腰椎间盘源性疼痛机理的临床研究

Clinical Research of Discogenic Lumbar Pain Mechanism

目的探讨腰椎间盘突出症的盘源性疼痛机理。方法方便选取2015年4月—2016年4月该院收治的160例患者为研究对象,纳入研究组,同时选取同期体检健康者为对照组,对所有受试者的一般资料进行综合性分析,检测研究组PLA2,SP与CGRP,与对照组进行比较。结果该组160例患者均伴有不同程度的腰痛或肢体放射痛,急性炎症组的Ⅳ级所占比重高于正常及慢性炎症组,差异有统计学意义(P<0.05)。IV级组腰椎间盘游离与膨出比率显著比上述3组高,且急性神经病理形态改变占据在较大比例;研究组髓核中PLA2活性与SP均优于对照组,差异有统计学意义(P<0.05);研究组患者血中与髓核中PLA2活性分别为(5.12±0.32)和(175.32±20.34);对照组为(5.02±0.25)与(18.42±4.23)。研究组SP与CGRP分别为(532.67±56.84)与(28.64±4.86),对照组为(365.85±34.73)与(21.85±4.12)。不同疼痛等级间髓核中PLA2活性、SP、CGRP比较,差异有统计学意义(P<0.05)。结论腰椎间盘突出症患者疼痛与机械压迫、局部炎症有关,临床实践中应对其给予关注。

Objective To study the discogenic lumbar pain mechanism. Methods Convenient selection 160 cases of patients admitted and treated in our hospital from April 2015 to April 2016 were selected as the research group, while the healthy physical examination persons at the same period were selected as the control group, and the general data of all subjects were comprehensively analyzed, and the PLA2, sp and CGRP in the research group were tested, and compared with the those in the control group. Results Lumbago or limb pains of different degrees was in the 160 cases of patients, the ratio ofⅣ level in the acute inflammation group was higher than that in the normal group and chronic inflammation group, and the difference had statistical significance（P0.05）, the lumbar herniated intervertebral disc stray and bulge ratio in the IV level group was obviously higher that in the above three groups, and the PLA2 activity and SP in the research group were better than those in the control group, and the difference had statistical significance（P0.05）, and the PLA2 activity in blood and nucleus pulposus was respectively（5.12±0.32） and（175.32±20.34）in the research group and（5.02±0.25） and（18.42±4.23）in the control group, and the SP and CGRP was respectively（532.67±56.84） and（28.64±4.86）in the research group and（365.85±34.73） and（21.85±4.12） in the control group, and the differences in the PLA2 activity in nucleus pulposus, SP and CGRP in different levels of pains had statistical significance（P0.05）. Conclusion The pain of patients with prolapse of lumbar intervertebral disc is related to the mechanical pressure and local inflammation, and we should pay attention to it in clinical practice.