摘要目的 探讨腰椎椎间盘突出症和椎间盘源性疼痛的免疫病理学改变及其异同点.方法 收集71例手术切除的椎间盘髓核标本,分为:腰椎椎间盘突出(A组)30例,腰椎间盘脱出或游离(B组)22例,两组均行椎间盘髓核摘除术;腰椎椎间盘源性疼痛(C组)10例,均经椎间盘造影证实并行前路手术切除;腰椎爆裂骨折(D组)9例,行前路手术切除伤椎远侧相对正常的椎间盘髓核.组织形态学观察各组椎间盘髓核细胞的病理变化;应用免疫组化技术检测髓核CD68阳性巨噬细胞和CD45RO阳性T细胞,并行统计学分析.结果 组织形态学观察:D组髓核细胞形态大小一致,分布均匀,未见明显细胞基质退变及炎性细胞浸润;其他各组均见髓核细胞空泡样变、形态大小不一、分布不均;A组和B组髓核组织边缘可见大量炎性细胞浸润、局灶性小血管增生,以B组更明显;C组细胞基质退变严重,髓核组织边缘可见散在炎性细胞浸润,未见明显血管增生.免疫组化检测:CD68阳性率,B组(63.6%)＞C组(40.0%)＞A组(26.7%)＞D组(0%),各组间差异有统计学意义(P＜0.05).CD45RO阳性T细胞均出现在CD68阳性巨噬细胞同一部位的连续切片上,阳性率B组(59.1%)＞A组(13.3%),C组和D组为阴性,各组间差异有统计学意义(P＜0.05).结论 腰椎椎间盘突出症髓核边缘有明显的炎症和自身免疫反应;椎间盘源性疼痛髓核边缘有散在炎性细胞和较多巨噬细胞,但小血管增生和T淋巴细胞浸润不明显,提示有炎性反应,但自身免疫反应不如椎间盘突出症明显.

abstractsObjective To evaluate and compare the immunopathological changes of lumbar disc herniation and discogenic pain. Methods Seventy-one lumbar disc nucleuses were collected intra-operation,and they were divided into four groups. Group A: 30 cases of disc herniation, Group B: 22 cases of sequestered disc herniation, and the patients in Group A and B received discectomy; Group C: 10 cases of discogenic pain were confirmed by discography, and the painful disc was excised through anterior retroperitoneal approach; Group D: 9 cases of lumbar bust fracture who received anterior subtotal corpectomy and discectomy, and the nearly normal caudal disc was collected as control. The disc nucleuses were processed in the following methods: 1) HE stain and pathological observation; 2) Immunocytochemical test using monoclonal antibodies to CD68 and CD45RO molecule for macrophage and T lymphocytes, respectively. The positive cells were counted and analyzed with statistic method. Results 1) Pathological observation with HE stain: compare to control group, the degeneration of nucleus cell was evident in the other groups. There were obvious infiltration of inflammatory cells and focal neovascularization in group A and especially in Group B.In Group C, only diffuse inflammatory cells was found without neovascularization, but the degeneration of matrix was more severe. 2) Positive rate of CD68 cells: Group B (63.6%)＞Group C (40.0%)＞Group A (26.7%)＞Group D (0%). There were significant differences among groups (P＜0.05). 3) Positive rate of CD45RO cells:Group B (59.1%)＞Group A (13.3%), Group C and D were negative, and the positive cell were found in slice of the same site of positive CD68 cells. The differences between each group were significant (P＜0.05). Conclusion The nucleus of herniated disc has evident inflammatory and autoimmunity reaction. The nucleus of discogenic pain is infiltrated with diffuse inflammatory cells and some macrophages, without T lymphocyte and neovasularization, so the autoimmunity course is not evident.