Lomber disk hernisi olan hastalarda ağrı şiddeti ile nöroinflamatuar marker ilişkisinin tespit edilmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızda vazoaktif duysal nöropeptidlerden olan Kalsitonin Geni İle İlişkili Peptid (CGRP), P Maddesi (SP), Vazoaktif İntestinal Polipeptid (VİP) ve Hipofiz Adenilat Siklaz Aktive Edici Polipeptid 38 (PACAP38)'in tek seviye lomber disk hernisi (LDH) olan hastalarda mikrodiskektomi operasyonu öncesi ve sonrası alınan kanlarındaki serum düzeyleri ile eş zamanlı visuel analog skalası (VAS) ile sorgulanan radiküler ağrı düzeylerini karşılaştırarak bu nöropeptitlerin LDH'ye bağlı radiküler ağrı ile olan ilişkisini incelemeyi planladık. Gereç ve Yöntem: B.A.İ.B.Ü Tıp Fakültesi Hastanesi Beyin ve Sinir Cerrahi Anabilim dalına kabul edilen 18-70 yaş arası siyataljisi olan lomber manyetik rezonans görüntülemesi (MRG) ile tek seviye lomber disk hernisi tanısı alan ve mikrocerrahi planlanan, daha önce lomber bölgeden operasyon geçirmemiş 30 hasta çalışma grubuna alındı. Kontrol grubuna ise vücudunun herhangi bir bölgesinde ağrısı bulunmayan, analjezik, antiinflamatuar ilaç kullanmayan, bilinen lomber disk hernisi, kronik herhangi bir nöroinflamatuar ve alerjik hastalığı bulunmayan 30 birey seçildi. Seçilen çalışma ve kontrol gruplarının ağrı skorlaması ile yaş, mevcut kronik hastalıkları, sigara, alkol tüketimi ve meslek grupları sorgulanmıştır. Her gruptaki bireylerden yaklaşık 12 cc kan alınmıştır. Kan alınmadan hemen önce hastalar radiküler ağrılarının şiddetini Visuel Analog Skalası kullanarak 0 ile 10 arasında bir sayısal değer ile belirlediler. Alınan tüm kanlar EDTA ve Protease içeren mor kapaklı hemogram tüplerine konuldu. Santrifüj edildikten sonra SP, CGRP, VİP ve PACAP38 isimli vasoaktif nöroinflamatuar markerların ELISA ile ölçümüne kadar – 20oC derecede saklandı. Alınan plazma örneklerindeki nöropeptid (SP, CGRP, VIP ve PACAP38) konsantrasyonlarının ölçümü için örneklerde bulunan immünoreaktif nöropeptid içerikleri kullanılmıştır. Assay protokolü üretici firmanın yönergelerine göre uygulanmıştır. Bulgular: Preoperatif hastaların plazma CGRP, SP, VİP ve PACAP38 düzeyleri kontrol grubuna göre anlamlı derecede artmış olduğu bulundu (p< 0.001, Mann-Whitney U testi). Bununla birlikte aynı hastaların post-operatif dönemde plazma CGRP, SP, VİP düzeyleri pre-operatif dönemlerine göre anlamlı düzeyde azalmış olarak bulundu (p< 0.001, Wilcoxon işaretli-sıralar testi). Diğer taraftan postoperatif dönemde plazma PACAP38 düzeyi preoperatif dönemdeki plazma düzeyine göre anlamlı düzeyde artmış olarak bulundu (p< 0.001, Wilcoxon işaretli-sıralar testi). Preoperatif ve Postoperatif hastaların ortalama VAS ağrı sokuru değerleri ile plazma CGRP, PACAP-38, SP ve VİP değerleri arasında bir korelasyon olmadığı tespit edildi. (p>0.05). Sonuç: Çalışmamızda preoperatif dönemde plazma düzeyleri artan ve postoperatif dönemde azalan CGRP, SP ve VİP'in LDH'de sinir kökü basısına bağlı oluşan nöroinflamasyonda ve buna bağlı oluşan radiküler ağrının patofizyolojisinde önemli rol oynadıklarını ve aynı zamanda kolay ölçülebilir olmaları ile tanıda ve takipte kullanılabilecek birer biyomarker adayı olabileceklerini gösterdik.
