腰椎间盘突出症的经椎间孔硬膜外类固醇注射：与微小RNA-155血清水平相关的对疼痛强度和认知功能的影响

Transforaminal Epidural Steroid Injection in Lumbar Disc Prolapse: Impact on Pain Intensity and Cognitive Function in Relation to MicroRNA-155 Serum Level.

作者信息

Fathy Wael, Hussein Mona, Magdy Rehab, Nasser Mona, Mohamed Jehan, Sayem Doaa Moaz, Elmoutaz Hatem, Mounir Nesma, Fakhry Dina Mahmoud, Abdelbadie Mohamed

机构信息

Department of Anesthesiology, Surgical Intensive Care and Pain Management, Beni-Suef University, Beni-Suef, Egypt.

Department of Neurology, Beni-Suef University, Beni-Suef, Egypt.

出版信息

Anesthesiol Res Pract. 2025 Apr 7;2025:2201031. doi: 10.1155/anrp/2201031. eCollection 2025.

DOI:10.1155/anrp/2201031

PMID:40230811

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11996268/

Abstract

Lumbar disc prolapse is a common cause of disabling low back pain. The prevalence of disc prolapses or herniation in the general population increases with age. This work aimed to evaluate the impact of transforaminal epidural steroid injection (TFESI) in lumbar disc prolapse on pain intensity, cognitive function, and miR-155 serum level. The present case-control study was conducted on 44 patients with symptomatic lumbar disc prolapse (L4-L5) and another 44 age- and sex-matched controls. Assessment of the pain intensity and functional disability was done before and 1 month after TFESI using the numeric rating scale (NRS), Oswestry disability index (ODI), and functional rating index (FRI). Cognitive assessment was done before and 1 month after TFESI. Estimation of miR-155 serum level was done for the included patients (before and 1 month after TFESI) and controls. There was a statistically significant improvement in pain scales and cognitive test scores 1 month following TFESI ( value ≤ 0.05 in all comparisons). There was also a statistically significant reduction in miRNA-155 serum level in the included patients one month following TFESI ( value < 0.001). The median values for the change in NRS were 2 (1-4.75), in ODI were 18 (7-33), in FRI were 23.5 (12-31), in PALT were 1 (0-1.5), in COWAT were 2 (0.25-5), in PASAT were 3 (1.25-4), and in miRNA-155 were 0.555 (0.16-0.738). There were statistically significant correlations between miRNA-155 serum levels in the included patients and the scores of all the pain and disability scales (NRS, ODI, and FRI) and the scores of all the cognitive tests before TFESI ( value ≤ 0.05 in all correlations). This study highlights the epigenetic mechanisms of TFESI in lumbar disc prolapse, causing significant downregulation of miRNA-155, reduced pain intensity, and improved cognitive function. ClinicalTrials.gov identifier: NCT05626283.

摘要

腰椎间盘突出是导致致残性腰痛的常见原因。普通人群中椎间盘突出或疝出的患病率随年龄增长而增加。这项研究旨在评估经椎间孔硬膜外类固醇注射（TFESI）治疗腰椎间盘突出对疼痛强度、认知功能和miR-155血清水平的影响。本病例对照研究纳入了44例有症状的腰椎间盘突出症（L4-L5）患者以及另外44例年龄和性别匹配的对照。在TFESI治疗前和治疗后1个月，使用数字评分量表（NRS）、Oswestry功能障碍指数（ODI）和功能评定指数（FRI）评估疼痛强度和功能障碍。在TFESI治疗前和治疗后1个月进行认知评估。对纳入患者（TFESI治疗前和治疗后1个月）及对照进行miR-155血清水平测定。TFESI治疗1个月后，疼痛量表评分和认知测试分数有统计学意义的改善（所有比较中P值≤0.05）。TFESI治疗1个月后，纳入患者的miRNA-155血清水平也有统计学意义的降低（P值<0.001）。NRS变化的中位数为2（1-4.75），ODI为18（7-33），FRI为23.5（12-31），PALT为1（0-1.5），COWAT为2（0.25-5），PASAT为3（1.25-4），miRNA-155为0.555（0.16-0.738）。纳入患者的miRNA-155血清水平与所有疼痛和功能障碍量表（NRS、ODI和FRI）的评分以及TFESI治疗前所有认知测试的评分之间存在统计学意义的相关性（所有相关性中P值≤0.05）。本研究强调了TFESI治疗腰椎间盘突出的表观遗传机制，即导致miRNA-155显著下调、疼痛强度降低和认知功能改善。ClinicalTrials.gov标识符：NCT05626283。