SD大鼠竖脊肌植入椎间盘髓核组织后植入组织质量以及局部组织和血液中MMP-3的变化

发布时间：2018-08-18 10:44

【摘要】：腰椎间盘突出症是最常见的一种脊柱疾病,严重威胁着人类的健康生活,随着生活方式及生活习惯的改变,其发病率逐年增加,而且呈现出年轻化。脱垂游离型椎间盘突出症是其中的一种特殊类型,其不仅可以引起神经根症状,还容易压迫马尾神经。非手术治疗往往无效,主要以手术治疗为主,手术可以及时清除突出组织,从而解除脊神经根等的受压,效果理想。然而,在临床发现有不少该类型的患者拒绝手术治疗,其中部分患者经过坚持保守治疗症状明显缓解甚至痊愈。尽管有文献证明脱垂游离型椎间盘突出容易发生自吸收,但是,在没有更多的证据前也不能够轻易决定采取保守治疗方案,以免引起马尾神经受压等严重后果。因此,为这类患者寻找另一种支持保守治疗的证据十分必要。目的:通过模拟脱垂游离型大鼠椎间盘突出症,检测大鼠竖脊肌植入椎间盘髓核组织局部及大鼠血液中MMp-3的含量以及植入组织质量的改变,分析血液和植入组织MMp-3以及植入组织质量变化之间的联系,探讨血液MMp-3在保守治疗椎间盘突出症中的运用。方法:随机将50只3月龄健康SD大鼠,分为正常对照组、阴性对照组(包括45天手术组和60天手术组)、实验组(包括45天手术组和60天手术组),正常对照组10只,其余两组每组20只。分别在手术45d,60d后,用ELISA法检测植入椎间盘髓核组织局部及血液中MMp-3含量。同时称量记录髓核组织植入前和两次不同手术观察时间后的质量。结果:(1)手术45天后,与正常对照组相比,实验组植入椎间盘髓核组织及血液中MMp-3浓度上升,差异有统计学意义(P0.05)。阴性对照组血液中MMp-3浓度较正常对照组升高,差异有统计学意义(P0.05)。(2)60天手术组植入组织及血液中MMp-3的浓度值较45天手术组高,差异有统计学意义;前者植入组织质量减少速度较后者快,即前者植入组织较后者自吸收快。(4)实验组在手术后不同观察时间点,植入椎间盘髓核组织与血液中MMp-3的浓度变化高度正相关,相关系数分别为0.835和0.895,均P0.05。结论:(1)竖脊肌间隙植入椎间盘髓核组织后组织局部MMp-3不断升高,随着MMP-3水平升高,植入组织自吸收加快;(2)植入组织中MMP-3含量上升与血液中MMP-3的含量升高高度正相关;(3)脱出游离型椎间盘突出症的患者或许可以通过检测血液中MMP-3的浓度变化来了解局部突出组织MMP-3水平,从而了解突出组织自吸收的潜在能力,进而为该类疾病保守治疗手段的选择提供参考依据。
[Abstract]:Lumbar disc herniation is the most common spinal disease, which is a serious threat to the healthy life of human beings. With the change of life style and habits, the incidence of lumbar disc herniation is increasing year by year, and showing a younger age. Prolapse free disc herniation is one of the special types, which can not only cause nerve root symptoms, but also compression of cauda equina nerve. Non-surgical treatment is often ineffective, mainly surgical treatment, surgery can remove protruding tissue in time, so as to relieve the spinal nerve root pressure, the effect is ideal. However, it is found that many patients in this category refuse surgical treatment, and some of the patients are obviously relieved or even cured after adhering to conservative treatment. Although it has been proved that herniation of prolapsed free intervertebral disc is prone to self-absorption, conservative treatment can not be easily decided without more evidence, so as to avoid serious consequences such as compression of cauda equina nerve. Therefore, it is necessary to find another evidence of conservative treatment for these patients. Objective: to investigate the content of MMp-3 in rat nucleus pulposus tissue and the changes of tissue quality by simulating prolapse of rat intervertebral disc herniation. To analyze the relationship between MMp-3 of blood and implanted tissue and the quality of implanted tissue, and to discuss the application of blood MMp-3 in conservative treatment of disc herniation. Methods: fifty 3-month-old healthy SD rats were randomly divided into normal control group, negative control group (including 45 days operation group and 60 day operation group), experimental group (including 45 days operation group and 60 day operation group) and normal control group (10 rats). The other two groups had 20 rats in each group. After 45 days of operation, the content of MMp-3 in the tissue and blood of the implanted nucleus pulposus was measured by ELISA method. At the same time, the quality of nucleus pulposus tissue was measured before implantation and after two different operation time. Results: (1) after 45 days of operation, compared with the normal control group, the concentration of MMp-3 in the implanted nucleus pulposus tissue and blood of the experimental group increased significantly (P0.05). The concentration of MMp-3 in blood of negative control group was higher than that of normal control group (P0.05). (2). The concentration of MMp-3 in implanted tissue and blood in 60 days operation group was higher than that in 45 day operation group, and the difference was statistically significant. The quality of implanted tissue in the former group was decreased faster than that in the latter group. (4) in the experimental group, there was a high positive correlation between the concentration of MMp-3 in the blood and the implanted nucleus pulposus tissue at different observation time points after operation. The correlation coefficients were 0.835 and 0.895, respectively (P 0.05). Conclusion: (1) the local MMp-3 of the intervertebral disc implanted into the intervertebral disc increased with the increase of MMP-3 level. (2) the increase of MMP-3 content in implanted tissue is highly positively correlated with the increase of MMP-3 content in blood; (3) patients with prolapse of free intervertebral disc may be able to understand the change of MMP-3 concentration in blood by detecting the change of MMP-3 concentration in blood. Local protruding tissue MMP-3 level, In order to understand the potential ability of highlighting tissue self-absorption, and then to provide a reference for the choice of conservative treatment for this kind of disease.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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