Objective: In our study, we compared the serum levels of vasoactive sensory neuropeptides Calcitonin Gene-Related Peptides (CGRP), Substance P (SP) and Vasoactive İntestinal Polypeptide (VIP), Pituitary Adenylate Cyclase Activating Polypeptide 38 (PACAP38) in blood taken before and after microdiscectomy operation in patients with single level lumbar disc herniation (LDH) and radicular pain levels questioned with simultaneous visual analog scale (VAS). We planned to examine those neuropeptides associated with LDH-Induced radicular pain. Materials and Methods: Thirty patients with sciatica, aged between 18-70 years, who were admitted to B.A.İ.B.Ü Medical Faculty Hospital, Department of Neurosurgery, diagnosed with single level lumbar disc herniation by lumbar MRI and planned for microsurgery, and who had not undergone any previous operation in the lumbar region were included in the study group. The control group included 30 healthy individuals who did not have pain in any region, did not use analgesic anti-inflammatory drugs, did not have known lumbar disc herniation, any chronic neuroinflammatory disease and allergic disease. Age, existing chronic diseases, smoking, alcohol consumption and occupational groups were also questioned by scoring the pain of the selected patient and control groups. Approximately 12 cc of blood was taken from each group. The severity of radicular pain of patients just before blood collection was determined with a numerical value between 0 and 10 using the Visual Analogue Scale. All the collected blood was placed in purple capped hemogram tubes in tubes containing EDTA and Protease. After centrifugation, SP, CGRP, VIP and PACAP38 vasoactive neuroinflammatory markers were stored at -20oC until measurement by ELISA. Immunoreactive neuropeptide contents of the samples were used for the measurement of neuropeptide (SP, CGRP, VIP and PACAP38) concentrations in the collected plasma samples. Assay protocol was applied according to the manufacturer's instructions. Findings: Plasma CGRP, SP, VIP and PACAP38 levels of pre-operative patients were found to be significantly increased compared to the control group (p< 0.001, Mann-Whitney U test). On the other hand, plasma CGRP, SP and VIP levels of the same patients were found to be significantly decreased in the post-operative period compared to their pre-operative periods (p< 0.001, Wilcoxon signed-rank test). Plasma PACAP38 level in the post-operative period was found to be significantly increased compared to the plasma level in the preoperative period (p< 0.001, Wilcoxon signed-row test). It was determined that there was no significant correlation between the mean VAS pain socket values of the preoperative and postoperative patients and the plasma CGRP, SP, PACAP-38 and VIP values. (p>0.05). Results: In our study, we showed that CGRP, SP and VIP, whose plasma levels increase in the preoperative period and decrease in the postoperative period, play an important role in the neuroinflammation caused by nerve root compression in LDH and in the pathophysiology of radicular pain, and also we showed that they can be biomarker candidates that can be used in diagnosis and follow-up as they are easily measurable.
Objective: In our study, we compared the serum levels of vasoactive sensory neuropeptides Calcitonin Gene-Related Peptides (CGRP), Substance P (SP) and Vasoactive İntestinal Polypeptide (VIP), Pituitary Adenylate Cyclase Activating Polypeptide 38 (PACAP38) in blood taken before and after microdiscectomy operation in patients with single level lumbar disc herniation (LDH) and radicular pain levels questioned with simultaneous visual analog scale (VAS). We planned to examine those neuropeptides associated with LDH-Induced radicular pain. Materials and Methods: Thirty patients with sciatica, aged between 18-70 years, who were admitted to B.A.İ.B.Ü Medical Faculty Hospital, Department of Neurosurgery, diagnosed with single level lumbar disc herniation by lumbar MRI and planned for microsurgery, and who had not undergone any previous operation in the lumbar region were included in the study group. The control group included 30 healthy individuals who did not have pain in any region, did not use analgesic anti-inflammatory drugs, did not have known lumbar disc herniation, any chronic neuroinflammatory disease and allergic disease. Age, existing chronic diseases, smoking, alcohol consumption and occupational groups were also questioned by scoring the pain of the selected patient and control groups. Approximately 12 cc of blood was taken from each group. The severity of radicular pain of patients just before blood collection was determined with a numerical value between 0 and 10 using the Visual Analogue Scale. All the collected blood was placed in purple capped hemogram tubes in tubes containing EDTA and Protease. After centrifugation, SP, CGRP, VIP and PACAP38 vasoactive neuroinflammatory markers were stored at -20oC until measurement by ELISA. Immunoreactive neuropeptide contents of the samples were used for the measurement of neuropeptide (SP, CGRP, VIP and PACAP38) concentrations in the collected plasma samples. Assay protocol was applied according to the manufacturer's instructions. Findings: Plasma CGRP, SP, VIP and PACAP38 levels of pre-operative patients were found to be significantly increased compared to the control group (p< 0.001, Mann-Whitney U test). On the other hand, plasma CGRP, SP and VIP levels of the same patients were found to be significantly decreased in the post-operative period compared to their pre-operative periods (p< 0.001, Wilcoxon signed-rank test). Plasma PACAP38 level in the post-operative period was found to be significantly increased compared to the plasma level in the preoperative period (p< 0.001, Wilcoxon signed-row test). It was determined that there was no significant correlation between the mean VAS pain socket values of the preoperative and postoperative patients and the plasma CGRP, SP, PACAP-38 and VIP values. (p>0.05). Results: In our study, we showed that CGRP, SP and VIP, whose plasma levels increase in the preoperative period and decrease in the postoperative period, play an important role in the neuroinflammation caused by nerve root compression in LDH and in the pathophysiology of radicular pain, and also we showed that they can be biomarker candidates that can be used in diagnosis and follow-up as they are easily measurable.
Açıklama
Tıp Fakültesi, Beyin ve Sinir Cerrahisi Ana Bilim Dalı
Anahtar Kelimeler
Nöroşirürji, Neurosurgery
