突出髓核中微血管生成的关键因素及其对疼痛与功能的影响

Key factors of microangiogenesis within herniated nucleus pulposus and effect on pain and functions

中文关键词:  腰椎间盘突出症  微血管  巨噬细胞  椎间盘退行性改变  髓核  椎间盘血管化

英文关键词:Lumbar disc herniation  Microvascular  Macrophage  Intervertebral disc degeneration  Nucleus pulposus  Intervertebral disc vascularisation

中文摘要:

  【摘要】 目的：探究腰椎间盘突出症（lumbar disc herniation，LDH）患者髓核中微血管生成的关键因素及其对疼痛与功能的影响。方法：回顾性分析2023年8月~2024年8月于新疆医科大学附属中医医院因腰椎间盘突出症接受手术治疗的181例患者临床资料，术中收集髓核组织。收集患者性别、年龄、突出节段等一般资料。入院时记录患者腰背部疼痛视觉模拟量表（visual analogue scale，VAS）评分、下肢VAS评分和Oswestry功能障碍指数（Oswestry disability index，ODI）及病程；在腰椎X线片、MRI上收集手术节段改良Pfirrmann椎间盘退变（intervertebral disc degeneration，ＩＤＤ）分级、Modic改变、纤维环完整性、突出部位、突出类型、椎间盘高度（intervertebral disc height，IDH）、突出髓核横截面积、突出率、突出髓核相对信号强度（signal intensity，SI）及其信号强度比（signal intensity rate，SIR）。通过苏木精-伊红（hematoxylin-eosin，HE）染色和免疫组织化学（immunohistochemical，IHC）染色观察两组CD34、CD68、CD163表达的差异。根据髓核内病理性微血管生成的重要标志CD34的IHC检测结果分为CD34（+）组与CD34（-）组。比较两组间患者的基线资料及临床症状、病程、影像学差异，并分析微血管生成与巨噬细胞浸润的关联性。结果：CD34（+）组99例，CD34（-）组82例。两组性别、年龄、突出节段等基线资料之间无统计学差异（P＞0.05）。CD34（+）组的腰背部VAS评分、下肢VAS评分以及ODI显著高于CD34（-）组（P＜0.05）。CD34（+）组的病程更长。影像学对比，CD34（+）组在退变程度、纤维环破裂率、突出类型等方面较CD34（-）组更显著（P＜0.05）；CD34（+）组的IDH、突出髓核相对SI及其SIR显著性低于CD34（-）组（P＜0.05），突出髓核面积、突出率显著性高于CD34（-）组（P＜0.05）。两组的Modic改变和突出部位无统计学差异（P＞0.05）。组织学检测发现CD34（+）组中巨噬细浸润率达93.94%，其与微血管增殖之间存在显著相关性（P＜0.05），Lambda系数=0.89，两者之间存在强相关性。结论：突出髓核中常出现微血管生成，其与疼痛的产生或加重具有显著相关性。病程长、IDD程度重、纤维环破裂、脱出或游离型LDH、IDH降低、突出髓核面积和突出率增加、SI和SIR的降低均是诱导椎间盘微血管生成的关键因素。

英文摘要:

  【Abstract】 Objectives: To investigate the key factors of microangiogenesis in nucleus pulposus and the impact on pain and function in patients with lumbar disc herniation(LDH). Methods: The clinical data of 181 patients diagnosed with LDH who underwent surgical treatment from August 2023 to August 2024 were retrospectively analyzed. The nucleus pulposus tissues were collected intraoperatively. The general data were collected, including gender, age, and herniated segments. Back pain visual analogue scale(VAS) scores, lower limb pain VAS scores, and Oswestry disability index(ODI) were recorded on admission to evaluate clinical symptoms. Meanwhile, the modifying Pfirrmann′s grading for intervertebral disc degeneration, Modic changes, annular integrity, herniation site and type, intervertebral disc height(IDH), herniated nucleus pulposus cross-sectional area, herniation rate, relative signal intensity(SI) of the herniated nucleus pulposus, and its signal intensity ratio(SIR) at the surgical segment were measured on X-ray films and MRIs. Expressions of CD34, CD68 and CD163 were observed by hematoxylin-eosin(HE) and immunohistochemical(IHC) staining. According to the IHC test result of CD34, an important marker of pathological microangiogenesis in the nucleus pulposus, the patients were divided into CD34(+) and CD34(-) groups. The two groups were compared in baseline data, clinical symptoms, disease duration, as well as imaging indicators for differences, and the correlation between microangiogenesis and macrophage infiltration was analyzed. Results: CD34(+) group consisted of 99 cases, and CD34(-) group consisted of 82 cases. There were no statistical differences in baseline data such as gender, age, and herniated segment between the two groups(P>0.05). The CD34(+) group showed significantly higher lumbar pain VAS scores, lower limb pain VAS scores, and ODI than the CD34(-) group(P<0.05). The CD34(+) group exhibited a longer disease duration. In terms of imaging, the CD34(+) group was more significant in the degree of degeneration, fibrous ring rupture rate, and type of herniation(P<0.05). However, the IDH, the relative SI of the herniated nucleus pulposus, and its SIR were significantly lower in the CD34(+) group than in the CD34(-) group(P<0.05), and the herniated nucleus pulposus area and herniation rate were significantly higher than those in the CD34(-) group(P<0.05). Differences between the two groups in terms of Modic changes and sites of herniation were not significant(P>0.05). Histological examination revealed that within the CD34(+) group, macrophage infiltration rate attained 93.94%, exhibiting a significant correlation with microvascular proliferation(P<0.05), with a strong correlation between the two(Lambda coefficient=0.89). Conclusions: Microvascular angiogenesis is commonly present in herniated nucleus pulposus tissue and it is significantly associated with the occurrence or exacerbation of pain. Long duration of illness, severe IDD, annulus fibrosus rupture, extrusive or sequestrated LDH, reduced IDH, increased herniated nucleus pulposus area and herniation rate, reduced SI and SIR are all key factors inducing microangiogenesis of the intervertebral disc.