偏心导杆结合可视化椎间孔镜术对中央型腰椎间盘突出患者β-内啡肽、MMPs/TIMPs及预后的影响

Effect of eccentric guide rod combined with visual transforaminal endoscopy on β-endorphin, MMPs/TIMPs and prognosis of patients with central lumbar disc herniation

目的探讨偏心导杆结合可视化椎间孔镜术对中央型腰椎间盘突出患者β-内啡肽、基质金属蛋白酶(MMPs)/基质金属蛋白酶组织抑制因子(TIMPs)及预后的影响。方法采用前瞻性研究,选择2017年1月到2020年10月在都江堰市人民医院进行治疗的中央型腰椎间盘突出患者120例,其中男性54例,女性66例;年龄40~55岁,平均年龄50.34岁;体质量指数(BMI)22.12~25.16 kg/m^(2),平均BMI 24.33 kg/m^(2);病程5~9个月,平均病程7.11个月;病灶部位L4~544例,L5~S176例。按照随机分组原则,将以上患者随机分为观察组和对照组,每组患者60例,所有患者均采取可视化椎间孔镜术进行治疗,观察组患者采用偏心导杆结合可视化椎间孔镜术治疗,比较两组患者的治疗效果、疼痛情况、β-内啡肽、MMPs/TIMPs水平之间的差异。结果观察组患者的治疗效果优于对照组(91.67%vs 78.33%),差异有统计学意义(χ^(2)=4.182,P=0.041);经过治疗后,两组患者的腰部视觉模拟量表(VAS)评分、下肢VAS评分均显著下降,且观察组患者腰部VAS评分(0.37分±0.11分vs 0.49分±0.27分)、下肢VAS评分(0.44分±0.12分vs 0.75分±0.23分)显著低于对照组(t=3.188、9.256,P=0.002、0.000);两组患者的β-内啡肽、TIMP1、TIMP2显著升高,MMP1、MMP2、MMP8、MMP9水平显著升高,且观察组患者的β-内啡肽[(455.03±51.22) mg/L vs (414.50±51.37) mg/L](t=4.328,P=0.000)、TIMP1[(286.52±11.81) pg/mL vs (225.49±12.21) pg/mL](t=27.829,P=0.000)、TIMP2[(167.31±21.89) pg/mL vs(126.79±22.06) pg/mL](t=10.099,P=0.000)显著高于对照组,MMP1[(1.16±0.39) ng/mL vs (1.32±0.54) ng/mL](t=3.256,P=0.001)、MMP2[(1.76±1.63) ng/mL vs (2.56±1.38) ng/mL](t=2.901,P=0.004)、MMP8[(78.71±2.12) ng/mL vs(96.54±1.54) ng/mL)(t=52.708,P=0.000)、MMP9[(2.14±0.27) ng/mL vs (3.81±0.26) ng/mL](t=34.511,P=0.000)显著低于对照组。结论中央型腰椎间盘突出患者通过偏心导杆结合可视化椎间孔镜术治疗,患者的β-内啡肽、MMPs/TIMPs显著下降,预后较好,建议临床推广。

Objective To investigate the effect of eccentric guide rod combined with visual transforaminal endoscopy onβ-endorphin,matrix metalloproteinases(MMPs)/tissue inhibitor of matrix metalloproteinases(TIMPs) and prognosis of patients with central lumbar disc herniation.Methods From January 2017 to October 2020,120 patients with central lumbar disc herniation were enrolled,which included 54 males and 66 females,aged 40-55 years old with mean age of 50.34 years old;body mass index(BMI) was 22.12-25.16 kg/m^(2)with mean BMI of 24.33 kg/m^(2);course of disease was 5-9 months with mean value of 7.11 months;44 cases of lesions at L4-5and 76 at L5-S1.According to principle of random grouping,all of the patients were randomly divided into observation group and control group,with 60 cases in each group,and all patients were treated with visual transforaminal endoscopy.The observation group was treated with eccentric guide rod combined with visual transforaminal endoscopy.The treatment effect,pain evaluation,β-endorphin,MMPs/TIMPs levels between 2 groups were compared.Results The treatment effect of observation group(91.67%) was significantly better than that of control group(78.33%),and difference was statistically significant(χ^(2)=4.182,P=0.041);after treatment,lumbar VAS score of observation group[(0.37±0.11) scores vs (0.49±0.27) scores]and lower limb VAS scores[(0.44±0.12) scores vs (0.75±0.23) scores]were significantly lower than those of control group(t=3.188,9.256,P=0.002,0.000).β-endorphin,TIMP1,TIMP2 increased significantly,and levels of MMP1,MMP2,MMP8,and MMP9 increased significantly in both groups.Theβ-endorphin[(455.03±51.22) mg/L vs(414.50±51.37) mg/L](t=4.328,P=0.000),TIMP1[(286.52±11.81) pg/mL vs (225.49±12.21) pg/mL](t=27.829,P=0.000),TIMP2[(167.31±21.89) pg/mL vs (126.79±22.06) pg/mL](t=10.099,P=0.000) in observation group were significantly higher than those in control group.The MMP1[(1.16±0.39) ng/mL vs (1.32±0.54) ng/mL](t=3.256,P=0.001),MMP2[(1.76±1.63)ng/mL vs (2.56±1.38) ng/mL](t=2.901,P=0.004),MMP8[(78.71±2.12) ng/mL vs (96.54±1.54) ng/mL](t=52.708,P=0.000),MMP9[(2.14±0.27) ng/mL vs (3.81±0.26) ng/mL](t=34.511,P=0.000) in observation group were significantly lower than those in control group.Conclusion It is demonstrated that eccentric guide rod combined with visual transforaminal endoscopy in treatment of patients with central lumbar disc herniation could significantly reduceβ-endorphins and MMPs/TIMPs,which with good prognosis and suitable for clinical promotion.