Biomarkers in the Degenerative Human Intervertebral Disc Tissue and Blood.
Biomarkers in the Degenerative Human Intervertebral Disc Tissue and Blood.
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DOI：
10.1097/phm.0000000000001943
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发表时间：
2022-10-01
影响因子：
3
通讯作者：
中科院分区：
文献类型：
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腰痛患者在门诊医师中占很大比例。诊断工具仅限于临床病史、体格检查和影像学检查。非手术治疗在很大程度上是经验性的，包括药物治疗、物理治疗、手工治疗和介入脊柱手术。大量文献证实，在背痛和/或神经根病患者中，包括炎症细胞因子在内的生物标志物水平升高，主要是因为蛋白质检测的敏感性增加了。这些生物标志物可以作为辅助诊断和评估结果的工具。椎间盘组织和血液中炎症介质的存在有助于证实与椎间盘退变相关的背痛的炎症基础。本文综述的文献表明，生物标志物可以帮助临床诊断和监测脊柱相关疼痛治疗期间和治疗后的生理结果。生物标志物必须在大量和多样化的无症状人群中测量，在年龄和合并症的背景下，以防止假阳性检测。这些水平可以合理地与椎间盘源性背痛、神经根病和椎管狭窄等背部疾病患者的水平进行比较。虽然本文回顾的研究使用了“候选标记物”方法，但未来在明确定义的患者群体中使用的无偏见方法可能会在患者的临床管理中发现新的生物标记物。
Patients with back pain comprise a large proportion of the outpatient practice among physiatrists. Diagnostic tools are limited to clinical history, physical examinations and imaging. Non-surgical treatments are largely empirical, encompassing medications, physical therapy, manual treatments and interventional spinal procedures. A body of literature is emerging confirming elevated levels of biomarkers including inflammatory cytokines in patients with back pain and/or radiculopathy, largely because the protein assay sensitivity has increased. These biomarkers may serve as tool to assist diagnosis and assess outcomes. The presence of inflammatory mediators in the intervertebral disc tissues and blood helped confirming the inflammatory underpinnings of back pain related to intervertebral disc degeneration. Literature reviewed here suggests that biomarkers could assist clinical diagnosis and monitor physiological outcomes during and following treatments for spine related pain. Biomarkers must be measured in a large and diverse asymptomatic population, in the context of age and comorbidities to prevent false positive tests. These levels can then be rationally compared to those in patients with back disorders including discogenic back pain, radiculopathy and spinal stenosis. While studies reviewed here used “candidate marker” approaches, future non-biased approaches in clearly defined patient populations could uncover novel biomarkers in clinical management of patients.