Diagnostic Utility of Cytokine Biomarkers in the Evaluation of Acute Knee Pain
Diagnostic Utility of Cytokine Biomarkers in the Evaluation of Acute Knee Pain
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DOI：
10.2106/jbjs.h.00835
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发表时间：
2009-10-01
影响因子：
5.3
通讯作者：
Yeomans, David C.
中科院分区：
文献类型：
--
作者：
Cuellar, Jason M.;Scuderi, Gaetano J.;Yeomans, David C.
背景资料：临床上重要的膝关节撕裂的诊断仍然具有挑战性，目前还不清楚为什么只有一些损伤变得疼痛。炎性细胞因子在尿道损伤后产生疼痛中的作用尚不清楚。本研究旨在探讨急性膝关节疼痛患者的细胞因子分布被认为是继发于aprocal damage.Methods：这项前瞻性队列研究包括32例无类风湿性关节炎的膝关节疼痛不到6个月，无论是急性或隐匿性发作，并选择有关节镜治疗后，非手术治疗失败。其中23例患者选择在关节镜检查时对对侧非手术治疗膝关节进行灌洗。15名无症状对照受试者也提供了膝关节液样本，共计47名受试者的70份样本。在关节镜检查前，患者在区域麻醉下对手术治疗的对侧和对照膝关节进行灌洗，如适用，将无菌生理盐水注入膝关节，然后立即撤回注射器中。使用多重免疫测定组测量17种炎性细胞因子和趋化因子的浓度。将术前磁共振成像结果和细胞因子检测结果与术中结果进行比较。结果：多变量方差分析检测到干扰素γ浓度显著升高（IFN-γ）;白细胞介素2、4、6、10和13（IL-2、IL-4、IL-6、IL-10和IL-13）;单核细胞趋化蛋白-1（MCP-1）;和巨噬细胞炎性蛋白-1 β（MIP-1 β）。相关性分析表明，患者报告的疼痛评分与IL-6（斯皮尔曼rho = 0.7）、MCP-1（rho = 0.8）、MIP-1 β（rho = 0.6）和IFN-γ（rho = 0.6）浓度之间存在显著正相关。这四种细胞因子也表现出彼此正相关（rho = 0.5至0.7）。IFN-γ、IL-6、MCP-1或MIP-1 β的存在以及磁共振成像可预测术中发现。四种炎性细胞因子IFN-γ，IL-6，MCP-1，和MIP-1 β与膝关节有症状性撕裂患者的疼痛相关，但在无症状正常膝关节和无症状膝关节有泪流满面。这些细胞因子可能参与神经损伤后疼痛的产生。
Background: The diagnosis of clinically important meniscal tears of the knee remains challenging, and it is unknown why only some injuries become painful. The role of inflammatory cytokines in generating pain following meniscal injury remains unclear. This study aimed to investigate the cytokine profile in patients with acute knee pain believed to be secondary to meniscal damage.Methods: This prospective cohort study included thirty-two patients without rheumatoid arthritis who had knee pain for less than six months, with either an acute or insidious onset, and elected to have arthroscopic treatment after nonoperative management had failed. Twenty-three of these patients elected to have the contralateral, nonoperatively treated knee lavaged at the time of arthroscopy. Fifteen asymptomatic control subjects also contributed samples of knee joint fluid, for a total of seventy samples from forty-seven subjects. Lavage of the operatively treated, contralateral, and control knees was performed with the patient under regional anesthesia prior to arthroscopy, if applicable, by the infusion of sterile saline solution into the knee followed by the immediate withdrawal into a syringe. The concentrations of seventeen inflammatory cytokines and chemokines were measured with use of a multiplexed immunoassay panel. Preoperative magnetic resonance imaging findings and cytokine assay results were compared with intraoperative findings.Results: Multivariate analysis of variance detected significantly greater concentrations of interferon gamma (IFN-gamma); interleukins 2, 4, 6, 10, and 13 (IL-2, IL-4, IL-6, IL-10, and IL-13); monocyte chemotactic protein-1 (MCP-1); and macrophage inflammatory protein-1 beta (MIP-1 beta) in fluid samples from painful knees than in samples from nonpainful knees. Correlation analysis demonstrated a significant positive correlation between patient-reported pain scores and concentrations of IL-6 (Spearman rho = 0.7), MCP-1 (rho = 0.8), MIP-1 beta (rho = 0.6), and IFN-gamma (rho = 0.6). These four cytokines also demonstrated a positive correlation with each other (rho = 0.5 to 0.7). The presence of IFN-gamma, IL-6, MCP-1, or MIP-1 beta performed as well as magnetic resonance imaging in the prediction of intraoperative findings.Conclusions: Intra-articular concentrations of four inflammatory cytokines IFN-gamma, IL-6, MCP-1, and MIP-1 beta correlated to pain in patients with symptomatic meniscal tears in the knee but were markedly lower in asymptomatic normal knees and in asymptomatic knees with meniscal tears. These cytokines may be involved in the generation of pain following meniscal injury.