Elevated inflammatory cytokine expression in CSF from patients with symptomatic thoracic disc herniation correlates with increased pain scores
Elevated inflammatory cytokine expression in CSF from patients with symptomatic thoracic disc herniation correlates with increased pain scores
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DOI：
10.1016/j.spinee.2018.07.023
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发表时间：
2018-12-01
期刊：
影响因子：
4.5
通讯作者：
Hoogland, Govert
中科院分区：
文献类型：
--
作者：
Andrade, Pablo;Cornips, Erwin M. J.;Hoogland, Govert
背景：对有症状的胸椎间盘突出症（TDH）患者疼痛的病理生理学仍知之甚少。单纯的机械压迫脊髓和/或退出神经根的椎间盘突出，不能解释在所有情况下的疼痛的发病机制。先前的研究报道了椎间盘活检中促炎细胞因子水平与腰椎间盘突出症患者下肢疼痛严重程度之间的直接相关性。TDH患者中类似的相关性尚未研究。目的：将脑脊液（CSF）中细胞因子和疼痛相关氨基酸的表达与有症状TDH患者的术前疼痛评分相关联。研究设计：对CSF样本和临床结果评分的前瞻性人体研究。采用酶联免疫吸附试验（ELISA）和高效液相色谱法（HPLC），我们测定了炎症细胞因子水平10名TDH患者和10名对照受试者的CSF样本中的TNF-α、IL-1 β和IL-10水平和氨基酸水平（谷氨酸、天冬氨酸、γ-氨基丁酸、甘氨酸和精氨酸），这些受试者没有患有炎症性疾病，也没有与脊髓压迫相关的疼痛，随后将这些水平与术前疼痛评分相关联。通过Mann-Whitney U检验评价两组之间的差异。为了估计细胞因子或氨基酸的表达和疼痛评分之间的相关性，数据进行了分析，使用线性回归analysis.Results：没有炎症细胞因子被发现在对照组的CSF样本，而TNF-α，IL-1b，IL-10的ELISA检测TDH患者的所有CSF样本。TNF-a和IL-10水平与术前疼痛评分中度相关，而IL-1b水平与术前疼痛评分中度相关。TNF水平升高与高疼痛评分呈正相关; IL-10水平升高与高疼痛评分呈负相关。在两组的所有样品中均检测到氨基酸。有没有显着差异，在任何组之间的氨基酸测定HPLC.CONCLUSION：增加促炎细胞因子的表达与症状性TDH患者疼痛评分升高。另一方面，疼痛的强度与疼痛传递相关的氨基酸的局部或全身存在之间没有决定性的相关性。(C)2018爱思唯尔公司All rights reserved.
BACKGROUND: The pathophysiology of pain in patients with symptomatic thoracic disc herniation (TDH) remains poorly understood. Mere mechanical compression of the spinal cord and/or the exiting nerve root by a prolapsed disc cannot explain the pathogenesis of pain in all cases. Previous studies report a direct correlation between the levels of proinflammatory cytokines in disc biopsies and the severity of leg pain in patients with lumbar disc herniation. A similar correlation in patients with TDH has not been investigated.PURPOSE: To correlate the cerebrospinal fluid (CSF) expression of cytokines and pain-related amino acids with preoperative pain scores in patients with symptomatic TDH.STUDY DESIGN: A prospective human study of CSF samples and clinical outcome scores.METHODS: Using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC), we determined inflammatory cytokine levels (TNF-alpha, IL-1 beta, and IL-10) and amino acid levels (glutamate, aspartate, gamma-aminobutyric acid, glycine, and arginine) in CSF samples from 10 patients with TDH and 10 control subjects who did not suffer an inflammatory disease nor pain related to spinal cord compression and subsequently correlated these levels with preoperative pain scores. Differences between both groups were evaluated by a Mann-Whitney U test. In order to estimate the correlation between cytokine or amino acid expression and pain scores, data were analyzed using a linear regression analysis.RESULTS: No inflammatory cytokines were found in CSF samples from control subjects, whereas TNF-a, IL-1b, and IL-10 were detectable by ELISA in all CSF samples from patients with TDH. TNF-a and IL-10 but not IL-1b levels moderately correlated with preoperative pain scores. Elevated TNF-alevels positively correlated with high pain scores; elevated IL-10 levels negatively correlated with high pain scores. Amino acids were detectable in all samples from both groups. There were no significant differences between the groups in any of the amino acids measured with HPLC.CONCLUSION: Increased proinflammatory cytokine expression is associated with elevated pain scores in patients with symptomatic TDH. On the other hand, there is no conclusive correlation between the intensity of pain and the local or systemic presence of amino acids associated with pain transmission. (C) 2018 Elsevier Inc. All rights reserved.