Cytokine and neuropeptide levels are associated with pain relief in patients with chronically painful total knee arthroplasty: a pilot study.
Cytokine and neuropeptide levels are associated with pain relief in patients with chronically painful total knee arthroplasty: a pilot study.
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DOI：
10.1186/s12891-016-1375-2
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发表时间：
2017-01-14
影响因子：
2.3
通讯作者：
Knutson KL
中科院分区：
文献类型：
--
作者：
Singh JA;Noorbaloochi S;Knutson KL
很少有研究评估细胞因子或神经肽的水平与疼痛和疼痛缓解疼痛的关节疾病患者的相关性。我们的目的是评估疼痛性全膝关节置换术（TKA）患者注射后2个月血清细胞因子、趋化因子和P物质水平从基线至2个月的改善是否与临床上有意义的疼痛缓解相关。使用来自60例TKA的随机试验的数据，我们评估了细胞因子/趋化因子/P物质水平变化与主要研究结局的相关性，使用Student t检验和斯皮尔曼相关系数（非参数）评估了注射后2个月西部安大略麦克马斯特骨关节炎指数（WOMAC）疼痛子量表的临床重要改善。将患者分类为疼痛应答者（在0-100 WOMAC疼痛上减少20分或更多）与疼痛无应答者。敏感性分析使用0-10日间疼痛数字评定量表（NRS）代替WOMAC疼痛子量表。在一项初步研究中，与2个月时WOMAC疼痛量表的无应答者（n = 23）相比，疼痛应答者（n = 12）从基线至注射后2个月的血清IL-7、IL-10、IL-12、嗜酸性粒细胞趋化因子、干扰素γ和TNF-α水平的增加显著更大（均为p < 0.05）。从注射前到2个月随访期间，几种细胞因子/趋化因子和P物质水平的变化与WOMAC疼痛变化显著相关，相关系数范围为−0.37至−0.51：IL-2、IL-7、IL-8、IL-9、IL-16、IL-12 p、GCSF、IFN γ、IP-10、MCP、MIP 1b、TNF-α和VEGF（n = 35）。敏感性分析显示，疼痛反应者的P物质从基线到2个月显著下降（0.54 ± 0.53; n = 10）比疼痛无应答者（0.48 ± 1.18; n = 9; p = 0.023），血清P物质的这种变化与日间NRS疼痛的变化显著相关，相关系数为0.53（p = 0.021; n = 19）。应谨慎解释结果，因为对整个试验人群的亚组进行了细胞因子分析。在一项随机试验中，关节内注射后疼痛性TKA患者的血清细胞因子、趋化因子和P物质水平与疼痛反应相关。
There are few studies with an assessment of the levels of cytokines or neuropeptides as correlates of pain and pain relief in patients with painful joint diseases. Our objective was to assess whether improvements from baseline to 2-months in serum cytokine, chemokine and substance P levels were associated with clinically meaningful pain relief at 2-months post-injection in patients with painful total knee arthroplasty (TKA). Using data from randomized trial of 60 TKAs, we assessed the association of change in cytokine/chemokine/Substance P levels with primary study outcome, clinically important improvement in Western Ontario McMaster Osteoarthritis Index (WOMAC) pain subscale at 2-months post-injection using Student’s t-tests and Spearman’s correlation coefficient (non-parametric). Patients were categorized as pain responders (20-point reduction or more on 0-100 WOMAC pain) vs. pain non-responders. Sensitivity analysis used 0–10 daytime pain numeric rating scale (NRS) instead of WOMAC pain subscale. In a pilot study, compared to non-responders (n = 23) on WOMAC pain scale at 2-months, pain responders (n = 12) had significantly greater increase in serum levels of IL-7, IL-10, IL-12, eotaxin, interferon gamma and TNF-α from baseline to 2-months post-injection (p < 0.05 for all). Change in several cytokine/chemokine and substance P levels from pre-injection to 2-month follow-up correlated significantly with change in WOMAC pain with correlation coefficients ranging −0.37 to −0.51: IL-2, IL-7, IL-8, IL-9, IL-16, IL-12p, GCSF, IFN gamma, IP-10, MCP, MIP1b, TNF-α and VEGF (n = 35). Sensitivity analysis showed that substance P decreased significantly more from baseline to 2-months in the pain responders (0.54 ± 0.53; n = 10) than in the pain non-responders (0.48 ± 1.18; n = 9; p = 0.023) and that this change in serum substance P correlated significantly with change in daytime NRS pain, correlation coefficient was 0.53 (p = 0.021; n = 19). Findings should be interpreted with caution, since cytokine analyses were performed for a sub-group of the entire trial population. Serum cytokine, chemokine and Substance P levels correlated with pain response in patients with painful TKA after an intra-articular injection in a randomized trial.