Kato F, Mimatsu K, Iwata H, Miura T
Department of Orthopaedic Surgery, School of Medicine, Nagoya University, Japan.
Clin Orthop Relat Res. 1993 Mar(288):294-302.
Although chemonucleolysis with chymopapain is an approved treatment for lumbar intervertebral disk herniation, recent serious complications have raised doubt concerning its safety. It is therefore necessary to search for a safer and more selective agent than chymopapain for chemonucleolysis. Experimental chemonucleolysis with chondroitinase ABC was thus tested and compared with chymopapain. Acute tissue reactions to chondroitinase ABC were investigated and compared with chymopapain. The epidural space, yellow ligament, sciatic nerve, knee joint, and Achilles tendon were examined. Chymopapain damaged nervous and ligamentous tissues as well as cartilaginous tissue. Chondroitinase ABC did not damage nervous and ligamentous tissue. Chondroitinase ABC affected only cartilaginous tissue, and its action was chiefly limited to digestion of the matrix. Chondroitinase ABC has high enzymatic specificity for matrix in vivo. In addition, chondroitinase ABC is less toxic to noncartilaginous tissues than chymopapain. Chondroitinase ABC might be a more suitable and safer enzyme than chymopapain for chemonucleolysis.
尽管木瓜凝乳蛋白酶化学髓核溶解术是治疗腰椎间盘突出症的一种获批疗法，但近期出现的严重并发症引发了对其安全性的质疑。因此，有必要寻找一种比木瓜凝乳蛋白酶更安全、更具选择性的化学髓核溶解剂。于是对软骨素酶ABC进行了化学髓核溶解实验，并与木瓜凝乳蛋白酶进行了比较。研究了对软骨素酶ABC的急性组织反应，并与木瓜凝乳蛋白酶进行了比较。对硬膜外间隙、黄韧带、坐骨神经、膝关节和跟腱进行了检查。木瓜凝乳蛋白酶会损伤神经和韧带组织以及软骨组织。软骨素酶ABC不会损伤神经和韧带组织。软骨素酶ABC仅作用于软骨组织，其作用主要局限于基质的消化。软骨素酶ABC在体内对基质具有高度的酶特异性。此外，软骨素酶ABC对非软骨组织的毒性比木瓜凝乳蛋白酶小。对于化学髓核溶解术而言，软骨素酶ABC可能是一种比木瓜凝乳蛋白酶更合适、更安全的酶。
