壮族肝肾亏虚下腰痛老年病人黄韧带、小关节退变的实验研究

Senile degenerative low back pain is a common spinal pain syndrome, common problems of human health and disease, its incidence, social and economic burden. Chinese medicine believes that the main renal bone spleen liver reinforcement muscles, lower back pain is degenerative organ dysfunction caused by disease, and kidney, liver and is closely related to liver and kidney deficiency is the most common cause of lumbar degeneration. Degenerative lumbar organize the subject of 30 years of age and over 60 years of normal for liver and kidney deficiency syndrome Zhuang older specimens for study. Using pathology, immunohistochemistry, scanning electron microscopy, determination of sex hormones and other technologies. Were observed yellow ligament, small articular cartilage cell morphology, ultrastructure and pathological changes. Explore the youth group and the older group sex hormone levels and kidney deficiency, yellow ligament TGFβ1 and type Ⅱ collagen, small joints MMP-13 IL-lα, psoas leptin, adiponectin and content changes. Clarify liver reinforcement, renal bone Zhuang kidney deficiency in elderly patients with low back pain lumbar yellow ligament, the mechanism of small joint degeneration. To reveal the liver and kidney deficiency lumbar degenerative physical relationship is important. Guided by delaying the degeneration of the spine, treatment of degenerative diseases of the spine to provide a theoretical basis.

老年退变性下腰痛是一种常见的脊柱疼痛综合征，困扰人类健康的常见病和多发病，其发病率高，社会经济负担重。中医学认为肝主筋肾主骨脾主肌肉，退变性下腰痛是脏腑功能失调导致的疾病，与肾、肝关系密切，肝肾亏虚是导致腰椎退变的最常见原因。本课题以30岁以下正常人及60岁以上辨证为肝肾亏虚壮族老年人的退变腰椎组织为研究标本。采用病理学检查、免疫组化、扫描电镜、性激素含量测定等技术。观察两组黄韧带、小关节软骨细胞形态学、超微结构及病理学改变。探索青年组和肝肾亏虚老年组在性激素水平、黄韧带TGFβ1和Ⅱ型胶原、小关节MMP-13和IL-lα、腰肌瘦素、脂联素含量变化。阐明肝主筋、肾主骨在壮族肝肾亏虚腰痛老年病人腰椎黄韧带、小关节退变的作用机制。对揭示肝肾亏虚体质与腰椎退变关系有重要意义。为指导延缓脊柱退变、治疗脊柱退变性疾病提供理论依据。

本研究以120例中医辨证为肝肾亏虚壮族下腰痛患者为实验组，120例非肝肾亏虚壮族下腰痛患者为对照组（患者需行腰椎开放性手术治疗，术中取黄韧带、腰椎小关节、椎旁肌肉组织作标本）。运用显微影像学、组织形态细胞学、病理学、透射电镜等技术和方法，测定肝肾亏虚组和非肝肾亏虚组两组间血液中性激素含量、检测相关细胞因子表达等指标，光镜下观察其黄韧带、腰椎小关节、椎旁肌肉的组织形态病理学改变，透射电镜下观察超微结构变化。结果显示：两组人群性激素含量测定存在差异，部分指标与下腰痛肝肾亏虚证型具有相关性；肝肾亏虚组患者腰椎黄韧带、小关节、椎旁肌组织发生明显退变；肝肾亏虚组患者腰椎黄韧带、小关节、椎旁肌超微结构发生改变，细胞破坏死亡，并伴随基质改变，可能与组织退变有关；肝肾亏虚组患者黄韧带TGF-β1和Ⅱ型胶原、小关节MMP-13和IL-lα、椎旁肌瘦素、脂联素可能参与了组织退变的病理过程中。