星状神经节阻滞对帕金森疼痛患者VAS评分炎症指标及JAK/STAT3信号通路的影响

Effect of stellate ganglion block on pain VAS score,inflammatory indexes and JAK/STAT3 signaling pathway in patients with Parkinson’s pain

目的 探讨星状神经节阻滞对帕金森疼痛患者VAS评分、炎症指标及Janus激酶(JAK)/信号转导及转录激活因子3(STAT3)信号通路影响。方法 参考电脑随机数字表法,按1∶1试验原则将2020-04—2022-05厦门大学附属中山医院的80例帕金森疼痛患者随机分为药物组和阻滞组各40例。药物组给予常规药物治疗,阻滞组在此基础上给予星状神经节阻滞。比较2组视觉模拟评分法(VAS)评分、30项帕金森病非运动症状筛查问卷(NMSS)、39项帕金森病生活质量量表(PDQ-39)、血疼痛物质[5-羟色胺(5-HT)、血清P物质(SP)、神经肽Y(NPY)、前列腺素E_2(PGE_2)、去甲肾上腺素(NE)、β-内啡肽(β-EP)]、炎症指标[白介素-2(IL-2)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、可溶性IL-2受体(s IL-2R)、可溶性IL-6受体(sIL-6R)]、磷酸化JAK(p-JAK mRNA)、磷酸化STAT3(p-STAT3 mRNA)、不良反应。结果 阻滞组治疗后疼痛VAS评分、NMSS评分、PDQ-39评分低于药物组(P<0.05);阻滞组治疗后5-HT、SP、NPY、PGE2、NE低于药物组,β-EP高于药物组(P<0.05);阻滞组治疗后IL-2、IL-6、IL-8、TNF-α、sIL-2R、sIL-6R低于药物组(P<0.05);阻滞组治疗后p-JAK mRNA、p-STAT3 mRNA低于药物组(P<0.05);阻滞组不良反应发生率5.00%(2/40)与药物组10.00%(4/40)比较,差异无统计学意义(P>0.05)。结论 星状神经节阻滞可有效抑制疼痛因子合成,增加镇痛因子合成,缓解帕金森疼痛,改善非运动症状,提高生活质量,其机制可能与抑制炎症反应和JAK/STAT3信号通路活化有关。

Objective To investigate the effect of stellate ganglion block on pain VAS score,inflammatory indexes and Janus kinase(JAK)/signal transducer and activator of transcription 3(STAT3)signaling pathway in patients with Parkinson’s pain.Methods Referring to the computer random number table method,according to the principle of 1∶1 experiment,80 patients with Parkinson’s pain from April 2020 to May 2022 were randomly di⁃vided into a drug group and a block group,with 40 cases in each group.The drug group was given routine drug treatment,and the block group was given stellate ganglion block on this basis.The visual analogue scale(VAS)score,30-item Parkinson’s disease non-motor symptom screening questionnaire(NMSS),39-item Parkinson’s disease quality of life scale(PDQ-39),blood pain substance[5-hydroxytryptamine(5-HT),serum substance P(SP),neuropeptide Y(NPY),prostaglandin E2(PGE2),norepinephrine(NE),β-endorphin(β-EP)],inflammatory markers[interleukin-2(IL-2),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),solu⁃ble IL-2 receptor(sIL-2R),soluble IL-6 receptor(sIL-6R)],phosphorylated JAK(p-JAK mRNA),phosphorylated STAT3(p-STAT3 mRNA),adverse reactions were compared between the two groups.Results The pain VAS score,NMSS score and PDQ-39 score of the block group after treatment were lower than those of the drug group(P<0.05).EP was higher than that in the drug group(P<0.05).IL-2,IL-6,IL-8,TNF-α,sIL-2R,sIL-6R in the block group after treatment were lower than those in the drug group(P<0.05).After treatment,the p-JAK mRNA and p-STAT3 mRNA in the blocking group were lower than those in the drug group(P<0.05).The incidence of adverse reactions in the blocking group was 5.00%(2/40)compared with 10.00%(4/40)in the drug group,the difference wasn’t statistically significant(P>0.05).Conclusion Stellate ganglion block can effectively inhibit the synthesis of pain factors,increase the synthesis of analgesic factors,relieve Parkinson’s pain,improve non-mo⁃tor symptoms,and improve quality of life.The mechanism may be related to the inhibition of inflammatory re⁃sponse and the activation of JAK/STAT3 signaling pathway.