Changes Of Peripheral Blood Cells In Patients With Lumbar Disc Herniation And The Preliminary Clinical Observation By Glycyrrhizin Injection

Objectives Lumbar disc herniation(LDH) is one of the most common back and leg pain diseases, and the main pathological mechanism is considered to be lumbar disc degenerative changes. Existing studies have shown that autoimmune reactions play an important role in the process of disc degeneration, and this has been confirmed by the involvement of immune cells(such as monocyte, eosinophil and basophil) and various immune-related cytokines in disc tissue cells. Glucocorticoids Hormone(GH) was widely used for LDH treatments based on the anti-inflammatory and analgesic effects, it is also limited because of the side effect like sodium and water retention. The compound glycyrrhizin injection(Compound licorice Injection, GL) as the main active ingredient glycyrrhizin, bearing corticosteroid-like activity, including anti-inflammatory, anti-allergic detoxification and immune regulation, lower side effect, so it is used for replacement therapy in hormone-dependent diseases. This study focused on the variation of peripheral blood-related parameters observed in LDH patients during 2008-2013 in Air Force General Hospital, and exploring its role in the development of LDH in order to provide new ideas for experimental research, clinical diagnosis and treatment. In addition, we further observed the efficacy of GL treatment in LDH and the impact on peripheral blood of each index.Methods The study is divided into two parts: the first part is to observe the characteristic variation of peripheral blood from LDH patients, the second part is to compare the treatments of GL and Glucocorticoid for LDH patients.Part I: patients with lumbar disc herniation conservative treatment in Air Force General Hospital from 2008 to 2013 were selected as the observation group(LDH group, n = 494); healthy volunteers in our hospital medical center in 2013 were selected as control group(CON group, n = 8674). The general clinical data of two groups were collected, and methods such as five taxonomy, photodiode law, latex turbidimetry were used to detect the blood parameters including erythrocyte sedimentation rate, serum ferritin and other indicators, and so on.Part II: Total 42 LDH patients were recruited into this self controlled clinical study, 20 of them were divided into GL group, in which patients were given with GL infusion intravenously for one week. Then single or continuous epidural steroid anti-inflammatory analgesic complex liquid were given to another 11 LDH patients(GL + GH group). Pain and signs of each group were assessed by using the visual analogue scale(VAS) and straight leg raising test(SLR) respectively, and blood pressure was monitored(including systolic blood pressure, diastolic blood pressure and mean arterial pressure) before and after the treatments. Blood samples of patients in each group were collected for measurements of the peripheral blood routine test, biochemical indicators, high- sensitivity C reactive protein, and dynamic erythrocyte sedimentation rate before and after the treatments. General characteristics and peripheral blood data were analyzed by SPSS 22.0 software, p < 0.05 was considered as statistically significant.Results Part I: Compared with CON group, the red blood cell count(RBC) hemoglobin,(Hb) and hematocrit were significantly lower(p < 0.001), while red cell distribution width(RDW) and Ferritin were significantly higher(p < 0.001) in LDH group; otherwise, mononuclear cells(Mo), basophilic granulocytes(B) and Eosinophil(Eos) were significantly higher(p < 0.001, p < 0.001, p < 0.05 respectively).Part II: Compared with pre-therapy, VAS score and SLR positive rates were significantly lower in GL group and GL+GH group(p < 0.01), however there was no significant difference between the two groups(p > 0.05), and blood glucose(GLU) and blood pressure(BP) levels as well(p > 0.05) after the two treatments.(2) Compared with pre-therapy, red blood cell count(RBC) and the levels of hemoglobin(Hb) and hematocrit(HCT) were decreased significantly in GL group(p < 0.01), and the absolute value of mononuclear cells(Mono) was much lower(p < 0.05); meanwhile the platelet(PLT) in GL+GH group was also decreased obviously(p < 0.05). Compared with GL group, mean red cell volume(MCV) was significantly decreased(p < 0.05), while Mono, PLT and platelet thrombocytocrit(PCT) were increased significantly(p < 0.05) in GL+GH group.(3) Compared with pre-therapy, uric acid(Ua), alanine aminotransferase(ALT) and ferrum(Fe) were decreased significantly(p < 0.01), and Kalium(K), total bilirubin(TBIL), direct bilirubin(DBIL), aspartate aminotransferase(AST) were decreased significantly(p < 0.05) as well; S-CRP was significantly decreased(p < 0.01) in GL+GH group, otherwise, ESR was increased(p < 0.05). Compared with GL group, S-CRP increased significantly, but ALT decreased significantly(p < 0.01) in GL+GH group, and the level of CD3+T cell was lowered(p < 0.05).Conclusion(1) Significant higher levels of mononuclear cells, basophil and eosinophil in LDH patients based on peripheral blood test indicated that chronic peripheral inflammation and autoimmune responses may play important roles in the pathological development of lumbar disc herniation. Furthermore, the lower levels of red blood cells and hemoglobin with the higher level of ferritin also indicated that the important role of chronic consumption of red blood cell induced by chronic inflammation involved in the development of LDH indirectly.(2) GL could significantly relieve symptoms and signs of LDH patients, which was similar to GH, on the other hand, GL also showed protection effect of liver function, and played a preventive role for some side effects of GH.