腰椎MRI终板信号改变的影响因素及其动物模型的建立和评估

发布时间：2018-04-29 09:38

  本文选题：腰椎 + Modic改变　； 参考：《天津医科大学》2011年硕士论文

【摘要】：目的：探讨腰椎终板Modic改变患者的分布特点。评估性别、体重、劳动量、吸烟量等影响因素与Modic改变整体发生率以及Modic改变各个分型之间发生率的相关性。探讨Modic改变的发病机制,进一步理解力学因素以及自身免疫反应在Modic改变中的作用。 方法：回顾分析2009年2月～2010年10月间我院因腰痛和／或坐骨神经痛行腰椎MRI检查的患者210例,分析腰椎Modic改变的发生率、类型以及在椎间盘节段、性别、体重、劳动量、吸烟量中的分布特点,并利用逐步回归分析法评估Modic改变与上述因素之间的相关性。 数据用SPSS 16.0版本软件进行处理,组间比较采用χ2检验,相关性使用Binary Logistics回归方程。P0.05为差异具有统计学意义。 结果：210例1050个腰椎间盘中,共有47例患者的58个椎间盘邻近椎板存在Modic改变,占入选患者的22.4%。其中男16人；女31人,Modic改变Ⅰ型、Ⅱ型和Ⅲ型的人数分别为16人、25人、6人,其发生率分别为7.6%、11.9%、2.9%。最常出现Modic改变的节段为L5-S1(28个),其余节段为：L4-5(17个)、L3-4(9个)、L2-3(4个)、L1-2(0个)。其发生率分别为：48.3%、29.3%、15.5%、6.9%、0%。 ①性别方面：男性99人,女性111人。其中出现Modic改变的男性有16人,发生率为16.2%；女性为31人,发生率为27.9%。两者差异有统计学意义(P0.05)。 ②体重方面：正常组有98人,其中17人出现了Modic改变,81人无Modic改变,发生率为17.3%；超重组有80人,14人出现了Modic改变,66人无Modic改变,发生率为17.5%；肥胖组有32人,16人出现Modic改变,16人无Modic改变,发生率为50%。Modic改变在正常组和超重组之间的差异无统计学意义(P0.05),正常组与肥胖组之间的差异具有统计学意义(P0.05),超重组与肥胖组之间的差异具有统计学意义(P0.05),Modic改变在肥胖组中发生率最高。 ③劳动量方面：轻体力劳动组54人,其中8人出现了Modic改变,46人无Modic改变,发生率为14.8%；中等体力劳动组有99人,16人出现了Modic改变,83人无Modic改变,发生率为16.2%；重体力劳动组有57人,23人出现Modic改变,34人无Modic改变,发生率为40.4%。Modic改变在轻体力劳动组与重体力劳动组之间的差异具有统计学意义(P0.05),中等体力劳动组与重体力劳动组之间的差异具有统计学意义(P0.05)。Modic改变在重体力劳动组中发生率最高。 ④吸烟量方面：不吸烟组138人,其中35人出现了Modic改变,103人无Modic改变,发生率为25.4%；轻度嗜烟组有53人,6人出现了Modic改变,47人无Modic改变,发生率为11.3%；重度嗜烟组有19人,6人出现Modic改变,13人无Modic改变,发生率为31.6%。Modic改变在各组间的差异不具有统计学意义(P0.05)。 ⑤劳动量和体重与ModicⅢ型改变密切相关(P0.05),与其他分型无明显相关性(P0.05)。回归方程为Y=-4.288+0.560S+0.606W+0.775L(Y为Modic改变,S为性别,W为体重,L为劳动量),F=32.51,P=0.00,EXP值：L=2.171,W=1.833,S=1.750。 结论：腰腿痛患者中Modic改变以Ⅱ型最多,以L5-S1节段最为常见；女性多于男性,Modic改变在肥胖人群中发生率高于正常体重和超重人群。患者的性别、体重及劳动量等因素与Modic改变的发生具有相关性。力学因素可能在Modic改变中发挥着重要作用。 目的：研究通过终板下椎体穿刺、髓核置入法,建立兔自身免疫反应动物模型的可行性,并通过影像学、组织学和分子生物学等实验来分析Modic改变的发病机制。旨在通过建立动物模型,为相关研究提供实验依据,进一步理解自身免疫反应在Modic改变中的作用。 方法：54只新西兰大白兔随机分为正常对照组、肌肉置入组和髓核置入组,利用腰椎前外侧手术入路暴露的腰4/5、腰5/6椎间盘右前外侧,使用16G骨穿针在腰5/6椎间盘紧邻骺板的椎体处钻孔,深度约3毫米；利用5毫升空针刺入腰4/5椎间盘中,抽取髓核。按照各实验组的要求,分别将髓核、肌肉推入至已钻孔的椎体内,止血、冲洗后缝合各层组织和皮肤。对照组除不置入任何组织外,其操作与其它两组相同。在术后12周、16周和20周行MRI检测后分批处死各组动物,行HE染色、实时荧光定量PCR及Western blot观察其实验部位炎症因子的表达。 结果：实验后的12周、16周和20周,MRI显示髓核置入组T1WI上可见有低信号出现,T2WI上则在低信号的背景下出现了不同程度的混杂高信号,而正常对照组及肌肉置入组均未见明显信号改变。大体观察及HE染色结果也证实了在髓核置入部位会出现组织的异常增殖。Rt-PCR及、Vestern blot则检测到了IL-4、IL-17及IFN-γ在髓核置入组的高表达现象。 结论：终板下椎体穿刺,髓核置入法可以建立Modic改变的动物模型,自身免疫因素很有可能在Modic改变中发挥着重要的作用。
[Abstract]:Objective : To study the distribution characteristics of lumbar vertebral endplate Masked , and to evaluate the relationship between the factors such as sex , body weight , labor intensity , smoking amount , and the incidence of Masks .

