%0 Journal Article %T 腰椎间盘应激状态下髓核组织中HSPA1A表达的变化及其临床意义 %A 刘畅　相宏飞　吴晓淋　丁文元　李祥林　张薇　黄辉　王冠荣　陈伯华　张英泽 %J - %D 2019 %R 10.13362/j.jpmed.201904003 %X 摘要目的　探讨腰椎间盘不同应激状态下髓核组织中诱导型热休克蛋白70（HSPA1A）表达的变化及其临床意义。方法　收集2017年3月—2019年4月在青岛大学附属医院行腰椎手术治疗患者的腰椎间盘组织标本共42例，其中13例标本取自外伤后急性及亚急性期腰椎间盘突出症患者（急性应激组），17例标本取自无明显外伤史且经6个月以上保守治疗的腰椎间盘突出症患者(慢性应激组)，12例标本取自腰椎滑脱症患者（病理退变组）。术前根据MRI检查结果对患者的腰椎间盘进行Pfirrmann分级。术中取出纤维环及髓核组织，经电镜观察各组患者腰椎间盘纤维环形态；各组随机抽取6例组织结构较全的样本经组织学处理后采用Western blotting方法对各组髓核组织中HSPA1A的表达水平进行检测；经细胞培养及染色后采用流式细胞术对HSPA1A抗凋亡特性进行检测。结果　MRI检查结果显示急性应激组较慢性应激组及病理退变组Pfirrmann分级低（Z=2.725、4.651，P<0.05），而慢性应激组Pfirrmann分级与病理退变组比较差异无显著性（P>0.05）。电镜观察结果显示，急性应激组椎间盘纤维环纤维排列整齐、有弹性且光滑，破裂处断面平整；慢性应激组和病理退变组中纤维环纤维排列紊乱，无弹性且粗糙，纤维交联，但两组纤维紊乱程度不一；各组髓核侵入处均有纤维粘连现象存在。Western blotting方法检测结果显示，3组腰椎间盘髓核中央区、髓核与纤维环交界区组织中HSPA1A均稳定表达但表达依次降低，差异有显著性(F=606.531、1 129.424，P<0.01)。流式细胞术检测结果显示，各组髓核细胞未干预组与HSPA1A干预组相比有下调早期凋亡细胞比例的现象（t=3.15～4.95，P<0.05）。结论　HSPA1A在人椎间盘髓核组织急性、慢性应激状态及病理退变状态下均呈稳定表达，其表达与椎间盘应激程度具有相关性，HSPA1A抗凋亡特性在该过程中可能发挥了作用。
Abstract：Objective To investigate the expression of HSPA1A in nucleus pulposus tissue under different states of lumbar disc stress and its clinical significance. Methods A total of 42 specimens of human lumbar intervertebral discs were collected from the patients who underwent surgical treatment of the lumbar vertebra in The Affiliated Hospital of Qingdao University from March 2017 to April 2019, among which 13 were obtained from the patients with acute and subacute intervertebral disc herniation after trauma (acute stress group),17 were obtained from the patients with intervertebral disc herniation who had no history of trauma and underwent conservative treatment for more than 6 months (chronic stress group), and 12 were obtained from the patients with lumbar spondylolisthesis (pathological degeneration group). Pfirrmann grade was determined according to preoperative MRI findings. The annulus fibrosus and nucleus pulposus were obtained during surgery, and the morphology of the annulus fibrosus was observed under an electron microscope. Six specimens with a relatively complete structure were randomly selected from each group, and after histological treatment, Western blotting was used to measure the expression of HSPA1A in nuclear tissue. Flow cytometry was used to observe the anti-apoptotic effect of HSPA1A after cell culture and staining. Results MRI showed that the acute stress group had a significantly lower Pfirrmann grade than the chronic stress group and the pathological degeneration group (Z=2.725,4.651,P<0.05), while there was no significant difference in Pfirrmann grade between the chronic stress group and the pathological degeneration group (P>0.05). Electron microscopy showed ordered arrangement of the annulus %K 椎间盘移位 %K 脊椎滑脱 %K 椎间盘退行性变 %K 诱导型热休克蛋白70 %K 氧化性应激 %K 细胞凋亡
Intervertebral disc displacement %K Spondylolysis %K Intervertebral disc degeneration %K Inducible heat shock protein 70 %K Oxidative stress %K Apoptosis %U http://jpmed.qdu.edu.cn/CN/10.13362/j.jpmed.201904003