腰椎间盘突出症的免疫学相关性研究进展

www.yongyao.net　　2009-8-6 11:00:59　　来源：　　责任编辑：

分享到：

4.2 免疫学的治疗思路

目前, 针对该病免疫功能异常的治疗开展较少。1979年Rask^[22]报道口服或静脉注射秋水碱治疗急、慢性损伤性椎间盘综合征, 并在1985 年报道3000 例患者, 有效率达92%, 这说明针对缓解神经根炎性疼痛(包括免疫炎性)的治疗大有可为。最近,Webling 等^[23]对一组小鼠神经根痛模型以IL- 1 受体拮抗剂进行实验性治疗, 症状可获明显缓解,疗效不亚于非甾体类镇痛药物。免疫抑制剂的应用, 缓解了髓核对神经根的化学及自体免疫刺激等作用, 在临床上也取得了较好的效果。对于病情较重的腰椎间盘突出症, 刘志伟等^[14]认为给予适当的免疫抑制剂并结合其他保守治疗方法,在经过一段时间治疗若无明显好转, 可考虑手术摘除髓核,通过手术不仅可解决了髓核的机械压迫又停止了自身免疫反应过程, 手术摘除髓核时, 对突出的髓核要仔细查找, 避免遗漏。术后要进行免疫学指标的检测及免疫功能改变的可能机理分析, 对判断预后、病情随访观察有较高临床应用价值。

参考文献
[1] Naylar A. Enzymic and immunological activity in the intervertebraldisc[J]. Orthop Clin N Am,1975,6: 51.
[2] Macnab I.Lumbar root entrapment syndrome [J]. J Bonre Jount Surg(BR), 1975, 57: 534.
[3] Kamg JD, Georgescu H I,M cintyreLL, et al. Jerniated lumbar intervertebral disc spotaneously producematrixmetal loproteinase nitric oxide, interleukin- 6 and prostaylandin E2[J].Spine, 1996,21: 271.
[4] Bobechko WP, Hirsch C. Autoimmune response to nucleus pulposus in the rabbit[J]. J Bone Joint Surg, 1965, 47: 574—580.
[5] 王葵光, 胡有谷. 腰椎间盘突出症的自身免疫状态[J]. 中华骨科杂志, 1994, 14(5): 258.
[6] Gertzbein SD, Tait JH,Devlin SR. The stimulation of lymphocytes bynucleuspulposus in patients with degenarative disk of the lumbar spine[J]. Clin Orthop, 1979, 123: 149.
[7] Marshall LL, Trethew ie Er,Cutrain CC.Chemical racliculitis[J].Clin Orthop, 1977, 129: 149.
[8] Takenake Y. Experimental autoimmune spondylodiscitis in rats[J]. J Rheu matology,1986,13:397.
[9] Spiliopoulou I, Korovessis P, Konstantinou D, et al.IgG and IgM concentration in the prolapsed human intervertebral disc and sciatica etiology[J]. Spine, 1994, 19: 1320.
[10] 李家平. 腰椎间盘突出症影像学表现与免疫学的相关研究[M].影像诊断与介入放射学,1998, 3: 158—160.
[11] Virri J,Gronblad M,Seitsalo S, et al. Comparison of the prevalence of inflamematory cells in subtypes of disc herniations and associations with straight leg raising [J]. Spine,1996,21(2):2311—2315.
[12] 王建忠, 周跃, 梅芳瑞. 腰椎间盘突出物中IL- 1 含量与SLR 相关性骨与关节损伤杂志[J].2001, 16( 1) : 22—23.
[13] 李军. 腰椎间盘突出症的病理分型和全身及局部体液免疫水平的相关性研究[J]. 西安医科大学学报, 1999, 20(3): 374.
[14] 刘志伟, 洪天禄, 孙有声, 等.腰椎间盘突出症突出髓核中抗原抗体复合物测定的临床意义[J].实用骨科杂志, 2002, 8: 351—356.
[15] Spangler DM. Lumbar disectomy, results with limited disc excision and selective foraminotomy[J]. Spine, 1983, 7: 604.
[16] 周泽美, 周志雄. 免疫球蛋白IgG 及IgM含量与腰椎间盘突出症病理分型的相关性[J].中国临床康复, 2003, 7: 2040—2041.
[17] 张强.腰椎间盘突出症脑脊液和血清免疫球蛋白升高机理的初步探讨[J].颈腰痛杂志,1996, 4: 210—212.
[18] Arai Y,Yasuma T,Shitoto K,et al, Immunohistological study of intervertebral disc herniation of lumbar spine [J].J Orthop Sci,2000,5(3):229—231.
[19] Doita M, Kanatani T, Harada T, et al. Immunonistoyic study of the ruptured interertebral disc of the lumbar spine [J].Spine, 1996, 21: 235.
[20] Ryderik BL. Pathoanatomg and pathophysiology of nerve root compression[J]. Spine,1984,9:7
[21] Skouen JS,Larsen JL,Voulset SE.Cerebrospinal fluid proteins as indicators of nerve root compression in patients with sciatica caused by disc herniation[J].Spine.1993,18:72.
[22] Rask MR. Colehicine use in the damaged disc syndrome: Report of 590 patients[J]. Clin Orthop, 1979, 14: 187.
[23] Wehling P, Cleveland SJ, Heininger K, et al. Nearophy sioogic changes in lumbar nerve root inflammation in the rat after treatment with cytokine inhibitors [J]. Spine,1996,21 (8):931—935.