Effects Of Epidural Steroids Injection On Blood Glucose,Lipid And Hypothalamic-pituitary-adrenal Cortical Axis

Objective:To observe the effect of single dose of compound betamethasone or dexamethasone palmitate epidural injection on blood glucose,blood lipids and HPA axis.Methods:Forty patients with protrusion of lumbar intervertebral disc combined with lower extremity pain were selected,including 18 females and 22 males?age range,22⁶5 years;body weight,48⁷5 kg;course of disease,1⁶ years?.All the patients received epidural catheterization with single injection of drugs.Based on the types of drugs and different doses,the patients were divided into 4 groups using a random number table.The group A₁ was injected with 3.5 mg compound betamethasone,the group A₂ was injected with 7 mg compound betamethasone,the group B₁ was injected with 4 mg dexamethasone palmitate,and the group B₂ injected 8 mg dexamethasone palmitate,with 10 patients per group.Routine disinfection was performed by direct puncture in the space between lesions and puncture by lateral approach.The entering of puncture needle into the epidural space was determined by resistance breakthrough and no bubble compression.After epidural catheterization with 3 cm left in the epidural space and no blood or cerebrospinal fluid in pumpback,glucocorticoid,1 ml 2%lidocaine and 5 ml0.9%mixed sodium chloride injection were injected.The group A₁ was injected with 3.5 mg compound betamethasone,the group A₂ with 7 mg compound betamethasone,the group B₁ with 4 mg dexamethasone palmitate,and the group B₂ with 8 mg dexamethasone palmitate.Pain[visual analogue scale?VAS?score]in each group was recorded before and after treatment.Fasting blood-glucose?FBG?,plasma total cholesterol?TC?,triglyceride?TG?,serum cortisol and adreno-corticotropic hormone?ACTH?concentrations were detected at 8:00 before treatment?T₀?,2 d?T₁?,4 d?T₂?,6 d?T₃?,14 d?T₄?and 21 d?T₅?after treatment,and blood glucose concentration was detected 2 h after meal at 10:00.Results:1.General conditionsAge,gender,BMI,and VAS before treatment showed no statistically significant differences among the 4 groups?P>0.05?.2.Pain reliefCompared with T₀,VAS score reduced at T₁,T₂,T₃,T₄ and T₅ in the 4 groups,with statistically significant differences?P<0.05?.Comparison in VAS score among the 4 groups showed no statistically significant differences?P>0.05?.3.Effect on blood glucoseCompared with T₀,FBG and 2hPG in the 4 groups increased at T₁,T₂,T₃,T₄ and T₅,with statistically significant differences?P<0.05?.FBG and 2hPG in group A₂ and B₂ reached the highest point at T₃.FBG and 2hPG in group A₁and B₁ reached the highest point at T₄.No statistically significant differences were detected in FBG or 2hPG between the group A₂ and B₂ at T₃ and between the group A₁and B₁at T₄?P>0.05?.4.Effect on blood fatCompared with T₀,TC and TG at T₁,T₂,T₃,T₄ and T₅ in the 4 groups showed no statistically significant differences?P>0.05?.At the same time points,TC and TG showed no statistically significant differences in each group?P>0.05?.5.Effect on HPA axisCompared with T₀,cortisol and ACTH in the 4 groups at T₁,T₂ and T₃decreased,with statistically significant differences?P<0.01?,and recovered at T₅.Comparison in cortisol and ACTH among the 4 groups showed no statistical significance?P>0.05?.Conclusion:Single epidural injection of 3.5 mg and 7 mg compound betamethasone or 4 mg and 8 mg compound betamethasone in the treatment of protrusion of lumbar intervertebral disc all can obviously relieve patients'pain.Within 2weeks,they can increase FBG and 2hPG and reduce cortisol and ACTH,cortisol and ACTH recovered to normal levels at 21d.They have no obvious effect on TC and TG.