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黄韧带肥厚与腰椎管狭窄症关系的研究

阚敏慧1,才素分1,武英蕾2   

  1. 1. 唐山市第二医院
    2. 华北煤炭医学院附属医院
  • 收稿日期:2010-05-24 修回日期:2010-10-16 出版日期:2011-03-15 发布日期:2011-03-15
  • 通讯作者: 阚敏慧

A Basic Study on the Hypertrophy of Lumbar Ligamentum Flavum and Its Relationship to Lumbar Spinal Stenosis

  • Received:2010-05-24 Revised:2010-10-16 Published:2011-03-15 Online:2011-03-15

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摘要： 目的 通过基础研究探讨腰椎黄韧带变性、肥厚的病因及其与腰椎管狭窄症的关系。方法 黄韧带组织取材于两组病例：腰椎管狭窄症患者及腰椎间盘突出症患者。选取切片用于HE染色及免疫组化染色。结果 腰椎管狭窄症组：①胶原纤维增生明显，且排列不规则；②纤维细胞数量减少，而成纤维细胞数量增生明显，成纤维细胞向软骨细胞过渡区域扩大；③出现灶性钙化；④血管数目增多，个别有炎性细胞浸润；两组患者黄韧带中白介素-6（IL-6）、转化生长因子-β1（TGF-β1）、肿瘤坏死因子-α（TNF-α）阳性表达程度比较，差异均有统计学意义（p<0.01）。结论 TGF-β1、TNF-α、IL-6 3种炎性因子在椎管狭窄症肥厚黄韧带中的表达呈相对一致性，较腰椎间盘突出症均明显增高。黄韧带变性、增殖、肥厚，也是无菌性炎性因子作用的结果。

关键词: 腰椎, 黄韧带, 细胞因子, HE染色, 免疫组织化学

Abstract: Objective To study the etiology of the degenerative and hypertrophied lumbar ligamentum flavum and its relationship to lumbar spinal stenosis Methods Ligamentum flavum specimens were obtained at operation from a total of 25 cases of LSS and 25 cases of lumbar disc herniation.These slices were selected for HE staining and immunohistochemistry staining. With immunohistology stain ,the expression of the three cytokines –TGF-β1 ,TNF-αand IL-6 were observed and compared between LSS and LDH, which was used to research the etiology of HLF. Results HE stain： LSS group: (1) Large fibrotic areas where collagenous tissue increased were almost consistently observed. (2) Fibrocytes were fewer and fibroblasts were more numerous than normal. The fibrocartilaginous zone near the bone insertion underwent enlargement. (3) Areas of calcification were often observed in the ligamentous tissue of stenotic patients, particularly the most elderly ones. (4) Blood vessels had increased in numbers and inflammatory cells were observed occasionally; immunohistochemistry staining：Comparing the degree of positive expression of TGF-β1 ,TNF-αand IL-6 in ligamentum flavum of LSS and LDH group ,the difference was statistically significant（p<0.01）;Conclusion: In the course of degeneration of LF, we observed that anti-inflammatory cytokines and inflammatory cytokines had gradually increased. Sterile inflammatory cytokines also lead to the degeneration, proliferation and hypertrophy of lumbar LF.

Key words: Lumbar vertebrae, cytokine, Ligamentum flavum, HE staining, Immunohistochemistry