射频靶点热凝治疗腰椎间盘突出症对外周血中TNF-α和IL-1β的影响

The effect of target ablation with radiofrequency thermocoagulation in the treatment of lumbar disc herniation on serum TNF-α and IL-1β

目的探讨后路管状位穿刺靶点法射频热凝治疗腰椎间盘突出症的临床效果及作用机制。方法 选取武汉市普仁医院疼痛科2012年6月～2013年12月收治的腰椎间盘突出症患者180例,随机分为两组,每组各90例。治疗组采用后路管状位穿刺靶点法射频热凝靶点治疗,对照组采用臭氧注射治疗。采用改良Macnab评估临床疗效;肿瘤坏死因子α（TNF-α）和白介素-1β（IL-1β）检测采用酶联免疫法测定。观察两组治疗前后临床疗效及外周血中TNF-α和IL-1β的变化。结果 术后1周、1个月及3个月时进行疗效评估,治疗组优良率分别为85.6%（77/90）、90.0%（81/90）及92.2%（83/90）,均高于同时期对照组72.2%（65/90）、78.9%（71/90）及68.9%（62/90）,差异有统计学意义（P〈0.05）。治疗后两组患者血中TNF-α和IL-1β含量均较治疗前显著减低（P〈0.01）,治疗组治疗后TNF-α[（17.15±2.27）ng/m L]、IL-1β[（9.39±1.03）pg/m L]含量显著低于对照组[（29.62±3.36）ng/m L、（14.59±2.23）pg/m L],差异有统计学意义（P〈0.05）。结论 后路管状位穿刺靶点法射频热凝治疗腰椎间盘突出症安全高效,远期效果显著,并对外周血中TNF-α和IL-1β含量有明显的良性调节作用,这可能是射频热凝靶点治疗腰椎间盘突出症的作用机制之一。

Objective To investigate the clinical effect and mechanism of target ablation with radiofrequency thermocoagulation by posterior approach of tubular position in the treatment of lumbar disc herniation. Methods 180 cases of patients with lumbar disc herniation in Department of Pain Management, Wuhan Puren Hospital, from June 2012 to December 2013 were selected and randomly divided into two groups, 90 cases in each group. The treatment group was treated with radiofrequency thermocoagulation by posterior approach of tubular position. The control group was treated with ozone injection therapy. Clinical efficacy was assessed using modified Macnab. TNF-α and IL-1β were determined by enzyme-linked immunosorbent assay, The clinical efficacy, and changes of TNF-α and IL-1β levels before and after treatment were observed. Results 1 week, 1 month and 3 month after surgery, the excellent and good rates of the treatment group were 85.6% （77/90）, 90.0% （81/90） and 92.2% （83/90） respectively, which were higher than those of the control group [72.2% （65/90）, 78.9% （71/90）, 68.9% （62/90）] at the same time, the differences were statistically significant （P 〈 0.05）. After treatment, in the two groups the serum TNF-α and IL-1β levels were significantly lower than before treatment （P 〈 0.01）. After treatment, TNF-α [（17.15±2.27） ng/mL] and IL-1β [（9.39±1.03） pg/mL] levels of the treatment group were significantly lower than those of the control group [（29.62±3.36） ng/mL, （14.59±2.23） pg/mL], the differences were statistically significant （P 〈 0.05）. Conclusion There are benign regulation effects and good efficacy of target ablation with radiofrequency thermocoagulation by posterioi approach of tubular position on the TNF-α and IL-1β levels in peripheral blood of patients with lumbar disc herniation. This may be one of the mechanisms for the treatment of lumbar disc herniation by radiofrequency thermocoagulation.