腰椎间盘突出物中TNF-α、IL-1、IL-6的表达与神经根性疼痛的相关性研究

The Correlation between the Concentration of TNF-α,IL-1,IL-6 in the Protrusion of the Lumbar Intervertebral Disc and the Sciatic Pain

目的探讨腰椎间盘突出物中TNF-α、IL-1、IL-6与神经根性疼痛的关系。方法收集我院2008年1月~2010年12月期间入院准备手术的腰椎间盘突出症患者60例及腰椎骨折手术患者20例。腰椎间盘突出症患者根据手术中髓核突出的程度分为三组（隆起型、突出型及游离型）,每组20例。检测三种不同髓核突出类型腰椎间盘突出物TNF-α、IL-1与IL-6的水平,统计分析其与患者神经根性疼痛的关系。并检测20例腰椎骨折手术患者髓核组织TNF-α、IL-1与IL-6的水平作为正常对照。结果①三组腰椎间盘突出症患者腰椎间盘突出物中TNF-α、IL-1、IL-6的表达均比正常对照组增高（P〈0.05）;②腰椎间盘突出物中TNF-α、IL-1、IL-6的表达随着椎间盘突出程度的加重而逐渐升高,即表现为游离型〉突出型〉膨出型（P〈0.05）;③三种不同髓核突出类型之间的疼痛VAS评分之间无明显差异（P〉0.05）;④三种不同髓核突出类型的腰椎间盘突出物TNF-α、IL-1、IL-6的表达与疼痛VAS评分均呈明显正相关（P〈0.05）。结论腰椎间盘突出症患者髓核组织与正常髓核组织之间腰椎间盘突出症的TNF-α、IL-1、IL-6的表达存在差异性;椎间盘髓核中TNF-α、IL-1、IL-6活性水平增高随着椎间盘突出程度的加重而逐渐升高;不同突出类型对神经根的机械压迫与其引起的临床疼痛症状程度无明确关系。

Objective To study the correlation between the concentration of TNF-α,IL-1,IL-6 in the protrusion of the lumbar inter-vertebral disc（PLID） and the sciatic pain.Methods Sixty patients diagnosed with PLID and another twenty patients diagnosed with bursting fracture of lumbar spine（BFLS） were selected.The sixty patients with PLID were classified into three groups：bulge group,protrusion group and prolapsus group.Nucleus adjacent to the nerve roots at the herniation were excised and analyzed by ELISA method for TNF-α,IL-1,IL-6.Another 20 normal nucleus from patients suffering from BFLS were excised and analyzed by the same procedure as the control group.Visal analogue scale（VAS） was recorded to evaluate the severity of sciatic pain.Results ①The levels of TNF-α,IL-1,IL-6 in PLID patients were higher than the control group（P 0.05）;②The levels of TNF-α,IL-1,IL-6 in PLID patients increased with the aggravation of degener-ation（prolapsus group protrusion group bulge group）;③There was no significant difference of VAS pain score among the three groups of PLID patients（P 0.05）;④There was significant correlation between the expression of cytokine（TNF-α or IL-1 or IL-6） and the VAS pain score（P 0.05）.Conclusions There is significant difference of expression of cytokine（TNF-α or IL-1 or IL-6） in the nucleus between the PLID patients and BFLS patients,which increases with the aggravation of degeneration.There is no clear relationship between the type of mechanical pression and the severity of sciatic pain.