Clinical Significance of M1/M2 Macrophages and Related Cytokines in Patients with Spinal Tuberculosis.

BACKGROUND: Macrophages are important immune cells involved in Mycobacterium tuberculosis (M.tb) infection. To further investigate the degree of disease development in patients with spinal tuberculosis (TB), we conducted research on macrophage polarization. METHODS: Thirty-six patients with spinal TB and twenty-five healthy controls were enrolled in this study. The specific morphology of tuberculous granuloma in spinal tissue was observed by hematoxylin-eosin (H&E) staining. The presence and distribution of bacilli were observed by Ziehl-Neelsen (ZN) staining. Macrophage-specific molecule CD68 was detected by immunohistochemistry (IHC). M1 macrophages play a proinflammatory role, including the specific molecule nitric oxide synthase (iNOS) and the related cytokine tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ). M2 macrophages exert anti-inflammatory effects, including the specific molecule CD163 and related cytokine interleukin-10 (IL-10). The above markers were all detected by quantitative real-time PCR (RT-PCR), enzyme-linked immunosorbent assay (ELISA), and IHC. RESULTS: Typical tuberculous granuloma was observed in the HE staining of patients with spinal TB. ZN staining showed positive expression of Ag85B around the caseous necrosis tissue and Langerhans multinucleated giant cells. At the same time, IHC results indicated that CD68, iNOS, CD163, IL-10, TNF-α, and IFN-γ were expressed around the tuberculous granuloma, and their levels were obviously higher in close tissue than in the distant tissue. RT-PCR and ELISA results indicated that IL-10, TNF-α, and IFN-γ levels of TB patients were also higher than those of the healthy controls. CONCLUSION: The report here highlights that two types of macrophage polarization (M1 and M2) are present in the tissues and peripheral blood of patients with spinal TB. Macrophages also play proinflammatory and anti-inflammatory roles. Macrophage polarization is involved in spinal TB infection.

[Efficacy of 3D print guide technique in one stage posterior approach for the treatment of cervical and thoracic tuberculosis with kyphosis].

Objective: To investigate the application of 3D printing technology in the treatment of patients with cervical kyphosis and paraplegia in different segments of the cervical spine after one-stage debridement, bone graft fusion and pedicle screw fixation. Methods: From January 2008 to January 2017, a total of 31 patients with thoracolumbar tuberculosis were treated in the Department of Orthopaedics, the Xinjiang Uygur Autonomous Region people's Hospital.Lesions of the thoracic spine (T1-T4) in 8 cases, (C5-C7) in 10 cases, cervical and thoracic segment in 13 cases, involving a total of 2 cases of vertebral body in 7 cases, 3 cases of vertebral body in 14 cases, 4 cases of vertebral body. 3D printing group (group A) 12 cases, non 3D printing group (group B) of 19 cases.All cases were treated with a posterior approach to the treatment of the cervical spinal cord around the spinal cord.After taking regular anti tuberculosis drugs in 6-12 months, follow-up observation of correction of kyphosis and paraplegia recovery, blood sedimentation rate (ESR), C-reactive protein (CRP) changes. Results: All cases were followed up for at least 6 months. Twelve patients were treated with 3D printing technique before operation, and the operation was performed according to the preoperative plan.The diameter and length of pedicle screws, the direction of insertion, and the distance between the insertion point and the posterior midline of the pedicle screw were similar to those in the 3D.Three days after the operation, the effect of fracture reduction was satisfactory, and the position of pedicle screws was good.After 6 months of follow-up, the X-ray showed that the pedicle screws were in good position, and there was no loosening and fracture.All the patients were healed, and there was no segmental instability.3D printing group during surgery bleeding, operation time, postoperative drainage volume, compared with the non 3D print group of surgical results, 3D printing group significantly reduce the surgical trauma[(131±18) min vs (162±23), P<0.01; (528±34) ml vs (615±41) ml, P<0.01; (257±46) vs (327±56), P<0.01; (not grouping, before after operation), (64±42) mm/1 h vs (6±7) mm/1 h, P<0.01; CRP (not packet): (72±41) µg/L, (13±6) mm/1 h, P<0.01]. There was significant difference between two groups.The JOA scores of patients in the 3D group were better than those in the non 3D group after the operation in 1, 2 week and in 1, 3, and month.There was no significant difference between the two groups after the operation.Two groups of patients before and after correction of Cobb angle were satisfied, and no significant difference between the two groups.Cobb lost an average of 1 degrees angle correction.The spinal tuberculosis in this group were cured without serious complications. Conclusions: According to the cervical and thoracic tuberculous kyphosis and paraplegia severity, choose a posterior surgery can achieve effective cure, feasible thorough debridement with fixed spinal stability before and after the party obtained bone fusion and deformity correction in 3D technology to increase the accuracy and safety of operation, and can be provide more detailed preoperative, intuitive, three-dimensional, realistic personalized operation scheme.It can reduce the operation trauma, and achieve rapid recovery after operation.