炎性指标在脊髓损伤后神经功能恢复和神经病理性疼痛中的预测作用研究

Investigation of the predictive value of inflammatory markers on neural functional recovery and neuropathic pain in patients with spinal cord injury

目的探讨炎性指标与急性脊髓损伤患者神经功能恢复和神经病理性疼痛(neuropathic pain,NP)之间的关系,以及炎性指标在此类患者预后的潜在预测价值。方法选取2017年5月~2019年6月于六安市第二人民医院神经外科收治的急性脊髓损伤患者58例,均采用前路或后路脊髓减压、内固定手术治疗。术后随访6个月,根据患者是否存在NP分为NP组和非NP组;NP组进一步分为持续疼痛组、疼痛进展组。分别于术后1个月和6个月分别进行血清炎性指标[包括C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT),肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]进行检测,同时采用JOA评分评价脊髓损伤情况(依据JOA改善率,分为优、良、一般和差)。结果①术后1个月:在颈段,NP组患者的血清TNF-α、CRP和PCT水平均显著高于非NP组,差异有统计学意义(P<0.05);在胸段,NP组患者的血清TNF-α、PCT水平显著高于非NP组,差异有统计学意义(P<0.05);在腰段,NP组TNF-α水平显著高于非NP组,差异有统计学意义(P<0.05)。②术后6个月:预后优、良组患者的TNF-α水平和CRP水平均显著低于一般组和差组(P<0.01);而血清PCT水平在各组之间,无统计学差异(P=0.44)。③术后1个月和6个月时,持续疼痛组的血清TNF-α、CRP和PCT水平均明显高于非NP组(P<0.05);疼痛进展组在术后1、6个月时的血清TNF-α水平均明显高于非NP组(P<0.05),术后6个月时的CRP和PCT水平均明显高于非NP组(P<0.05)。持续疼痛组的血清TNF-α、CRP和PCT水平在术后1个月和6个月时比较,差异无统计学意义(P>0.05);疼痛进展组的血清TNF-α、CRP和PCT水平在术后6个月时均明显高于术后1个月时(P<0.05)。结论血清炎性指标与脊髓损伤后的神经功能恢复和NP之间存在一定的关系,具有潜在的预测价值。

Objective To explore the relationship between inflammatory indicators and neurological recovery and neuropathic pain(NP)in patients with acute spinal cord injury,and the potential predictive value of inflammatory indicators in the prognosis of such patients.Methods From May 2017 to June 2019,58 patients with acute spinal cord injury treated in the Department of Neurosurgery of the Second People's Hospital of Lu'an were treated with anterior or posterior spinal cord decompression and internal fixation.The patients were followed up for 6 months.They were divided into NP group and non-NP group according to the existence of NP.NP group was further divided into continuous pain group and pain progression group.Serum inflammatory indicators[C-reactive protein(CRP),procalcitonin(PCT)and tumor necrosis factorα(TNF-α)]were measured at 1 month and 6 months after operation.At the same time,JOA score was used to evaluate the spinal cord injury(divided into excellent,good,fair and poor according to the JOA improvement rate).Results①At 1 month after operation,in cervical segment,the serum levels of TNF-α,CRP and PCT in NP group were significantly higher than those in non-NP group(P<0.05).In the thoracic segment,the serum levels of TNF-αand PCT in NP group were significantly higher than those in non-NP group(P<0.05).In the lumbar segment,the serum levels of TNF-αand PCT in NP group were significantly higher than those in non-NP group(P<0.05).②At 6 months after operation,the serum levels of TNF-αand CRP in patients with excellent and good prognosis were significantly lower than those in patients with fair and poor prognosis group(P<0.01),There was no significant difference in serum PCT level among groups(P=0.44).③At 1 and 6 months after operation,the serum levels of TNF-α,CRP and PCT in the persistent pain group were significantly higher than those in non-NP group(P<0.05).At 1 and 6 months after operation,the serum level of TNF-αin pain progression group was significantly higher than that in non-NP group(P<0.05).At 6 months after operation,the levels of CRP and PCT in pain progression group were significantly higher than those in non-NP group(P<0.05).At 1 month and 6 months after operation,the levels of TNF-α,CRP and PCT had no significant differences in persistent pain group(P>0.05).At 6 months after operation,the levels of TNF-α,CRP and PCT were significantly higher than that at 1 month after operation in pain progression group(P<0.05).Conclusion There is a certain relationship between serum inflammatory indicators and neurological recovery and NP after spinal cord injury,which has potential predictive value.