腰椎间盘突出症患者经皮椎间孔镜手术后血清疼痛介质及炎症因子的分析

Analysis of Pain Mediators and Inflammatory Factors of Patients with Lumber Disc Herniation after Percutaneous Transforaminal Endoscopic Discectomy

目的探讨腰椎间盘突出症(LDH)患者经皮椎间孔镜手术(PTED)后疼痛介质及炎症因子的变化特点。方法选择2016年2月到2017年9月在本院治疗的163例LDH患者作为研究对象。根据手术方案的不同将患者分成PTED组83例以及开窗术组80例,对比两组血清中疼痛介质和炎症因子的水平,分析患者疼痛介质与炎症因子的相关性。结果术后两组患者血清中去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)及P物质(SP)水平均低于术前(P均<0.05),且PTED组低于开窗术组(P均<0.05)。术后两组患者血清中白细胞介素-4(IL-4)和白细胞介素-10(IL-10)水平高于术前(P均<0.05),且PTED组高于开窗术组(P均<0.05)。两组白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平低于术前(P均<0.05),且PTED组低于开窗术组(P均<0.05)。IL-4和IL-10炎症因子与NE、DA、5-HT及SP疼痛介质呈负相关,而IL-6和TNF-α分别与NE、DA、5-HT及SP疼痛介质呈正相关(P均<0.05)。结论 PTED治疗LDH患者具有较好的疗效,可改善患者血清中疼痛介质及炎症因子水平。

Objective To explore change characteristic of pain mediators and inflammatory factors of patients with lumber disc herniation(LDH)after percutaneous transforaminal endoscopic discectomy(PTED).Methods Total 163 patients with LDH who were treated in the hospital from February 2016 to September 2017 were selected as the subjects.According to the different surgical protocols,the patients were divided into 83 cases of the PTED group and 80 cases of the fenestration group.The levels of pain mediators and inflammatory factors were compared between the two groups,and the correlation between pain mediators and inflammatory factors was analyzed.Results After operation,the levels of norepinephrine(NE),dopamine(DA),5-hydroxytryptamine(5-HT)and substance P(SP)in the two groups were significantly lower than those before operation,and the PTED group was significantly lower than the fenestration group,the difference was statistically significant(P<0.05).The levels of interleukin-4(IL-4)and interleukin-10(IL-10)in the two groups were significantly higher than those before operation,and the PTED group was significantly higher than the fenestration group.The levels of interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)in the two groups were significantly lower than those before surgery,and the PTED group was significantly lower than the fenestration group(P<0.05).According to the Spearman method,the correlation between the pain mediators and inflammatory factors was analyzed,and it was found that IL-4 and IL-10 were negatively correlated with NE,DA,5-HT and SP respectively,and IL-6 and TNF-αwere positively related to NE,DA,5-HT and SP respectively.Conclusion There is a good curative effect for LDH patients treated with PTED,which can improve the pain mediators and inflammatory factors.