Modic Ⅱ型改变软骨终板中核因子-κB、白介素18和P物质的表达及意义

Protein expression levels and the significances of nuclear factor-kappa B, interleukin-18 and substance P in degenerative endplates with type Ⅱ Modic changes

中文关键词:  Modic Ⅱ型改变  腰痛  核因子-κB  白介素-18  P物质

英文关键词:Modic Ⅱ changes  Low back pain  Nuclear factor-kappa B  Interleukin-18  Substance P

中文摘要:

  【摘要】 目的：观察核因子-κB（NF-κB）、白介素-18（IL-18）和P物质（SP）在Modic Ⅱ型改变软骨终板中的表达情况，并分析其意义。方法：收集2010年10月~2011年10月因单节段腰间盘退变性疾病行椎体间融合术的患者41例，男18例，女23例，年龄20~70岁，平均47.1±13.7岁。根据手术节段终板有无Modic Ⅱ型改变，将其分为Modic Ⅱ型改变组（A组）和无Modic改变组（B组）。同时收集因腰椎爆裂性骨折行前路手术治疗的5例年轻患者作为对照组（C组），男3例，女2例，年龄20~29岁，平均24.2±3.7岁。对术中取出的软骨终板标本行HE染色观察软骨终板组织形态学变化，免疫组化法检测NF-κB、IL-18和SP表达阳性率及阳性细胞指数。结果：HE染色结果显示，C组软骨终板无明显退变，A组退变程度重于B组。免疫组化结果显示，A、B、C组NF-κB阳性细胞指数分别为55.39±17.74、36.01±14.80、4.42±2.84，IL-18阳性细胞指数分别为45.23±12.95、30.22±12.01、5.22±3.46，SP阳性细胞指数分别为38.29±19.26、25.83±16.52、0.97±1.32。A、B组NF-κB、IL-18和SP阳性细胞指数均明显高于C组（P<0.05），A组明显高于B组（P<0.05），NF-κB与IL-18的表达水平呈高度正相关关系（P<0.05）。结论：Modic Ⅱ型改变软骨终板中NF-κB、IL-18和SP表达的阳性细胞数显著性升高，可能是Modic Ⅱ型改变引起腰痛的原因之一。

英文摘要:

  【Abstract】 Objectives: To investigate the protein expression levels and significances of nuclear factor-kappa B (NF-κB), interleukin(IL)-18 and substance P(SP) in degenerative endplates with type Ⅱ Modic changes (MCs). Methods: Forty-one patients who received single level interbody fusion from October 2010 to October 2011(18 males, 23 females) and with a mean age of 47.13±13.67 years(range, 20-70 years) were included in the study. Patients were divided into 2 groups: group A, type Ⅱ MCs on magnetic resonance imaging(MRI) and group B, without MCs. In addition, 5 patients(3 males, 2 females) with a mean age of 24.20±3.70 years with lumbar vertebral fractures were included as control group (group C). Endplate specimens were stained with hematoxylin and eosin(HE) and observed with light microscopy. Concentrations of NF-κB, IL-18 and SP were detected by immunochemistry. Results: Light microscopy showed no obvious degeneration in group C, and the staining of group B was lighter than that of group A. The positive cell index of NF-κB in group A, B and C was 55.39±17.74, 36.01±14.80 and 4.42±2.84 respectively. That of IL-18 in group A, B and C was 45.23±12.95, 30.22±12.01 and 5.22±3.46 respectively. That of SP in group A, B and C was 38.29±19.26, 25.83±16.52 and 0.97±1.32 respectively. Immunochemistry showed that the positive cell indexes of NF-κB, IL-18 and SP in group A and B were higher than those in group C(P<0.05), and group A was higher than group B(P<0.05). A positive relationship between the levels of NF-κB and IL-18 was noted(P<0.05). Conclusions: The early results of interbody fusion are better than simple discectomy for single segmental LDH when type Ⅱ MCs occur in lumbar endplates, the protein expression levels of NF-κB, IL-18 and SP in cartilage endplates will increase. Elevated levels of NF-κB, IL-18 and SP may be the cause of low back pain in patients with degenerative endplates with type II MCs.