腰椎间盘突出髓核的自身免疫性

背景：引起椎间盘源性腰腿痛的发病机制很多,在椎间盘退变的发生和发展过程中血管内皮生长因子与T,B淋巴细胞的表达与突出类型、病程等是否具有相关性还未完全清楚。目的：观察不同类型腰椎间盘突出症患者腰椎间盘组织中T,B淋巴细胞及血管内皮生长因子的表达变化,分析其与患者症状、体征的相关性。方法：选取腰椎间盘突出症患者的腰椎间盘标本作为实验组,包括游离脱出型、突出型及膨出型;以腰椎骨折患者的正常椎间盘作为对照。采用苏木精-伊红染色法观察椎间盘标本中血管形成及周边淋巴细胞聚集情况,免疫组化法检测CD4,CD8,IgG,IgM及血管内皮生长因子的分布。结果与结论：①在突出髓核组织中有大量新生血管形成并可见血管内皮细胞,在其周围可见明显的淋巴细胞聚集。②实验组均有活化的CD4,CD8阳性T细胞、IgG,IgM阳性B细胞和血管内皮生长因子表达,其中脱出游离组和突出组的阳性细胞率高于膨出组（P〈0.05）,而对照组均无阳性表达。提示髓核组织暴露于自身免疫系统中可以激活T、B细胞,引起自身免疫反应,血管内皮生长因子参与了退变椎间盘新生血管的形成,并可能与T,B细胞引起的自身免疫反应对椎间盘突出腰腿痛机制有协同作用。

Autoimmune properties of nucleus pulposus in the patients with lumbar disc herniation

BACKGROUND：Much pathogenesis can cause discogenic low back pain.During the occurrence and development of disc degeneration,the correlation between the expression of vascular endothelial growth factor,T lymphocytes and B lymphocytes and the highlight type and duration is not yet fully clear.OBJECTIVE：To investigate the expression of T lymphocytes,B lymphocytes and vascular endothelial growth factor in the lumbar disc tissue of the patients with different types of lumbar disc herniation,and to analyze the association between their expression and clinical symptoms and signs.METHODS：The lumbar disc specimens were selected from the patients with lumbar disc herniation as the experimental group,it included extrusion group,herniation group and bulge group;the normal lumber discs of the patients with vertebral body fracture were collected as control group.Angiopoiesis and gathering of peripheral lymphocytes of the lumbar disc specimens were observed by hematoxylin-eosin staining.Immunohistochemistry method was used to detect the distribution of CD4,CD8,IgG,IgM and vascular endothelial growth factor.RESULTS AND CONCLUSION：①Plenty of vascular endothelial cells and neovascularization can be observed in the degenerative nucleus pulpous.Lymphocyte aggregation was found around them.②Expression of activated T cells CD4＋ and CD8＋,as well as the IgG and IgM positive B cells and vascular endothelial growth factor were observed by immunohistochemistry staining.The expression level in extrusion group and bulge group was obviously higher than that in herniation group（P 0.05）.Otherwise,there was no positive expression in the control group.Nucleus pulpous can activate T and B cells and cause immune reaction when exposed to autoimmunity system.Vascular endothelial growth factor plays a key role in the neovascularization of degenerative lumbar disc.At the same time,it has synergistic effect on the discogenic low back pain with the autoimmunity reaction caused by T and B cells.