颈椎间盘MRI退变分级中软骨终板的病理学比较研究

发布时间：2018-08-17 16:11

【摘要】：目的:比较颈椎间盘退变MRI不同分级中软骨终板的病理学改变。方法:通过椎间盘MRI的Pfirrmann分级方法确定人颈椎间盘的退变程度,选取宁夏医科大学总医院脊柱骨科2016年6月至2016年12月因颈椎退行性疾病行手术治疗的患者软骨终板40例,按照椎间盘不同退变程度进行分组,A组为I级,B组为II级,C组为III级,D组为IV级,E组为V级,每组包含8个病例。所有病例术前均常规行X线、CT重建及核磁共振影像学检查,手术方式均为颈椎前路椎间盘切除,植骨融合内固定术(ACDF术)。术后对各组颈椎软骨终板行HE染色、甲苯胺蓝染色,观察各组软骨终板细胞形态变化。用免疫组织化学法检测Caspase-3和X型胶原在软骨终板细胞中的表达情况,并对结果进行统计学分析。结果:1.HE染色可见A组软骨终板中软骨细胞的形态类似球形,细胞外基质红染、匀称,细胞数目较多,软骨陷窝也较多;B组软骨终板中软骨细胞的数目减少,软骨陷窝减少,细胞周围的纤维组织排列杂乱;C组软骨终板中软骨细胞皱缩,软骨陷窝明显减少,部分细胞间质淡染,基质呈纤维化;D组软骨终板中软骨陷窝结构模糊,胞浆内可以看到大量空泡,伴随胞核的消失,软骨细胞附近的结缔组织能够看到玻璃样变性;E组软骨终板中软骨细胞的数目最少,软骨陷窝结构难以分辨,基质中可见裂隙,附近结缔组织玻璃样变性也更为严重。2.甲苯胺蓝染色可见A组中,软骨终板的染色是呈深蓝紫色的,且厚度较厚,软骨细胞的数目较多,细胞外基质也较为丰富。B—E组中,软骨终板的染色依次变淡,且厚度逐渐变薄,软骨细胞的数量及胞外基质也逐渐变少,B组软骨细胞密度相对最高,其基质蓝染着色相对最深,C、D组次之,E组软骨细胞密度最低,基质着色也最浅。3.Caspase-3免疫组化,在各组软骨终板中均发现有caspase-3表达,且表达于细胞质中。随着颈椎间盘MRI退变分级的升高,caspase-3在软骨终板细胞中表达时着色程度越来越深,且阳性细胞数也逐渐递增,A组阳性细胞率16.34±2.62%,B组阳性细胞率40.27±3.26%,C组阳性细胞率47.13±5.69%,D组阳性细胞率68.27±4.58%,E组阳性细胞率74.82±3.53%,各组间比较存在统计学差异(P㩳0.05)。4.X型胶原免疫组化,在A组软骨终板中发现无明显阳性着色;而在B—E组软骨终板中均发现有X型胶原表达,且表达于细胞质中及肥大软骨细胞周围,随着颈椎间盘MRI退变分级的升高,X型胶原在软骨终板细胞中表达时着色程度越来越深,且阳性细胞数也逐渐递增。A组阳性细胞率2.18±0.9%,B组阳性细胞率14.04±1.24%,C组阳性细胞率22.12±2.54%,D组阳性细胞率31.73±3.34%,E组阳性细胞率41.43±2.38%,各组间比较存在统计学差异(P㩳0.05)。结论:1.颈椎间盘退变MRI不同分级中软骨终板的病理学改变存在差异;2.Caspase-3及X型胶原在软骨终板细胞中表达与椎间盘MRI退变分级呈正相关;3.椎间盘退变的Pfirrmann分级,与软骨终板退变是一致的,可以反应出软骨终板在细胞水平的退变程度。
[Abstract]:Objective: To compare the pathological changes of cartilage endplates in different grades of cervical disc degeneration MRI. Methods: The degeneration degree of human cervical disc was determined by PFIRMANN grading method, and 40 cases of cartilage endplates were selected from the Department of Spinal Orthopedics, General Hospital of Ningxia Medical University from June 2016 to December 2016. Patients were divided into three groups according to the degree of intervertebral disc degeneration: group A was grade I, group B was grade II, group C was grade III, group D was grade IV, and group E was grade V. Each group contained eight cases. HE staining and toluidine blue staining were used to observe the morphological changes of the cartilage endplate cells in each group. The expression of Caspase-3 and collagen X in the cartilage endplate cells was detected by immunohistochemical method, and the results were statistically analyzed. Results: 1. HE staining showed that the morphology of chondrocytes in group A was similar to that of globules. In group B, the number of chondrocytes in the cartilage endplate decreased, the cartilage lacunae decreased, and the fibrous tissue around the cells arranged disorderly; in group C, the chondrocytes in the cartilage endplate shrank, the cartilage lacunae decreased significantly, some of the cells interstitial lightly stained, and the matrix showed fibrosis. In group E, the number of chondrocytes in the cartilage endplate was the least, the structure of cartilage lacunae was difficult to distinguish, the matrix was visible fissures, and the adjacent connective tissue was more serious. 2. Toluidine blue staining showed that the cartilage endplate of group A was dark blue-purple, and the thickness was thicker, the number of chondrocytes was more, and the extracellular matrix was more abundant. In group B-E, the staining of cartilage endplate was gradually lighter, and the thickness was gradually thinner, the number of chondrocytes and extracellular matrix were gradually reduced, and the density of chondrocytes in group B was gradually reduced. Caspase-3 immunohistochemistry showed that caspase-3 was expressed in all groups of cartilage endplates and expressed in cytoplasm. With the increase of degeneration grade of cervical intervertebral disc MRI, caspase-3 was expressed in cartilage endplate cells. The positive cell rate in group A was 16.34 (+ 2.62%), in group B was 40.27 (+ 3.26%), in group C was 47.13 (+ 5.69%), in group D was 68.27 (+ 4.58%) and in group E was 74.82 (+ 3.53%). There was statistical difference between groups (P No obvious positive staining was found in the endplate, but the expression of collagen X was found in the cytoplasm and around mast chondrocytes in group B-E. With the increase of degeneration grade of cervical intervertebral disc MRI, the staining degree of collagen X in the endplate cells became deeper and deeper, and the number of positive cells gradually increased. The positive rate of sex cells was 2.18 [0.9], that of group B was 14.04 [1.24], that of group C was 22.12 [2.54], that of group D was 31.73 [3.34], and that of group E was 41.43 [2.38]. There were statistical differences among the groups (P 0.05). Conclusion: 1. The pathological changes of cartilage endplates in different grades of cervical intervertebral disc degeneration were different. The expression of collagen type I in cartilage endplate cells was positively correlated with the degeneration grade of intervertebral disc MRI; 3. The Pfirrmann grade of intervertebral disc degeneration was consistent with the degeneration of cartilage endplate, which could reflect the degeneration degree of cartilage endplate at the cellular level.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.53;R445.2

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