椎体成形术后疼痛缓解与认知功能、血液中COR和ACTH变化的相关性研究

Study on the correlation between pain relief and cognitive function,plasma COR and ACTH after percutaneous vertebroplasty

目的探讨经皮椎体成形术治疗老年女性骨质疏松椎体压缩性骨折患者疼痛缓解后认知功能的改变与血液皮质醇COR与促肾上腺皮质激素ACTH水平变化的相关性,为经皮椎体成形术治疗骨质疏松症椎体压缩性骨折的患者生活质量改善提供理论依据。方法选择2016年12月—2017年10月本院老年女性患者40例作为研究对象,年龄65-75岁,平均(71.72±6.02)岁,记录入院时、手术后第1天和手术后第5天疼痛视角模拟VAS评分,简明精神状态量表MSSE问卷评分,并检测血液中COR、ACTH含量,比较治疗前后VAS评分、MSSE评分及血液中COR、ACTH水平的变化。同时比较治疗前后疼痛VAS评分,MSSE问卷评分与相应时段血液中COR、ACTH水平的相关性。结果入院时、术后第1天及第5天疼痛VAS评分分别(7.05±1.38)分、(1.73±1.04)分、(1.39±1.04)分。与入院时比较,术后第1天明显降低,疼痛明显缓解,差异有统计学意义(P<0.01);入院时、术后第1天及第5天MSSE评分分别为(20.82±5.50)分、(22.11±5.11)分及(23.95±4.86)分。与入院时比较,术后第1天和第5天MSSE评分均升高,认知功能较术前改善,差异有统计学意义(P<0.05);血液COR含量分别为(402.50±221.22)nmol/L,(74.96±132.18)nmol/L和(302.52±197.94)nmol/L,与术前比较,术后第1天,明显降低,差异有统计学意义(P<0.05);术后第5天,COR又升高,但入院时相比,仍然较低,差异有统计学意义(P<0.05);血液中ACTH含量分别为(5.14±4.05)pmol/L,(1.40±1.52)pmol/L和(9.84±15.65)pmol/L,与入院时相比,术后第1天血液中ACTH含量明显下降,差异有统计学意义(P<0.05);术后第5天,与入院时比较,明显升高,差异有统计学意义(P<0.05);与术后第天1相比,也明显升高,差异有统计学意义(P<0.05)。同时发现,血液中COR的水平与疼痛VAS评分降低的相关系数为0.306(P<0.05),呈正相关,MSSE问卷评分也与疼痛VAS评分降低程度的相关系数为-0.804(P<0.05),呈负相关。结论椎体压缩性骨折后疼痛可以加重认知功能障碍,椎体成形术可以明显缓解疼痛,并且改善认知功能障碍。COR和ACTH参与疼痛对骨质疏松症椎体压缩性骨折患者认知功能障碍的改善。

Objective To explore the correlation between cognitive function alter and change of level of COR and ACTH after pain relief in elder women with Osteoporotic vertebral compression fractures those treated with percutaneous vertebroplasty.To provide a theoretical basis for improving the quality of life of patients with osteoporosis vertebral compression fracture treated by percutaneous vertebroplasty.Methods 40 elderly female patients(aged range from 65 to 75 years,71.2 years on average)those were admitted to our hospital from December 2016 to October 2017 were enrolled in this study.The pain perspective simulated VAS score,and score of Mini-Mental State Examinationscale(MMSE)at admission,on the 1st and 5th day after surgery were recorded.The contents of COR and ACTH in blood were detected.The MMSE score,VAS score,and the levels of serum COR and ACTH were compared before and after treatment.The correlation between VAS score and MMSE score and COR and ACTH levels were compared.Results The VAS scores at admission,1st day and 5th day after operation were(7.05±1.38),(1.73±1.04)and(1.39±1.04),respectively.Compared with the VAS score at admission,the VAS score at the 1st day after operation was significantly decreased,and the pain was significantly relieved(P<0.01).The score of MSSE questionnaire survey were(20.82±5.50),(22.11±5.11)and 23.95±4.86,respectively at admission,1stand 5th day after operation.Compared with those before treatment,the MMSE scores at 1st and 5th day after operation were increased,cognitive function was improved compared with that before surgery,and the difference was statistically significant(P<0.05).Serum COR content in blood was(402.50±221.22)nmol/L,(74.96±132.18)nmol/L and(302.52±197.94)nmol/L at admission,1st day and 5th day after operation,respectively,which were significantly decreased on the first day after surgery compared with that before surgery,with statistical significance(P<0.05);On day 5 postoperative,COR was elevated again,but it was still significantly lower than that at admission(P<0.05).The contents of ACTH in blood were(5.14±4.05)pmol/L,(1.40±1.52)pmol/L and(9.84±15.65)pmol/L at admission,1st day and 5th day after operation,respectively.Compared with that admission,the ACTH content in blood decreased significantly on postoperative day 1,the difference was statistically significant(P<0.05).Compared with those at admission and on the 1st day after surgery,the content of serum ACTH was significantly increased,the difference was statistically significant(P<0.05).Serum concentration of COR was positively correlated with the decrease of VAS score(r=0.306,P<0.05),and MMSE score was negatively correlated with the decrease of VAS score(r=-0.804,P<0.05).Conclusions Pain after a vertebral compression fracture could worsen cognitive dysfunction,and percutaneous vertebroplasty could significantly alleviate pain and improve cognitive dysfunction.COR and ACTH are involved in improvement of cognitive dysfunction induced by pain in patients with osteoporotic vertebral compression fractures.