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腰椎间盘突出症经椎间孔镜治疗术后残留腰腿痛的分子机制研究

摘要点击次数: 1410 全文下载次数: 383 投稿时间：2023-10-19

作者	Author	单位	Address	E-Mail
杨坤	YANG Kun	安徽省界首市人民医院中医科, 安徽界首 236500	Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
陈子龙	CHEN Zi-long	安徽省界首市人民医院中医科, 安徽界首 236500	Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
陈衍熙	CHEN Yan-xi	安徽省界首市人民医院中医科, 安徽界首 236500	Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
任利军	REN Li-jun	安徽省界首市人民医院中医科, 安徽界首 236500	Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
侯雷	HOU Lei	贵州中医药大学第二附属医院风湿免疫科, 贵州贵阳 550003	Department of Rheumatology and Immunology, the Second Hospital Affiliated to Guizhou University of TCM, Guiyang 550003, Guizhou, China	houleigzzyydx@126.com

期刊信息：《中国骨伤》2024年，第37卷，第2期，第159-165页

DOI：10.12200/j.issn.1003-0034.20230558

基金项目:贵州省科技厅科技计划项目（编号：20201Y383）；阜阳市卫生健康委员会科研项目（编号：FY2021-186）

中文摘要:

目的：探讨低氧诱导因子-1α（hypoxia inducible factor-1 α，HIF-1α）和瞬时受体电位香草酸1（transient receptor potential vanillate 1，TRPV1）通路在包含型（contained type，CT）和非包含型（non-contained type，NCT）腰椎间盘突出症（lumbar disc herniation，LDH）经椎间孔镜髓核摘除术后腰腿痛残留中发挥的作用。

方法：选取2021年7月至2022年10月收治的单节段LDH患者68例，男44例，女24例；年龄26~67（43.63±11.94）岁；病程4~36（18.91±10.34）个月；身体质量指数（24.45±4.00） kg·m^-2；L_3，4节段7例，L_4，5节段32例，L₅S₁节段29例；均采用经皮椎间孔镜髓核摘除手术治疗，并据术中观察椎间盘纤维环外层的完整性分为包含型组（CT组）和非包含型组（NCT组）各34例。收集同期采用脊柱侧弯矫形或椎体骨折开放手术治疗的17例作为对照组，男12例，女5例；年龄21~65（39.41±12.80）岁；身体质量指数（24.86±4.11） kg·m^-2。采用实时荧光定量PCR法检测髓核HIF-1α、TRPV1 mRNA相对表达量。采用ELISA法检测髓核神经激肽1受体（neurokinin 1 receptor，NK1R）、神经生长因子（nerve growth factor，NGF）、血管内皮生长因子（vascular endothelial growth factor，VEGF）及血清P物质（substance P，SP）、降钙素基因相关肽（calcitonin gene-related peptide，CGRP）蛋白含量。采用压力测痛仪检测患者腰压痛阈值。分别采用视觉模拟评分（visual analog scale，VAS）刻度表和Oswestry功能障碍指数（Oswestry disability index，ODI）评估患者腰腿痛程度和腰椎功能。评价患者术后腰腿痛残留率。

结果：各组髓核HIF-1α、TRPV1 mRNA相对表达量和NK1R、NGF、VEGF含量及术前血清SP、CGRP水平比较，NCT组均高于CT组（P<0.05），CT组均高于对照组（P<0.05）。术后7 d时，两LDH组血清SP、CGRP水平及腰腿痛VAS、腰椎ODI均较术前降低（P<0.05），且NCT组均高于CT组（P<0.05），NCT组腰压痛阈值低于CT组（P<0.05）。NCT组腰腿痛VAS、腰椎ODI、腰压痛阈值术前与术后7 d差值均低于CT组（P<0.05）。NCT组术后7 d腰腿痛残留率高于CT组（P<0.05）。

结论：HIF-1α和TRPV1通路促进髓核NGF、VEGF、NK1R及血清神经肽SP、CGRP过量产生，可能导致非包含型腰椎间盘突出症较高的术后腰腿痛残留率。

【关键词】非包含型腰椎间盘突出症腰压痛阈值术后残留症状神经肽

Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation

ABSTRACT

Objective To observe the residual of lumbago and leg pain with contained type (CT) and non-contained type (NCT) lumbar disc herniation (LDH) after transforaminal endoscopic treatment, and to explore the role of hypoxia-inducible factor-1α(HIF-1α) and transient receptor potential vanillate 1(TRPV1) pathway.