Methods : 210 patients with lumbar spine pain and / or sciatica were analyzed retrospectively from February 2009 to October 2010 . The incidence , type and distribution of lumbar intervertebral disc segment , sex , body weight , labor intensity and smoking amount were analyzed .

The data was treated with SPSS 16.0 software , and 蠂2 test was used to examine the correlation between the two groups .

Results : In 210 cases of 1050 lumbar intervertebral discs , there were 47 cases of 58 intervertebral discs adjacent to the vertebral lamina , which accounted for 22.4 % of the patients , including 16 men ;
Among 31 women , there were 16 persons , 25 persons and 6 persons , respectively , and the occurrence rate was 7.6 % , 11.9 % and 2.9 % , respectively . The most frequently occurring segments were L4 - 5 ( 17 ) , L3 - 4 ( 9 ) , L2 - 3 ( 4 ) , L1 - 2 ( 0 ) . The occurrence rates were 48.3 % , 29 . 3 % , 15.5 % , 6.9 % , 0 % , respectively .

( 1 ) Gender : 99 men and 111 women . Among them , there were 16 males and 16.2 % in females .
The incidence rate was 27 . 9 % in 31 women ( P 0 . 05 ) .

( 2 ) Body weight : 98 in the normal group , 17 of them had Masked change , 81 had no Masked change , the incidence was 17.3 % ;
There were 80 people in the supergene group , 14 had Masks change , 66 had no Masked change , the occurrence rate was 17.5 % ;
There were 32 persons in the obese group , 16 had Masked change , 16 had no Masked change , the incidence was 50 % . The difference between the normal group and the obese group was not statistically significant ( P0.05 ) . The difference between the normal group and the obese group was statistically significant ( P0.05 ) .

( 3 ) labor intensity : 54 people in the light manual labor group , 8 of them had Masks changed , 46 had no Masks change , the incidence rate was 14.8 % ;
There were 99 people in the medium - sized labor group , 16 in the middle - manual labor group , 83 in the middle - manual labor group , and the incidence rate was 16.2 % .
There were 57 persons in the heavy manual labour group , 23 had Masked change , 34 had no Masked change , the occurrence rate was 40.4 % . The difference between the group of light manual labour and the heavy labour force group had statistical significance ( P0.05 ) . The difference between the middle and heavy labour groups was statistically significant ( P0.05 ) .

( 4 ) Smoking quantity : 138 persons in the non - smoking group , 35 of them had Masked change , 103 had no Masked change , the incidence rate was 25.4 % ;
There were 53 patients in the mild smoke group and 6 in 6 patients , and 47 had no Masked change , and the incidence was 11.3 % .
There were 19 people in the severe smoke group , 6 in the group of Masks , 13 had no Masked change , the incidence rate was 31.6 % . The difference between the groups was not statistically significant ( P0.05 ) .

The regression equation is Y = - 4.288 + 0.560 S + 0.606W + 0.775 L ( Y is Midea change , S is sex , W is body weight , L is labor ) , F = 32.51 , P = 0.00 , EXP value : L = 2.171 , W = 1.833 , S = 1.750 .

Conclusion : The most common type 鈪，

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