腰椎间盘突出症患者手术前后血清MMP-2和MMP-9水平的变化及其对疼痛感知的影响

Effect of changes of serum metalloproteinase-2 and metalloproteinase-9 levels on pain perception in patients with lumbar disc herniation before and after surgery

目的探讨腰椎间盘突出症(LDH)患者手术前后血清基质金属蛋白酶-2(MMP-2)和金属蛋白酶-9(MMP-9)水平的变化及其对疼痛感知的影响。方法选择2021年1月~2022年6月在该院接受手术的78例LDH患者作为研究组,抽取同期在该院健康体检的78例受试者作为对照组。观察两组患者血清MMP-2、MMP-9、金属蛋白酶组织抑制因子(TIMP)-1、TIMP-2水平,观察LDH患者术前、术后1个月、术后3个月时的MMP-2、MMP-9、TIMP-1、TIMP-2水平,观察患者MMP-2、MMP-9、TIMP-1、TIMP-2水平与McGill疼痛问卷(SF-MPQ)得分的相关性。结果研究组术前MMP-2、TIMP-2水平均高于对照组(P<0.05),两组MMP-2/TIMP-2水平差异无统计学意义(P>0.05)。研究组术前MMP-9/TIMP-1水平低于对照组,TIMP-1水平高于对照组,差异均有统计学意义(P<0.05)。术前、术后3个月时,研究组MMP-2、TIMP-2、MMP-2/TIMP-2、MMP-9、TIMP-1、MMP-9/TIMP-1水平与患者腰痛视觉模拟评分(VAS-B)、腿痛视觉模拟评分(VAS-L)、PRI、PPI评分均不存在显著相关性(P>0.05)。研究组患者术后1个月、3个月时MMP-2、TIMP-1、TIMP-2水平均高于术前(P<0.05),术后1个月、3个月时MMP-2/TIMP-2水平和MMP-9/TIMP-1水平均低于术前(P<0.05);研究组患者术后1个月、3个月时MMP-9水平差异无统计学意义(P>0.05)。结论MMP-2和MMP-9水平不能解释LDH患者的疼痛及术后疼痛缓解作用,MMPs作为LDH患者疼痛治疗潜在靶点的价值应谨慎考虑。

Objective To investigate the effect of changes in serum matrix metalloproteinase-2(MMP-2)and matrix metalloproteinase-9(MMP-9)levels on pain perception in patients with lumbar disc herniation(LDH)before and after surgery.Methods 78 patients with LDH who underwent surgery in our hospital from January 2021 to June 2022 were selected as the study group,and 78 subjects who underwent physical examination in our hospital at the same time were selected as the control group.The serum levels of MMP-2,MMP-9,tissue inhibitor of metalloproteinase(TIMP)-1 and TIMP-2 were observed in the two groups.The levels of MMP-2,MMP-9,TIMP-1 and TIMP-2 were observed before operation,1 month after operation and 3 months after operation in patients with LDH.The correlation between the levels of MMP-2,MMP-9,TIMP-1,TIMP-2 and McGill Pain Questionnaire(SF-MPQ)was observed.Results The levels of MMP-2 and TIMP-2 in the study group were higher than those in the control group(P<0.05),but there was no significant difference in MMP-2/TIMP-2 between the two groups(P>0.05).The level of MMP-9/TIMP-1 in the study group(before surgery)was lower than that in the control group,and the level of TIMP-1 was higher than that in the control group,with statistical significance(P<0.05).There was no significant correlation between the levels of MMP-2,TIMP-2,MMP-2/TIMP-2,MMP-9,TIMP-1,MMP-9/TIMP-1 and VAS-B,VAS-L,PRI,PPI of patients before and 3 months after surgery(P>0.05).The levels of MMP-2 and TIMP-2 in patients with LDH at 1 month and 3 months after operation were higher than those before operation(P<0.05),and the levels of MMP-2 and TIMP-2 at 1 month and 3 months after operation were lower than those before operation(P<0.05).There was no significant difference in the level of MMP-9 in patients with LDH at 1 month and 3 months after operation(P>0.05).The level of TIMP-1 at 1 month and 3 months after operation was higher than that before operation(P<0.05),and the level of MMP-9/TIMP-1 was lower than that before operation(P<0.05).Conclusions The levels of MMP-2 and MMP-9 can not explain the pain and its relief effect in patients with LDH.The value of MMPs as potential targets for pain treatment in patients with LDH should be carefully considered.