McGregor Neil R, Zerbes Mariann, Niblett Suzanne H, Dunstan R Hugh, Roberts Timothy K, Butt Henry L, Klineberg Iven J
Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia.
J Orofac Pain. 2003 Spring;17(2):112-24.
To investigate whether the duration of chronic pain in temporomandibular disorder (TMD) patients is associated with a net depletion of amino acids, and a distinct process from pain intensity.
Twenty-nine patients defined by the research diagnostic criteria/TMD as having Type 1a muscle pain (TMD1A group), and 34 age- and sex-matched control subjects, were assessed for variation in urinary organic and amino acid excretion by gas chromatography-mass spectrometry.
The TMD1A patients' mean pain intensity, assessed on a visual analog scale (VAS), was 5.4 (95% confidence limits: 4.5 to 6.3), TMD1A illness duration was 5.0 +/- 1.2 (SD) years, number of body areas with pain/subject was 6.3 +/- 2.4 (range 0 to 10), and symptom prevalence from the Symptom Check List-90-Revised (SCL-90-R) was 25.5 +/- 11.3 symptoms/subject, which was higher than the controls (5.2 +/- 5.0 symptoms/subject, P < .001). TMD1A patient illness duration was positively correlated with symptom prevalence and body pain distribution, and all were independent of pain intensity. The TMD1A patients had: (1) and increased tyrosine:leucine ratio; and (2) reduced leucine concentrations (both P < .001), which suggests deregulated catabolism. Pain intensity was associated with: (1) changes in the multivariate urinary metabolite excretion patterns (P < .001); (2) reduced leucine concentrations (P < .001); and (3) increases in total urinary metabolites (P < .04), and in 2 unidentified molecules, UM28 (P < .001) and CFSUM1 (P < .002). TMD1A illness duration was associated with lower (1) urinary metabolite concentrations and (2) succinic acid and combined glutamine + glutamic acid levels, suggesting a progressive depletion of metabolite reserves.
In TMD1A patients, total amino acid excretion was positively correlated with pain intensity and negatively correlated with illness duration, which indicated that illness duration was associated with a different set of metabolic anomalies compared with those identified for pain intensity.
研究颞下颌关节紊乱病（TMD）患者慢性疼痛的持续时间是否与氨基酸的净消耗有关，以及这是否是一个与疼痛强度不同的过程。
根据研究诊断标准/TMD确定的29例1a型肌肉疼痛患者（TMD1A组）和34例年龄及性别匹配的对照者，通过气相色谱-质谱法评估尿中有机和氨基酸排泄的变化。
TMD1A患者在视觉模拟量表（VAS）上评估的平均疼痛强度为5.4（95%置信区间：4.5至6.3），TMD1A疾病持续时间为5.0±1.2（标准差）年，每个受试者疼痛的身体部位数量为6.3±2.4（范围0至10），症状自评量表90修订版（SCL-90-R）的症状患病率为25.5±11.3个症状/受试者，高于对照组（5.2±5.0个症状/受试者，P<.001）。TMD1A患者的疾病持续时间与症状患病率和身体疼痛分布呈正相关，且均与疼痛强度无关。TMD1A患者有：（1）酪氨酸：亮氨酸比值升高；（2）亮氨酸浓度降低（均P<.001），这表明分解代谢失调。疼痛强度与：（1）多元尿代谢物排泄模式的变化（P<.001）；（2）亮氨酸浓度降低（P<.001）；（3）尿代谢物总量增加（P<.04）以及2种未鉴定分子UM28（P<.001）和CFSUM1（P<.002）增加有关。TMD1A疾病持续时间与较低的（1）尿代谢物浓度和（2）琥珀酸以及谷氨酰胺+谷氨酸水平相关，提示代谢物储备逐渐耗尽。
在TMD1A患者中，总氨基酸排泄与疼痛强度呈正相关，与疾病持续时间呈负相关，这表明疾病持续时间与疼痛强度所识别的代谢异常不同。
