【目的】 探讨腰椎间盘突出症（LDH）患者的中医证型分布及其与血清缺氧诱导因子1α（HIF-1α）、NOD样受体热蛋白结构 域相关蛋白3（NLRP3）、白细胞介素1β（IL-1β）水平的关系。【方法】 收集2022年10月 ~ 2024年6月武汉市汉口医院门诊及住 院部收治的 160例 LDH患者（LDH组）病例资料及同期在该院体检的 20例健康志愿者（健康对照组）资料，比较 2组受试者血 清 HIF-1α、NLRP3、IL-1β 水平，分析血清 HIF-1α、NLRP3、IL-1β 水平与 LDH 患者疼痛视觉模拟量表（VAS）、日本骨科 协会腰痛评价量表（JOA）、Oswestry功能障碍指数（ODI）评分的相关性；统计LDH患者的中医证型分布情况，探讨LDH患者 中医证型与血清HIF-1α、NLRP3、IL-1β水平的关系；分析血清HIF-1α、NLRP3、IL-1β水平与LDH预后的相关性。【结果】 （1）与健康对照组比较，LDH组患者的血清HIF-1α、NLRP3、IL-1β水平均显著升高，差异均有统计学意义（P＜0.01）。（2）经 Spearman 相关分析，VAS、ODI 评分与血清 HIF-1α、NLRP3、IL-1β 水平呈正相关，JOA 评分与血清 HIF-1α、NLRP3、 IL-1β 水平呈负相关，差异均有统计学意义（P＜0.01）。（3）160 例 LDH 患者的中医证型分布由高到低依次为：血瘀证 65例 （40.63%）＞肾虚证 45 例（28.13%）＞寒湿证 30 例（18.75%）＞湿热证 20 例（12.50%）。（4）不同中医证型 LDH 患者血清 HIF-1α、 NLRP3、IL-1β 水平比较，差异均有统计学意义（P＜0.01）。其中，寒湿证患者血清 HIF-1α、NLRP3、IL-1β 水平高于肾虚 证（P＜0.05），湿热证患者血清HIF-1α、NLRP3、IL-1β水平高于寒湿证（P＜0.05），血瘀证患者血清HIF-1α、NLRP3、IL-1β 水平高于湿热证（P＜0.05）。（5）多因素 Logistic 回归分析结果显示：血清 HIF-1α、NLRP3、IL-1β 为 LDH 患者预后的危险因 素，且均呈负相关（P＜0.05或 P＜0.01）。【结论】 LDH患者的证型分布以血瘀证为主，其次为肾虚证；不同中医证型的血清 HIF-1α、NLRP3、IL-1β水平存在显著差异，血清 HIF-1α、NLRP3、IL-1β水平有可能成为 LDH 中医辨证的潜在生物学指 标，是LDH预后的危险因素。

Objective To investigate the distribution of traditional Chinese medicine （TCM） syndrome types in patients with lumbar disc herniation（LDH） and its correlation with serum levels of hypoxia-inducible factor 1α （HIF-1α），NOD-like receptor thermal protein domain associated protein 3（NLRP3） and interleukin 1β（IL- 1β） of the patients. Methods Data collection was conducted in 160 patients （LDH group） admitted to the LDH outpatient and inpatient department of Wuhan Hankou Hospital from October 2022 to June 2024 and in 20 healthy volunteers （healthy control group） who underwent physical examination in the hospital during the same period. The levels of serum HIF-1α，NLRP3 and IL-1β were compared between the two groups，and then the correlation of serum HIF-1α，NLRP3 and IL-1β levels with Visual Analogue Scale （VAS） score of pain，Japanese Orthopedic Association （JOA） score and Oswestry Dysfunction Index （ODI） score in LDH patients was explored. The distribution of TCM syndrome types in LDH patients was statistically analyzed，and then the correlation between TCM syndromes and serum HIF-1α，NLRP3 and IL-1β levels in LDH patients was investigated. Furthermore， the correlation between serum HIF-1α， NLRP3， IL-1β levels and prognosis of LDH was analyzed. Results （1）Compared with the healthy control group，the serum levels of HIF-1α，NLRP3 and IL-1β in the LDH group were significantly increased， and the differences were statistically significant （P＜0.01）. （2） Spearman correlation analysis showed that VAS and ODI scores were positively correlated with serum HIF-1α，NLRP3 and IL-1β levels， and JOA score was negatively correlated with serum HIF-1α， NLRP3 and IL-1β levels， the differences being statistically significant （P＜0.01）.（3） The percentage of TCM syndrome types in 160 patients with LDH in descending order was as follows：blood stasis syndrome （65 cases，40.63%）＞kidney deficiency syndrome （45 cases，28.13%）＞cold-damp syndrome （30 cases，18.75%）＞damp-heat syndrome （20 cases， 12.50%）.（4） There were statistically significant differences in serum levels of HIF-1α， NLRP3 and IL-1β among LDH patients with different TCM syndromes （P＜0.01）： the serum levels in patients with cold-damp syndrome were higher than those in patients with kidney deficiency syndrome （P＜0.05），serum levels in patients with damp-heat syndrome were higher than those in patients with cold-damp syndrome （P＜0.05），and serum levels in patients with blood stasis syndrome were higher than those in patients with damp-heat syndrome （P＜ 0.05）.（5） Multivariate logistic regression analysis showed that serum HIF-1α， NLRP3 and IL-1βwere risk factors for the prognosis of LDH patients，and they were negatively correlated with the prognosis of LDH （P＜0.05 or P＜0.01）. Conclusion Blood stasis syndrome is the predominated syndrome type in LDH patients，and then comes kidney deficiency syndrome. The levels of serum HIF-1α，NLRP3 and IL-1β vary in LDH patients with different TCM syndrome types， and are expected to be the potential biological indicators for TCM syndrome differentiation of LDH. Serum HIF-1α，NLRP3 and IL-1β are the risk factors for the prognosis of LDH.

R274.9

湖北省自然科学基金项目（编号：2024J011612）；武汉市中医药科技计划项目（编号：WZ24B62）