Cheng Lei, Fan Weiqiang, Liu Ben, Wang Xuping, Nie Lin
Department of Orthopaedics, Qilu Hospital, Shandong University, 107 WenhuaXi Road, Jinan 250012, People's Republic of China.
Injury. 2013 Dec;44(12):1805-10. doi: 10.1016/j.injury.2013.04.010. Epub 2013 May 13.
Th17 lymphocytes have important roles in inflammation and autoimmune disease. Research on relationship between Th17 lymphocytes and pain associated with lumbar disc herniation (LDH) is limited. The purpose of this study was to examine the association of pain and Th17 lymphocyte and interleukin (IL)-17 levels in patients with herniated and non-herniated lumbar discs.
Thirty-four patients with single lumbar intervertebral disc herniation (median age, 44 years), and 17 healthy adults (median age, 37 years) were enrolled. Patients were divided into 2 groups depending on their magnetic resonance imaging (MRI) results and visual observations during surgery (group P, non-ruptured disc, n=15; group E, ruptured disc, n=19). Patients received posterior or transforaminal lumbar interbody fusion. Preoperative pain intensity was recorded using a visual analogue scale (VAS) score. The percentage of Th17 lymphocytes and IL-17 and prostaglandin E2 (PGE2) levels in peripheral blood were determined. Disc tissue was examined by immunohistochemistry for Th17 and IL-17 expression.
Preoperative VAS pain scores were significantly higher in group E than group P (8.32±1.04 vs. 6.33±2.68, respectively, p=0.009). Similarly, PGE2 level was greater in group E than group P (3.75±1.41pg/ml vs. 2.63±0.89pg/ml, respectively, p=0.011). Compared to healthy controls (1.05±0.19%), the percentage of Th17 cells was significantly greater in group P (1.52±0.62%, p=0.031), and the percentage in group E (2.99±1.09%, p<0.001) was significantly greater than in group P. The IL-17 expressions were similar. VAS pain score was positively correlated with Th17 proportion (r=0.489, p=0.003), and IL-17 concentration (r=0.458, p=0.007). PGE2 was also positively correlated with Th17 proportion (r=0.539, p=0.001), and IL-17 concentration (r=0.500, p=0.003). The expression of IL-17 was higher in the cells of group E and group P compared with normal tissue (p<0.001).
Immune system activation is responsible, at least in part, for the pain experienced by patients with LDH, and increased levels of Th17 lymphocytes and IL-17 contribute to the pain.
Th17淋巴细胞在炎症和自身免疫性疾病中发挥重要作用。关于Th17淋巴细胞与腰椎间盘突出症（LDH）相关疼痛之间关系的研究有限。本研究的目的是探讨腰椎间盘突出和未突出患者的疼痛与Th17淋巴细胞及白细胞介素（IL）-17水平的相关性。
纳入34例单节段腰椎间盘突出症患者（中位年龄44岁）和17例健康成年人（中位年龄37岁）。根据磁共振成像（MRI）结果和手术中的视觉观察将患者分为2组（P组，未破裂椎间盘，n = 15；E组，破裂椎间盘，n = 19）。患者接受后路或经椎间孔腰椎椎间融合术。术前使用视觉模拟量表（VAS）评分记录疼痛强度。测定外周血中Th17淋巴细胞百分比、IL-17和前列腺素E2（PGE2）水平。通过免疫组织化学检测椎间盘组织中Th17和IL-17的表达。
E组术前VAS疼痛评分显著高于P组（分别为8.32±1.04和6.33±2.68，p = 0.009）。同样，E组PGE2水平高于P组（分别为3.75±1.41pg/ml和2.63±0.89pg/ml，p = 0.011）。与健康对照组（1.05±0.19%）相比，P组Th17细胞百分比显著更高（1.52±0.62%，p = 0.031），E组百分比（2.99±1.09%，p<0.001）显著高于P组。IL-17表达相似。VAS疼痛评分与Th17比例呈正相关（r = 0.489，p = 0.003），与IL-17浓度呈正相关（r = 0.458，p = 0.007）。PGE2也与Th17比例呈正相关（r = 0.539，p = 0.001），与IL-17浓度呈正相关（r = 0.500，p = 0.003）。与正常组织相比，E组和P组细胞中IL-17表达更高（p<0.001）。
免疫系统激活至少部分导致了LDH患者的疼痛，Th17淋巴细胞和IL-17水平升高促成了疼痛。
