Toll样受体4及白细胞介素-23、白细胞介素-17A在退变腰椎间盘髓核组织中的表达及其临床意义

Expression and clinical significance of TLR4 and IL-23/IL-17A in nucleus pulposus of the degenerative lumbar intervertebral disc

摘要:

目的 探讨Toll样受体4（TLR4）及白细胞介素-23（IL-23）、IL-17A在退变腰椎间盘髓核组织中的表达及其临床意义。方法 选取2019年2月—2022年2月青海大学附属医院收治的97例腰椎间盘突出症（LDH）患者作为研究组。另选取同期该院行前路减压内固定切除的脊柱骨折患者58例作为对照组。采用实时荧光定量聚合酶链反应检测两组腰椎间盘髓核组织TLR4、IL-23、IL-17A mRNA相对表达量。比较研究组不同腰椎间盘退变等级患者TLR4、IL-23、IL-17A mRNA相对表达量，分析研究组TLR4与IL-23、IL-17A mRNA相对表达量的相关性。结果 研究组TLR4、IL-23、IL-17A mRNA相对表达量高于对照组（P <0.05）。V级组TLR4、IL-23、IL-17A mRNA相对表达量高于Ⅱ级组、Ⅲ级组、Ⅳ级组（P <0.05），Ⅳ级组高于Ⅱ级组、Ⅲ级组（P <0.05），Ⅲ级组高于Ⅱ级组（P <0.05）。重度腰痛组TLR4、IL-23、IL-17A mRNA相对表达量高于中度腰痛组（P <0.05）。重度腰椎功能丧失组TLR4、IL-23、IL-17A mRNA相对表达量高于中度腰椎功能丧失组（P <0.05）。Pearson相关性分析显示，研究组退变腰椎间盘髓核组织TLR4 mRNA相对表达量与IL-23 mRNA、IL-17A mRNA相对表达量呈正相关（r =0.662和0.671，均P <0.05）。结论 LDH患者退变腰椎间盘髓核组织TLR4、IL-23、IL-17A异常高表达，且与LDH患者腰椎间盘退变等级、病情严重程度关系密切。

Abstract:

Objective To investigate the expression and clinical significance of Toll-like receptor 4 (TLR4), interleukin-23 (IL-23) and IL-17A in nucleus pulposus of the degenerative lumbar intervertebral disc.Methods A total of 97 patients with lumbar disc herniation (LDH) (study group) admitted to our hospital from February 2019 to February 2022 were selected, and 58 patients with spinal fractures who underwent anterior decompression and internal fixation during the same time period were enrolled as the control group. The relative mRNA expressions of TLR4, IL-23 and IL-17A in the nucleus pulposus of the lumbar intervertebral disc were detected via qPCR and they were compared among patients with varying grades of lumbar disc degeneration. The correlations between the relative mRNA expression of TLR4 and that of IL-23 and IL-17A in patients of the study group were analyzed.Results The relative mRNA expressions of TLR4, IL-23 and IL-17A in the study group were higher than those in the control group (P < 0.05). The relative mRNA expressions of TLR4, IL-23 and IL-17A in patients with grade V lumbar disc degeneration in the study group were higher than those in patients with grades II-IV lumbar disc degeneration (P < 0.05), those in patients with grade Ⅳ lumbar disc degeneration were higher than those in patients with grade Ⅱ and Ⅲ lumbar disc degeneration (P < 0.05), and those in patients with grade III lumbar disc degeneration were higher than those in patients with grade II lumbar disc degeneration (P < 0.05). Compared with the patients with moderate back pain, the relative mRNA expressions of TLR4, IL-23 and IL-17A were higher in patients with severe back pain (P < 0.05). The relative mRNA expressions of TLR4, IL-23 and IL-17A in patients with severe lumbar function loss were higher than those in patients with moderate lumbar function loss (P < 0.05). Pearson correlation analysis showed that the relative mRNA expression of TLR4 was positively correlated with the relative mRNA expressions of IL-23 (r = 0.662) and IL-17A (r = 0.671) in nucleus pulposus of the degenerative lumbar intervertebral disc among patients in the study group (P < 0.05).Conclusions The expressions of TLR4, IL-23 and IL-17 are abnormally high in the nucleus pulposus of the degenerative lumbar intervertebral disc in LDH patients, and are closely related to the grade and severity of lumbar intervertebral disc degeneration in these patients.