人胎盘脂多糖、地塞米松对椎间盘组织自发性吸收作用的研究

目的　探讨应用人胎盘脂多糖及地塞米松增强或抑制炎症反应后对bFGF、VEGF表达和突出腰椎间盘组织自发性吸收的影响。方法　将 2 4只健康新西兰大白兔制作成游离型椎间盘突出模型 ,随机分为 3组。人胎盘多糖组于术后第 2d开始腹腔内注射人胎盘脂多糖 2ml,每 1次 /4d ,共 3次。地塞米松组于术后第 2d开始按每日 1mg/kg标准静脉注射地塞米松共 14d。对照组按每日 3ml/kg标准静脉注射生理盐水共 14d。术后 12周将动物麻醉后 ,取出埋植的椎间盘称重。然后作组织学、免疫组化检查 ,分析其差异。结果　⑴地塞米松组植入的椎间盘的重量较植入前有所减轻 ,但差异无显著性 (P >0 0 5 ) ;对照组植入的椎间盘的重量减轻较明显 ,差异有显著性 (P <0 0 5 ) ;人胎盘脂多糖组植入的椎间盘的重量明显减轻 ,差异有非常显著性 (P <0 0 1)。脂多糖组植入的椎间盘的重量的减轻量明显高于对照组 ,差异有显著性 (P <0 0 1)。而在对照组植入的椎间盘的重量的减轻量又明显高于地塞米松组 ,差异有显著性 (P <0 0 5 )。⑵VEGF蛋白bFGF蛋白、CD68蛋白及MVD在对照组中的表达高于地塞米松组 ,低于人胎盘脂多糖组 ,均有显著性差异 (P <0 0 5 )。结论　自体椎间盘组织进入硬膜外腔后可以逐渐被新生血管和巨噬细胞浸润 ,然后溶解、

The Effect of Human Placenta Lipopolysaccharide and Dexamethasone on Spontaneous Resorption of Herniated Intervertebral Disc

Objective To explore the effect of human placenta lipopolysaccharide (LPS) and dexamethasone (DXM) on spontaneous resorption of herniated intervertebral disc. Methods The animal model of intervertebral disc herniation was set up by placing the harvested disc into the epidural space at L4 or L5 of the same rahbit. Then the 24 rabbits were randomly divided into three groups. In human placenta LPS group, rabbits were intraperitoneally injected 2ml of human placenta LPS at the second, 6th and 10th days after surgery. In DXM group, rahbits were intravenously injected 1mg/kg of DXM at the second to 15th days after surgery. In control group, rubbits were intravenously injected 3ml/kg of normal saline at the second to 15th days after surgery. All rahbits were killed, and herniated intervertebral disc was removed for histological and immunohisto- chemical examination at the 12th weeks after surgery. Results A great amount of newly formed vessles and inflammation cells were founded in the disc tissues in the LPS group. In the control group, a lot of granular tissues were founded in the disc tissues. In the DXM group, small amount of granular tissues were founded in the disc tissues. The expression levels of bFGF, CD68 and VEGF in the LPS group were significantly higher than those in the control group (P<0.05). The expression levels of bFGF, CD68 and VEGF were significantly higher in the control group than those in the DXM group (P<0.05). There was significant difference in MVD between the control group and DXM group(P<0.05), and between the LPS group and control group. Conclusion Autologous intervertebral disc grafted into the epidural space was penetrated by newly formed vessels and macrophages, and resolved as the result of inflammatory reaction. Human placenta LPS could accelerate the spontaneous resorption of herniated intervertebral disc by upregulating VEGF, bFGF expression and angiogenesis, whereas DXM could inhibit the resportion of herniated intervertebral disc by downregulating the expression of VEGF and bFGF.