黄韧带中成纤维细胞生长因子1、血管内皮生长因子表达与腰椎管狭窄患者腰椎减压术后再狭窄的关系

doi:10.3969/j.issn.1006-5725.2023.18.001

Abstract

Abstract:

Objective To investigate the relationship between the expressions of fibroblast growth factor 1 （FGF?1） and vascular endothelial growth factor （VEGF） in the ligamentum luteum in patients with lumbar spinal stenosis （LSS） and restenosis after decompression. Methods 138 LSS patients underwent lumbar decompression were selected， including mild group ［absolute claudication distance （ACD） ≤ 200 m， 41 cases］， moderate group （ACD 201 ~ 400 m， 67 cases） and severe group （ACD > 400 m， 30 cases）， and 138 non?LSS patients were selected as control group. The expressions of FGF?1 and VEGF in ligamentum flavum were detected， and the restenosis was measured after the operation. Results The expression of FGF?1 in LSS group was lower than that in control group （P < 0.001）， and the expression of VEGF was higher than that in control group （P < 0.001）. The expression of FGF?1 in severe group was lower than that in moderate and low degree groups （P < 0.05）， and the expression of VEGF was higher than that in moderate and low degree groups （P < 0.05）. Severe spinal stenosis， incomplete decompression and high expression of VEGF were risk factors for restenosis after lumbar decompression in patients with LSS （P < 0.05，P < 0.001）， and FGF?1 was protective factor （P < 0.05）. Conclusion FGF?1 expression decreased and VEGF expression increased in ligamentum flavum of LSS patients， which was related to the degree of spinal canal stenosis and postoperative restenosis.

Key words: lumbar spinal stenosis, lumbar decompression, fibroblast growth factor 1, vascular endothelial growth factor

CLC Number:

R681.5+7

Yaoxin CHEN,Songbo LI,Guanjun FANG,Guobiao YE,Xianyin. LIU. Analysis of the relationship between FGF⁃1 and VEGF expression in the ligamentum flavum of patients with lumbar spinal stenosis and restenosis after decompression[J]. The Journal of Practical Medicine, 2023, 39(18): 2289-2293.

Figures/Tables 4

Tab.1

Tab.2

Tab.3

Analysis of factors affecting restenosis after lumbar decompression in LSS patients"

项目	再狭窄组（n = 48）	无再狭窄组（n = 88）	t/χ² 值	P值
年龄（岁）	58.32 ± 6.02	53.02 ± 5.09	5.433	< 0.001
性别［例（%）］			4.407	0.036
男	35（72.92）	48（54.55）
女	13（27.08）	40（45.45）
体质量指数（kg/m²）	23.12 ± 0.69	23.05 ± 0.51	0.673	0.502
吸烟史［例（%）］	30（62.50）	36（40.91）	5.797	0.016
饮酒史［例（%）］	21（43.75）	30（34.09）	1.236	0.266
基础疾病［例（%）］
高血压	23（47.92）	32（36.36）	1.721	0.190
糖尿病	30（62.50）	29（32.95）	11.038	0.001
高脂血症	19（39.58）	26（29.55）	1.434	0.235
LSS病程（个月）	10.21 ± 2.03	7.12 ± 1.69	9.480	< 0.001
临床症状［例（%）］
腰痛	42（87.50）	80（90.91）	0.391	0.532
下肢痛	40（83.33）	79（89.77）	1.178	0.278
间歇性跛行	21（43.75）	33（37.50）	0.507	0.477
下肢肌力减退	10（20.83）	16（18.18）	0.141	0.707
LSS侧别［例（%）］			1.288	0.256
单侧	31（64.58）	65（73.86）
双侧	17（35.42）	23（26.14）
LSS椎管狭窄程度分级［例（%）］			20.301	< 0.001
轻中度	27（56.25）	79（89.77）
重度	21（43.75）	9（10.23）
手术部位［例（%）］			0.213	0.899
L_3-4	10（20.83）	16（18.18）
L_4-5	32（66.67）	62（70.45）
L₅-S₁	6（12.50）	10（11.36）
术后6个月ODI评分（分）	29.35 ± 6.09	15.21 ± 3.02	18.112	< 0.001
术后1年ODI评分（分）	17.21 ± 2.02	11.32 ± 2.65	13.411	< 0.001
术后6个月腰痛VAS 评分（分）	3.02 ± 0.95	2.11 ± 0.69	6.412	< 0.001
术后1年腰痛VAS 评分（分）	2.05 ± 0.47	1.25 ± 0.32	11.751	< 0.001
术后6个月下肢痛VAS 评分（分）	2.11 ± 0.69	2.05 ± 0.43	0.624	0.534
术后1年下肢痛VAS 评分（分）	1.67 ± 0.42	1.60 ± 0.41	0.943	0.347
减压不彻底［例（%）］	12（25.00）	9（10.23）	5.191	0.023
邻近节段病变［例（%）］	11（22.92）	8（9.09）	4.940	0.026
术后并发症［例（%）］
切口感染	4（8.33）	6（6.82）	0.150	0.699
脑脊液漏	2（4.17）	1（1.14）	0.291	0.590
FGF-1	1.85 ± 0.26	2.17 ± 0.36	-5.430	< 0.001
VEGF	8.10 ± 0.33	6.59 ± 0.37	23.607	< 0.001

Tab.3

Tab.4

References 22

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组别	例数	FGF-1	VEGF
LSS组	138	2.03 ± 0.42	7.02 ± 1.95
对照组	138	5.39 ± 1.57	4.18 ± 1.27
t值		-24.287	14.336
P值		< 0.001	< 0.001

组别	例数	FGF-1	VEGF
轻度组	41	2.20 ± 0.21	6.22 ± 0.16
中度组	67	2.05 ± 0.36^a	7.02 ± 1.21^a
重度组	30	1.75 ± 0.13^ab	8.11 ± 0.36^ab
F值		22.257	41.189
P值		< 0.001	< 0.001

因素	β	SE	Wald χ²	OR（95%CI）	P值
常数项	10.352	2.609	15.743	-	< 0.001
LSS椎管狭窄程度	1.295	0.298	18.885	3.651（2.036 ~ 6.547）	< 0.001
减压不彻底	1.541	0.341	20.422	4.669（2.393 ~ 9.110）	< 0.001
FGF-1	-0.619	0.262	5.582	0.538（0.373 ~ 0.778）	0.009
VEGF	0.577	0.231	6.239	1.781（1.269 ~ 2.499）	0.006

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Analysis of the relationship between FGF⁃1 and VEGF expression in the ligamentum flavum of patients with lumbar spinal stenosis and restenosis after decompression

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