因素之一。0～5岁低年龄组侧弯畸形的迅速进展主要由脊柱的快速生长引起,青春期及青春前期侧弯突然迅速进展,脊柱生长并不是主要影响因素。

Experimental study on the expression of growth factors in the vertebral growth plate from patients with congenital scoliosis

Objective To observe the expression of four kinds of growth factors including transforming growth factor-β_1, β_2 (TGF - β_1, β_2), basic fibroblast growth factor (bFGF) and bone morphogenetic protein-2 (BMP-2). Methods Twenty-one samples of congenital scoliosis patients were observed. The immunohistochemical methods and image analysis were used to measure the four kinds of growth factors' integral optical density value. The results were analyzed by statistics. Results All four kinds of growth factors in the convex side of apical vertebral epiphysis was significantly higher than the concave side (P ＜ 0.05). The expression of bFGF and TGF-β_1 in the convex side in three different age groups were significantly different (P ＜ 0.05). 0～5years-old group was significantly higher than ～10years-old group and ＞ 10years-old group (P＜ 0.05). There was no significant difference between ～10years-old group and ＞10years-old group(P ＞ 0.05). The expression of TGF-β_2, BMP-2 in the convex side and the expression of four kinds of growth factor in the concave side of each age group were not significantly different (P ＞ 0.05). Multiple correlation analysis showed that four kinds of growth factor were positively correlated. Conclusions The unbalanced growth in epiphyseal plate is the key factor of progress of congenital scoliosis. The rapid progress in 0～5 years old-group is mainly caused by the rapid spinal growth. Pre-adolescent and adolescent's spinal growth is not increased significantly. The rapid progress in this group is not mainly caused by spinal growth.