Cytokine evaluation in individuals with low back pain using discographic lavage
Cytokine evaluation in individuals with low back pain using discographic lavage
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DOI：
10.1016/j.spinee.2009.12.007
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发表时间：
2010-03-01
期刊：
影响因子：
4.5
通讯作者：
Scuderi, Gaetano J.
中科院分区：
文献类型：
--
作者：
Cuellar, Jason M.;Golish, S. Raymond;Scuderi, Gaetano J.
背景：退行性椎间盘疾病的病理生理机制及其在疼痛综合征中的意义尚不清楚。然而，脊柱磁共振成像（MRI）可以显示椎间盘水含量和纤维环的变化;诱发性椎间盘造影据称可以识别导致严重腰痛的退行性椎间盘;生化检测可以识别局部炎症标志物。目前还没有研究将椎间盘造影评估过程中的椎间盘注射疼痛与相关的MRI结果和生化标志物相关联。目的：本研究的目的是将椎间盘造影过程中的一致性疼痛与椎间盘灌洗和MRI结果获得的生化标志物相关联。研究设计：这是一项I期诊断测试评估队列研究患者样本：患者样本包括21名疑似椎间盘源性疼痛的症状性患者和3名1期对照受试者。结果测量包括椎间盘造影疼痛评分、MRI退行性分级和对椎间盘灌洗样本中存在的各种炎性细胞因子浓度的免疫反应性。21名有症状的腰椎退行性椎间盘疾病患者和3名对照组接受椎间盘造影、MRI和椎间盘灌洗液生化分析。对腰椎MRI进行Pfirrmann腰椎间盘分级评分，并通过椎间盘核灌洗确定环破裂。椎间盘灌洗样本进行了分析生化标记物的高灵敏度immunoassay.Results：83椎间盘24例进行了研究：67椎间盘21例轴性背痛（怀疑椎间盘源性疼痛组）和16椎间盘3脊柱侧凸患者没有背痛（第1阶段对照组）。在调查的生化标志物中，干扰素γ（IFN-γ）免疫反应性在轴性背痛患者中最一致。在视觉模拟评分为7 - 10/10时，有纤维环破裂和一致性疼痛再现的椎间盘比没有这种发现的椎间盘具有更高的IFN-γ免疫反应性（p= 0.003）;然而，在有症状组中，除一个椎间盘外，其他所有椎间盘中均发现了至少一些IFN-γ免疫反应性。在这项1期研究中检测的潜在炎症标志物中，IFN-γ免疫反应性在椎间盘造影“阳性”椎间盘中最常见升高，但在无症状对照组中不存在。然而，这种标记物在退行性但“阴性”椎间盘造影椎间盘中也经常升高。从这些发现来看，2期和3期有效性研究是合理的。可同时进行4期效用研究，以评估该方法在结局研究中的预测价值。(C)2010年爱思唯尔公司All rights reserved.
BACKGROUND CONTEXT: The pathophysiology underlying degenerative disc disease and its implication in painful syndromes remain unclear. However, spine magnetic resonance imaging (MRI) can demonstrate changes in disc water content and the annulus; provocative discography purportedly identifies degenerate discs causing serious low back pain; and biochemical assays have identified local inflammatory markers. No study to date has correlated pain on disc injection during discography evaluation with relevant MRI findings and biochemical markers.PURPOSE: The purpose of this study was to correlate concordant pain on during discography to biochemical markers obtained by disc lavage and MRI findings.STUDY DESIGN: This is a Phase 1 Diagnostic Test Assessment Cohort Study (Sackett and Haynes).PATIENT SAMPLE: The patient sample included 21 symptomatic patients with suspected discogenic pain and three Phase 1 control subjects.OUTCOME MEASURES: The outcome measures included discography pain scores, MRI degenerative grades, and immunoreactivity to various inflammatory cytokine concentrations present in disc lavage samples.METHODS: Twenty-one symptomatic patients with lumbar degenerative disc disease and three control subjects underwent discography, MRI, and biochemical analysis of disc lavage fluid. Lumbar MRI was scored for Pfirrmann grading of the lumbar discs, and annular disruption was identified by nuclear disc lavage. Disc lavage samples were analyzed for biochemical markers by high-sensitivity immunoassay.RESULTS: Eighty-three discs from 24 patients were studied: 67 discs from 21 patients with axial back pain (suspected discogenic pain group) and 16 discs from 3 scoliosis patients without back pain (Phase 1 control subjects). Among the biochemical markers surveyed, interferon gamma (IFN-gamma) immunoreactivity was most consistently identified in patients with axial back pain. Discs with annular disruption and concordant pain reproduction at a visual analog scale of 7 to 10/10 had greater IFN-gamma immunoreactivity than those without this finding (p=.003); however, at least some IFN-gamma immunoreactivity was found in all but one disc in the symptomatic group.CONCLUSIONS: Among the potential inflammatory markers tested in this Phase 1 study, IFN-gamma immunoreactivity was most commonly elevated in discogram "positive'' discs but absent in asymptomatic controls. However, this marker was also frequently elevated in degenerative but "negative'' discography discs. From these findings, Phase 2 and Phase 3 validity studies are reasonable to pursue. Phase 4 utility studies may be performed concurrently to assess this method's predictive value in outcome studies. (C) 2010 Elsevier Inc. All rights reserved.