| Objective:Observed the change of the plasma neuropeptide Y (NPY), plasma endothelin1(ET-1) andcalcitonin gene related peptide (CGRP) levels in patients with cervical vertigo by invasive treatment atdifferent times points.To explore the effect and clinical significance of these three kinds of vasoactivefactors in the pathogenesis of cervical vertigo.Methods:A total of73patients hospitalized patients with cervical vertigo in the Department of orthopedics andDepartment of pain in our hospita were enrolled at our site as study investigating operation verus nerveblock..33patients received ACDF or anterior cervical corpectomy and bone graft fusion and internalfixation,and40patients were given stellate ganglion block therapy.Patients in the two groups were takenfasting blood before the day of admission and treatment after11-15days (average2weeks),6weeks,12weeks,24weeks were taken fasting blood, NPY, ET-1, CGRP content were detected by radioimmunoassayin plasma, and28cases of the normal control group were observed and compared, at the same time atdifferent time points respectively by rating scale for cervical vertigo were evaluated, correlation analysisthe factor level and test effect in different periods, all packets were processed with SPSS17.0software.Results:①The two groups of patients before treatment compared to the mean plasma NPY, ET-1, CGRP levels,vertigo and DHI scores showed no significant difference(P>0.05); Compared with the normal group, thetwo groups plasma NPY, ET-1levels were higher than those in normal control group(P<0.01) compared with the normal group, the CGRP were not significant significant differences(P>0.05); The Two werestatistically comparable.②In the operation group of33cases of patients with cervical vertigo group2weeks after operation the levels of plasma NPY increased than that before operation(P<0.05), after2weeks, gradually began to decline, after6weeks,12weeks,24weeks, the plasma NPY levels comparedwith those before operation were significantly decreased, the plasma NPY water test24weeks after theoperation, the lowest, the difference was statistically significant(P<0.01);2weeks after operation thanbefore operation of plasma ET-1increased slightly(P>0.05),6weeks after operation than before operationafter the plasma levels of ET-1decreased (P<0.05), after12weeks and24weeks plasma ET-1continued todecline and closed to the normal level, there was significant difference compared with that beforeoperation (P<0.01),2weeks after operation than before operation of plasma CGRP decreasedslightly(P>0.05),6weeks postoperatively compared with the preoperative significantly increased (P<0.05),postoperative24weeks after the rise to the ideal level, there was significant difference compared with thatbefore operation(P<0.01); synthesis and metabolism of rejection that stimulates early anterior cervicaloperation trauma and implants will ET-1and CGRP NPY, the effect of plasma, after the stress response,active factor gradually to the normal level.③The plasma NPY level in the nerve block group40cases ofpatients with cervical vertigo compared with preoperative decreased slightly after2weeks (P>0.05),after6weeks and12weeks,the NPY levels were decreased significantly than preoperative (P<0.05), and were notsignificant(P>0.05) compared with those before operation after24weeks; plasma ET-1after2weeks andthen began to drop, after2weeks,6weeks,24weeks and12weeks after operation, the results comparedwith those before operation were significantly decreased(P<0.05),but the level of ET-1and operation groupremained at a high level, significant difference (P<0.01); plasma CGRP2weeks postoperatively comparedwith the preoperative have increased (P<0.05), after the6postoperative week reached a high level, compared with preoperative was statistically significant (P<0.01), after12weeks and then began to drop,but there were still significant difference compared with that before operation(P<0.05). After24weekspostoperative, plasma CGRP continued to decline, compared with those before operation had no significantdifference (P>0.05). The nerve block, inhibited the effect of sympathetic nerve on the plasma NPY, ET-1and CGRP, three early began to tend to balance, but with the passage of time, recovery of sympatheticnerve function, the three of the balance was broken again, gradually recovered to the preoperativelevel.