Methods A total of 68 single-segment LDH patients were selected from July 2021 to October 2022, including 44 males and 24 females;aged 26 to 67 years old with an average of(43.63±11.94) years old;course of disease was 4 to 36 (18.91±10.34) months;body mass index was (24.45±4.00) kg·m^-2;there were 7 cases of L_{3, 4} segments, 32 cases of L_{4, 5} segments, and 29 cases of L₅S₁ segments. All of them were performed with percutaneous intervertebral endoscopic extraction of nucleus pulposus and were divided into contained group(CT group) and non-contained group (NCT group) with 34 cases respectively according to the integrity of outer layer of fibrous annulus observed during operation. A total of 17 patients who underwent open surgery for scoliosis or vertebral fracture were selected as control group, including 12 males and 5 females;aged 21 to 65 years old with an average of (39.41±12.80) years old;body mass index was (24.86±4.11) kg·m^-2. The relative mRNA expression quantity of HIF-1α, TRPV1 in nucleus pulposus were measured by quantitative real-time PCR. The contents of neurokinin 1 receptor (NK1R), nerve growth factor (NGF), vascular endothelial growth factor (VEGF) in nucleus pulposus and the serum substance P (SP) and calcitonin gene-related peptide (CGRP) were detected by enzyme linked immunosorbent assay (ELISA). The threshold of lumbar tenderness was detected by a pressure pain meter. The degree of lumbago and lumbar function were evaluated by visual analog scale (VAS) and Oswestry disability index (ODI) separately. The residual rate of postoperative lumbago and leg pain was assessed.

Results The mRNA relative expression quantity of HIF-1α and TRPV1, and the contents of NK1R, NGF and VEGF in nucleus pulposus, and the levels of serum SP and CGRP before surgery in the NCT group were higher than those in the CT group(P<0.05), and those in the CT group were higher than the control group(P<0.05). At day 7 after surgery, the serum SP and CGRP levels, lumbago and leg pain VAS scores and lumbar ODI index in two LDH groups were lower than before surgery (P<0.05), and those in the NCT group were higher than the CT group(P<0.05), and the threshold of lumbar tenderness in the NCT group was lower than the CT group(P<0.05). The differences of lumbago and leg pain VAS scores, lumbar ODI index and lumbar tenderness threshold between preoperative and postoperative 7 days in the NCT group were lower than those in the CT group(P<0.05). The residual rate of lumbago and leg pain at 7 days after surgery in the NCT group was higher than that in the CT group(P<0.05).

Conclusion HIF-1α and TRPV1 pathway promoted the excessive production of NGF, VEGF, NK1R in nucleus pulposus and serum neuropeptides SP and CGRP, which may lead to the higher residual rate of lumbago and leg pain with non-contained lumbar disc herniation postoperative.

KEY WORDS Non-contained type lumbar disc herniation Threshold of lumbar tenderness Postoperative residual symptom Neuropeptide

引用本文，请按以下格式著录参考文献：

中文格式:	杨坤,陈子龙,陈衍熙,任利军,侯雷.腰椎间盘突出症经椎间孔镜治疗术后残留腰腿痛的分子机制研究[J].中国骨伤,2024,37(2):159~165
英文格式:	YANG Kun,CHEN Zi-long,CHEN Yan-xi,REN Li-jun,HOU Lei.Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(2):159~165

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