椎间盘生物化学研究的热点

近年来，国内外的学者对椎间盘的生物化学变化进行了大量深入的研究，对揭示椎间盘退变规律作出了很多贡献。但是，对椎间盘退变机制的解释尚不圆满，很多问题还有待于解决。目前这种状况还不能适应椎间盘疾病防治工作的需要。展望未来，椎间盘生物化学研究有望从以下几个方面获得突破性进展。

1．椎间盘细胞的生物学特性研究　椎间盘主要由细胞及周围基质构成，通过探讨细胞生长、繁殖、凋亡的规律，有助于深入了解椎间盘基质生化成分的代谢特点，探索椎间盘生物化学的变化规律，有助于寻找预防椎间盘退变的方法，对预防与治疗退变性疾病具有重要意义。

2．胶原与蛋白多糖调控机制的研究　随着对椎间盘基质成分结构、功能以及调节规律认识的逐步深入，用各种手段调节不同退变时期椎间盘内基质成分的种类和水平，利用不同基质成分及合成类抑制因子调节其活性可以从根本上调控椎间盘基质成分的含量与性质变化，改善椎间盘力学性能，从而达到预防或延缓椎间盘退变的目的。胶原和蛋白多糖作为椎间盘组织中的主要大分子物质，在椎间盘中具有极其重要的功能，对其结构和功能的进一步研究，将为椎间盘的退变的预防和椎间盘突出的治疗开拓一种新的途径。如对胶原与蛋白多糖基因的监测、蛋白多糖基因的体内转染等，在椎间盘疾病的预防和治疗方面都具有较高的研究价值和较好的应用前景。

3．椎间盘基质降解机制的研究　近年来，认为在椎间盘退变过程中，基质金属蛋白酶（MMPs）发挥着重要作用，但是到目前为止仅仅在椎间盘中发现几种MMPs，随着现代检测技术的进步，如免疫细胞化学、原位杂交技术、酶谱学等的应用，无疑将使我们能够在椎间盘中发现更多的MMPs，通过建立更接近于体内环境的培养体系，以观察各种因子对MMPs的影响，探讨MMPs的作用和调节机制，采用基因治疗策略，调控椎间盘中MMPs的表达，通过对MMPs降解基质成分及其调控机制研究，可寻找到阻止椎间盘退变的有效方法。在应用基质降解酶进行化学溶核疗法的基础和临床研究时，在观察它们对髓核作用的同时，进一步明确其对软骨终板、纤维环的作用特点，对神经组织的急慢性毒性反应以及硬膜外和椎间盘内注射引起的近、远期并发症等，对这些问题的正确认识和深入探讨将会使化学溶核疗法成为一种治疗椎间盘突出症真正有价值的方法。

4．组织工程和细胞生物学的研究与基因治疗椎间盘退变　近年来，组织工程和细胞生物学的研究取得突破性进展，从椎间盘的生物化学领域，用各种手段调节不同退变时期椎间盘内基质成分的种类和水平，利用基因调节其活性可以从根本上调控椎间盘基质成分的含量与性质变化。在椎间盘退变过程中，基质成分变化对椎间盘的生理功能产生较大的影响。基因治疗的主要方法应该是利用基因转染技术，使体细胞表达对椎间盘退变有抑制和逆转作用的生长因子，预防或延缓椎间盘退变，使椎间盘基质成分的产生变化。基因治疗中存在的缺点和不足，如生物安全性、表达稳定性差等，是基因治疗椎间盘退变需要解决的问题。基因治疗是今后治疗椎间盘退变的重要方向。

（杨华清）

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