MED对血清炎性细胞因子影响临床的研究.pdf

天血清IL-6 浓度两组均较术前明显升高(MED P ＝0.001 ，OD P0.001) ，OD 组 明显高于MED 组 (P=0.001) 。至术后3 天稍有下降但是仍维持在较高水平（MED P=0.031,OD P=0.021 ），OD 组仍高于MED 组（P=0.004 ），术后5 天，两组IL-6 浓 度下降至术前水平。术后1 天两组病例血清 CRP 浓度均较术前明显升高（MED P ＝0.001 ，OD P0.001) ，OD 组明显高于MED 组（P0.001 ），术后3 天OD 组 仍高于MED 组（P=0.002 ），术后5 天血清CRP 浓度明显下降至术前水平两组 无差异。 3．用 Spearman 秩相关分析分析TNF-α、IL-2、IL-6、CRP 和术中参数相 关关系，发现IL-6 和术中出血有正相关关系(r = 0.456，P ＝0.003) ，CRP 和术中 出血也有正相关关系(r = 0.377，P=0.018) 。IL-6 、CRP 和其他术中参数无相关关 系，TNF-α、IL-2 和本研究所有术中参数均无相关关系。 结论： 1．后路椎间盘镜下椎间盘切除术与传统开放腰椎间盘切除术相比具有切口 小、出血少、局部症状轻等优势；同时可取得和传统手术相当的临床效果。 2．后路椎间盘镜下腰椎间盘切除术与传统开放腰椎间盘切除术相比，MED 血清炎性细胞因子反应更小，全身创伤应激反应小于开放手术；对机体免疫系统 影响小。 3．术中出血可能是影响腰椎间盘切除手术创伤应激反应大小的因素。 关键词：腰椎间盘突出症，显微内窥镜下腰椎间盘切除术，手术应激反应，细 胞因子，C-反应蛋白。 3 The clinical study of the effect of MED on serum proinflammation cytokine Abstract Objective: This study was to investigate whether the Microendoscopic discectomy ( MED) technique had the minimally impact on systemic response , which had the minimal local invasive. By comparing variations in cytokine levels of patients following microendoscopic discectomy ( MED) versus open lumbar discectomy (OD) and observing surgical stress response, a quantitative comparison of surgical trauma result from MED and OD was performed through analyzing systemic immune response. Methods ： 40 patients who underwent procedure were prospectively randomized assigned to Microendoscopic discectomy group ( MED, N = 20) and open lumbar discectomy group (OD, N = 20) from April 2005 to June 2006. The serum sample of peripheral blood were collected before surgery and 1st, 3rd, 5th day after surgery. Concentrations of interleukin-6 (IL-6),