Rozen Todd, Swidan Sahar Z
Michigan Head Pain and Neurological Institute-Neurology, 3120 Professional Drive, Ann Arbor, MI 48104, USA.
Headache. 2007 Jul-Aug;47(7):1050-5. doi: 10.1111/j.1526-4610.2006.00722.x.
To determine if patients with new daily persistent headache (NDPH) have elevated levels of tumor necrosis factor alpha (TNF alpha) in the CSF.
NDPH is considered one of the most treatment resistant of all headache syndromes. This reflects a lack of understanding of its pathogenesis. As a certain percentage of NDPH patients have their headaches start after an infection, the possibility of a persistent state of systemic or CNS inflammation comes into question. TNF alpha is a proinflammatory cytokine involved in brain immune and inflammatory activities, as well as in pain initiation. The goal of this study was to look at TNF alpha levels in the CSF of NDPH patients, to determine if CNS inflammation may play some role in the pathogenesis of this condition.
CSF TNF alpha levels were studied in 38 patients: 20 with NDPH and a control population of 16 patients with chronic migraine (CM), and 2 with post-traumatic headache (PT).
CSF TNF alpha levels were elevated in 19 of 20 NDPH patients, 16 of 16 CM patients, and both PT patients. Serum TNF alpha levels were normal in most of the study subjects.
An elevation of CSF TNF alpha levels was found in almost all NDPH patients and suggest a role for TNF alpha in the pathogenesis of this condition. Surprisingly, all CM and PT patients tested had elevated CSF TNF alpha levels. In most patients with elevated CSF levels, serum TNF alpha levels were normal. All of these syndromes may be manifestations of CNS inflammation. As most of the positive-tested patients showed minimal to no improvement during aggressive inpatient treatment, persistent elevation of CSF TNF alpha levels may be one of the causes of treatment refractory CDH.
确定新发性每日持续性头痛（NDPH）患者脑脊液中肿瘤坏死因子α（TNFα）水平是否升高。
NDPH被认为是所有头痛综合征中最难治疗的一种。这反映了对其发病机制缺乏了解。由于一定比例的NDPH患者在感染后开始出现头痛，全身性或中枢神经系统炎症持续存在的可能性受到质疑。TNFα是一种促炎细胞因子，参与脑免疫和炎症活动以及疼痛起始过程。本研究的目的是观察NDPH患者脑脊液中的TNFα水平，以确定中枢神经系统炎症是否可能在该疾病的发病机制中起作用。
对38例患者的脑脊液TNFα水平进行了研究：20例NDPH患者、16例慢性偏头痛（CM）患者作为对照人群以及2例创伤后头痛（PT）患者。
20例NDPH患者中有19例脑脊液TNFα水平升高，16例CM患者中有16例升高，2例PT患者的脑脊液TNFα水平也升高。大多数研究对象的血清TNFα水平正常。
几乎所有NDPH患者的脑脊液TNFα水平均升高，提示TNFα在该疾病的发病机制中起作用。令人惊讶的是，所有接受检测的CM和PT患者脑脊液TNFα水平均升高。在大多数脑脊液水平升高的患者中，血清TNFα水平正常。所有这些综合征可能都是中枢神经系统炎症的表现。由于大多数检测呈阳性的患者在积极的住院治疗期间改善甚微或没有改善，脑脊液TNFα水平持续升高可能是慢性每日头痛（CDH）治疗难治的原因之一。
