寒湿型LDH疼痛-负面情绪的机制研究
Research on the Mechanism of Pain and Negative Emotion in Cold-Dampness-Type Lumbar Disc Herniation
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摘要: 目的 探讨寒湿型腰椎间盘突出症(LDH)疼痛-负面情绪的潜在机制。方法 收集LDH手术患者23例,根据中医辨证标准分为寒湿组、非寒湿组,获取血清样本各11个和12个,病变椎间盘样本各11个和7个。另收集10例健康体检者血清样本为正常组。ELISA法检测血清白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、5-羟色胺(5-HT)、降钙素相关基因肽(CGRP)、神经肽Y(NPY)、β-内啡肽(β-EP)、P物质(SP)等水平;qPCR、Western blot法检测病变椎间盘5-HT、CGRP、NPY、β-EP等mRNA和蛋白表达。结果 与非寒湿组比较,寒湿组年龄、病程、疼痛和麻木积分无明显差异,但失眠、焦虑积分明显升高(P<0.05)。血清学检测发现,与正常组比较,寒湿组和非寒湿组均出现CGRP显著降低和NPY显著升高(P<0.01)的共性趋势,而寒湿组β-EP也出现特征性显著升高(P<0.01);与非寒湿组比较,寒湿组CGRP降低(P<0.05),而β-EP显著升高(P<0.01)。椎间盘各因子mRNA和蛋白表达比较发现,与非寒湿组比较,寒湿组CGRP mRNA和蛋白表达升高(P<0.05),β-EP mRNA和NPY蛋白表达降低(P<0.05)。结论 与非寒湿证型比较,寒湿型LDH疼痛-负面情绪关系更为密切;CGRP、NPY、β-EP差异性表达于外周血和病变椎间盘,提示上述因子是介导疼痛-负面情绪的重要因子。Abstract: OBJECTIVE To investigate the potential mechanism of pain and negative emotion in cold-dampness-type lumbar disc herniation (LDH). METHODS 23 cases of LDH operation were collected. According to the dialectical standard of Chinese medicine, the patients were divided into cold dampness group and non cold dampness group, 11 and 12 serum samples were respectively obtained, 11 and 7 of the diseased intervertebral discs were respectively collected. The serum samples of 10 healthy persons were collected as normal group. The levels of serum interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), 5- serotonin (5-HT), calcitonin related gene peptide (CGRP), neuropeptide Y (NPY), β-endorphin (β-EP), P substance (SP) were detected by ELISA. The qPCR and Western blot were used to detect the mRNA and protein expression of 5-HT, CGRP, NPY and β-EP in diseased intervertebral discs. RESULTS Compared with the non cold dampness group, there was no significant difference in age, course of disease, pain and numbness score in cold dampness group, but the score of insomnia and anxiety increased significantly (P<0.05). Serological test showed that there was a common trend of significant decrease of CGRP and significant increase of NPY (P<0.01) in both the cold dampness group and the non cold dampness group compared with the normal group, while the β-EP in the cold dampness group was also significantly increased (P<0.01). Compared with the non cold dampness group, the CGRP decreased in the cold dampness group (P<0.05), and the β-EP increased significantly (P<0.01). Compared with the non cold dampness group, the expression of CGRP mRNA and protein increased in the cold dampness group (P<0.05), and the expression of β-EP mRNA and NPY protein decreased (P<0.05) in the cold dampness group. CONCLUSION Compared with the non cold dampness syndrome, the cold-dampness LDH has a closer relationship between pain and negative emotions. CGRP, NPY, and β-EP were differentially expressed in peripheral blood and diseased intervertebral discs, suggesting that these factors play a important role in mediating pain and negative emotions.