④The operation group of cervical vertigo patients after2weeks,6weeks,12weeks of vertigo scoreswere significantly increased(P<0.05),24weeks after operation compared with the preoperative vertigoscore the most significant differences(P<0.01), the vertigo score showed a linear increasing trend; and theDHI score of after2weeks compared with the preoperative declined slightly, there was no significantdifference(P>0.05), starting from6weeks after operation was significantly decreased, compared with thepreoperative difference was significant(P<0.05), after12weeks,24weeks of vertigo score continued todecline, compared with the preoperative most significant difference (P<0.01), indicating that DHI scorewas decreased;⑤Nerve block group after2weeks,6weeks,12weeks of vertigo score were significantlyincreased(P<0.05), the highest value reached6weeks after operation, then began to decline,24weekspostoperatively compared with the preoperative vertigo score no significant difference(P>0.05), the vertigoscore was first increased and then decreased; began to decline in DHI score at2weeks after operation,compared with the preoperative difference was significant(P<0.05),6weeks after operation, DHI scorecontinued to decline to the lowest, compared with the preoperative, the difference has statisticalsignificance(P<0.01), and DHI scores began to rise, surgery DHI score after12weeks still lower than thepreoperative (P<0.05),24weeks postoperatively compared with the preoperative DHI score was nosignificant difference(P>0.05), indicating that DHI score was firstly decreased and then increased;⑥Correlation using Pearson correlation analysis to test the plasma NPY level in patients withvertigo score, the DHI score of the two groups, the correlation coefficient and the vertigo score: r=-0.863(P=0.000<0.01), r’=-0.825(P=0.000<0.01), statistically significant, negative correlation score that plasmaNPY concentration and vertigo, the higher NPY concentration in patients with vertigo is, the lower, themore serious the degree of vertigo; Two group and DHI score correlation coefficientfor:r=0.949(P=0.014<0.05), r’=0.770(P=0.128>0.05),operation group that plasma NPY concentration waspositively associated with DHI score, the plasma NPY concentrations in patients with higher DHI score,higher degree of vertigo, more serious; nerve block group and the concentration of plasma NPY showed nocorrelation with DHI score.⑦UsingPearson correlation analysis to test the correlation between plasmaET-1level and vertigo score, DHI score, the two correlation coefficients and vertigoscore:r=-0.801(P=0.000<0.01),r’(P=0.000=-0.619<0.01),statistically significant,nega tivecorrelation scorethat plasma ET-1concentration and vertigo, the higher ET-1concentration in patients with vertigo is, thelower the degree of vertigo, more serious; obtain the two correlation coefficients and DHI score:r=0.957(P=0.011<0.05),r’=0.613(P=0.271>0.05), positive operation instructions the plasma ET-1concentration and DHI score, the plasma ET-1concentrations in patients with higher and higher, the higherthe score of vertigo, dizziness is more serious, and nerve block group, the plasma NPY concentrationshowed no correlation with DHI score.⑧Using Pearson correlation analysis to test the correlation betweenplasma CGRP level and vertigo score, DHI score, and two correlation coefficients and vertigoscore:r=0.888(P=0.044<0.05),r’=0.951(P=0.013<0.05),there was a statistically significant, positive scorethat plasma CGRP concentration and vertigo, higher than in patients with CGRP the concentration ofvertigo, the higher the score, the more light is dizzy; two correlation coefficients and DHIscore:0.956(P=0.000<0.01),r’=-0.976(P=0.000<0.01), operation group that was negatively correlated with plasma CGRP concentration and DHI score, the plasma CGRP concentrations in patients with lower,higher DHI scores, vertigo the more serious the degree.Conclusion:1．NPY, ET-1and CGRP participates in the pathogenesis and prognosis of cervical vertigo, plays animportant role in neural and humoral regulation.2.The plasma NPY, ET-1not only have the closest relations with cervical vertigo, and is a sensitiveindicator of judgment of dizziness.3．Stellate ganglion block can effectively reduce the level of plasma NPY、ET-1, increase the level ofCGRP in patients with cervical vertigo.The early curative effect signific antly(<12weeks),andgradually decreased12weeks later.4．Anterior cervical discectomy and fusion can effectively reduce the level of plasma NPY、ET-1,increase the level of CGRP in patients with cervical vertigo and improve the symptoms of dizziness, earlysurgery irritable reaction lasts10to17days, on average, two weeks, the forward curative effect is stablewithout repeatedly. |
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