中国组织工程研究

中国组织工程研究

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外周血T淋巴细胞与腰椎间盘突出类型及直腿抬高试验的相关性　　

田  鹏1，马信龙1，2，王  涛1，马剑雄1   

  1. 1天津医科大学总医院骨科，天津市   300052；2天津市天津医院，天津市   300211
  • 出版日期:2010-01-08 发布日期:2010-01-08
  • 通讯作者: 马信龙，教授，硕士生导师，天津医科大学总医院骨科，天津市 300052 maxinlong8686@sina.com
  • 作者简介:田 鹏★，男，1982年生，山东省日照市人，汉族，天津医科大学在读硕士，主要从事脊柱外科研究。 18269109@163.com
  • 基金资助:

    天津医科大学科学基金项目(2008ky22)；天津市应用基础及前沿研究计划(09JCZDJC19600)。

Correlation of peripheral blood T lymphocytes with the type of lumbar disc herniation and straight leg raising test

Tian Peng1, Ma Xin-long 1, 2, Wang Tao1, Ma Jian-xiong1   

  1. 1 Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin   300052, China; 2 Tianjin Hospital, Tianjin   300211, China
  • Online:2010-01-08 Published:2010-01-08
  • Contact: Ma Xin-long, Professor, Master’s supervisor, Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin 300052, China; Tianjin Hospital, Tianjin 300211, China maxinlong8686@sina.com
  • About author:Tian Peng★, Studying for master’s degree, Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin 300052, China 18269109@163.com
  • Supported by:

    the Science Foundation Program of Tianjin Medical University, No. 2008ky22*; the Applied Basic and Advance Research Plan of Tianjin, No. 09JCZDJC19600*

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摘要：

目的：观察腰椎间盘突出症患者外周血T淋巴细胞变化水平，探讨患者外周血T淋巴细胞水平变化与其突出类型、体征的关系。
方法：收集2008-01/10在天津医科大学总医院需外科治疗的49例单阶段腰椎间盘突出症患者外周血，男 26例，女23例。发病部位：L4~5 22例，L5S1 27例。治疗前直腿抬高试验阳性34例，阴性15例。根据术中所见腰椎间盘位置分为破碎疝出组30例和退变突出组19例。以同期健康献血者20名为对照组。采用流式细胞仪检测外周血T淋巴细胞分类。
结果：破碎疝出组CD3+ 、CD4+ 、CD4+ /CD8+水平较对照组高(P < 0.05)，CD8+低于对照组(P < 0.05)；直腿抬高试验阳性组CD4+ 、CD4+ /CD8+水平较阴性组高，阳性组CD8+水平较阴性组低，差异有显著性意义(P < 0.05)。破碎疝出组直腿抬高试验试验阳性率高于退变突出组直腿抬高试验阳性率。
结论：腰椎间盘疝出后出现外周血T淋巴细胞免疫变化，且其不同病理类型也存在差异，T细胞介导免疫反应在患者体征发生、发展中起重要的作用。直腿抬高试验可能有助于证实突出间盘对神经根的损伤及治疗方式的选择。

关键词: 椎间盘移位, 分型, T淋巴细胞亚群, 直腿抬高试验

Abstract:

OBJECTIVE: To observe peripheral T lymphocytes changes of patients with lumbar disc herniation, and investigate the relationship between the type of herniation, signs and T lymphocyte subsets.
METHODS: Blood samples from 49 patients with single-level lumbar intervertebral disc herniation were collected from General Hospital of Tianjin Medical University from January to October 2008, including 26 males and 23 females. There were 22 cases of L4-5 and 27 cases of L5S1. In the straight leg raising (SLR) test before treatment, 34 cases were positive and 15 were negative. According to the position of intervertebral disc observed in operation, the patients were divided into ruptured disc herniation (RDH, n=30) and degenerative disc herniation (DDH, n=19) groups. In addition, blood samples from 20 healthy blood donors were collected as control group. T lymphocytes subsets were detected by flow cytometry.
RESULTS: The levels of CD3+ , CD4+ , and CD4+ /CD8+ in RDH group were significantly higher than control group (P < 0.05), and the levels of CD8+ in RDH group were significantly lower than control group (P < 0.05). The levels of CD4+ and CD4+ /CD8+ in positive SLR test group were significantly higher than patients with negative results, but significantly lower levels of CD8+ was found in positive group than negative group (P < 0.05). The positive rate of SLR test in RDH group was significantly higher than that of SLR testing in DDH group.
CONCLUSION: Changes of T lymphocyte subsets in peripheral blood were found after herniation of lumbar intervertebral disc. T lymphocytes mediated immune response may play an important role in the occurrence and development of signs in patients with herniated lumbar intervertebral disc. The SLR test may help to confirm that the disc herniation may cause nerve root impairment by mechanical loading or inflammatory stimulus.

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