腰椎管内静脉血清中炎性因子与腰椎管狭窄的关系

Relationship between lumbar spinal stenosis and inflammatory factors in the vein serum of lumbar spinal canal

背景:大量研究表明,局部腰椎管狭窄可导致机体免疫学异常和局部慢性炎症的发生,而慢性炎症才是导致疼痛的主要原因。目前对于炎性因子与腰椎管狭窄症的相关性研究主要集中于椎间盘、小关节及黄韧带上,腰椎管内静脉中炎性因子与腰椎管狭窄的关系尚未见相关报道。目的:分析腰椎管内静脉血清中白细胞介素1α、肿瘤坏死因子α水平与腰椎管狭窄症的相关性。方法:选取2011年9月至2013年12月上海市同济大学附属东方医院脊柱外科接受腰椎后路椎板切除减压治疗的腰椎管狭窄症及腰椎爆裂性骨折患者,共51例,评估治疗前腰腿痛目测类比评分及Oswestry功能障碍指数。收集退变性腰椎管狭窄症及腰椎爆裂性骨折患者外周静脉及椎管内静脉血,酶联免疫吸附剂法测定血清中白细胞介素1α及肿瘤坏死因子α水平。结果与结论:退变性腰椎管狭窄症组椎管内静脉血清白细胞介素1α水平显著高于腰椎爆裂性骨折组,退变性腰椎管狭窄症组椎管内静脉血清白细胞介素1α水平显著高于外周静脉,差异均有显著性意义(P<0.05)。退变性腰椎管狭窄症组腰椎管狭窄节段越多,静脉血清白细胞介素1α水平越高,但统计学差异不显著。线性相关分析显示,退变性腰椎管狭窄症组椎管内静脉血清白细胞介素1α水平与腰腿痛及功能障碍评分呈显著正相关(r2=0.359 3,P<0.05;r2=0.526 4,P<0.05)。提示腰椎管内静脉中炎性因子可能是导致退变性腰椎管狭窄患者腰腿痛及功能障碍的原因之一。

BACKGROUND：Numerous studies have shown that local lumbar stenosis can cause immunological abnormalities and local chronic inflammation, which is the main cause of pain. At present, studies on inflammatory factors and lumbar spinal stenosis mainly focused on intervertebral discs, facet joint and ligamenta flava. No reports addressed the relationship between inflammatory factor in vein of lumbar spinal canal and lumbar spinal stenosis. OBJECTIVE：To analyze the correlation of serum interleukin-1αand tumor necrosis factor-αlevels with lumbar spinal stenosis. METHODS：A total of 51 patients with lumbar spinal stenosis or lumbar vertebral burst fracture, who underwent posterior lumbar decompression in the Department of Spine Surgery, Shanghai East Hospital, Tongji University in China from September 2011 to December 2013, were enrol ed in this study. Visual analogue scale score of low＆amp;nbsp;back pain and Oswestry disability index were evaluated before treatment. Peripheral vein blood and venous blood in the vertebral canal were col ected from patients with lumbar spinal stenosis or lumbar vertebral burst fracture. The concentrations of serum interleukin-1αand tumor necrosis factor-αwere determined using enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION：The concentration of interleukin-1αin degenerative lumbar stenosis group was significantly higher than that in the lumbar burst fracture group and peripheral veins （P〈0.05）. The more segments of lumbar spinal stenosis, the higher the venous serum interleukin-1αlevels were in the degenerative lumbar stenosis group, but the statistical difference was not significant. Linear correlation analysis results displayed that interleukin-1αlevels were positively associated with low back pain and disability scores in the degenerative lumbar stenosis group （r^2=0.359 3, P〈0.05;r^2=0.526 4, P〈0.05）. These results indicated that the lumbar spinal venous inflammatory factors may be one of the reasons of low back pain and dysfunction in patients with degenerative lumbar spinal stenosis.