Rannou François, Ouanes Walid, Boutron Isabelle, Lovisi Bianca, Fayad Fouad, Macé Yann, Borderie Didier, Guerini Henri, Poiraudeau Serge, Revel Michel
Assistance Publique-Hôpitaux de Paris, Université René Descartes, Groupe Hospitalier Cochin, Paris, France.
Arthritis Rheum. 2007 Oct 15;57(7):1311-5. doi: 10.1002/art.22985.
To assess high-sensitivity C-reactive protein (hsCRP) level as a measure of low-grade inflammation in relation to Modic vertebral end-plate marrow signal change on magnetic resonance imaging (MRI) in patients with chronic low back pain.
All patients hospitalized for chronic low back pain in our institution were prospectively enrolled in this pilot study. Serum hsCRP concentration was measured by immunoturbidimetric assay. MR images were evaluated independently by a panel of 2 spine specialists and a radiologist. Recording of clinical parameters, MRI evaluation, and hsCRP level of each patient was blinded.
Three groups of 12 consecutive patients (Modic 0, Modic I, and Modic II signal changes on MRI) were prospectively selected. Serum hsCRP level was significantly different in the 3 groups (P = 0.002) and especially high in the Modic I group (P = 0.002 compared with Modic 0 and II groups): mean +/- SD 1.33 +/- 0.77 mg/liter in the Modic 0 group, 4.64 +/- 3.09 mg/liter in the Modic I group, and 1.75 +/- 1.30 mg/liter in the Modic II group. The only difference in clinical parameters among the 3 groups (P = 0.001) was that the worst painful moment during the previous 24 hours occurred during the late night and morning for all Modic I patients (P = 0.001 compared with Modic 0 and P = 0.002 compared with Modic II).
Low-grade inflammation indicated by high serum hsCRP level in patients with chronic low back pain could point to Modic I signal changes. This result could help physicians predict the patients with Modic I signals to more precisely prescribe the correct imaging procedure and local antiinflammatory treatment in such patients.
评估高敏C反应蛋白（hsCRP）水平，作为慢性下腰痛患者磁共振成像（MRI）上Modic椎体终板骨髓信号改变相关的低度炎症指标。
本机构中因慢性下腰痛住院的所有患者均前瞻性纳入本初步研究。采用免疫比浊法测定血清hsCRP浓度。由2名脊柱专科医生和1名放射科医生组成的小组独立评估MR图像。对每位患者的临床参数记录、MRI评估和hsCRP水平进行盲法处理。
前瞻性选择了三组连续12例患者（MRI上分别为Modic 0、Modic I和Modic II信号改变）。三组患者血清hsCRP水平差异有统计学意义（P = 0.002），Modic I组尤其高（与Modic 0组和II组相比，P = 0.002）：Modic 0组平均±标准差为1.33±0.77 mg/升，Modic I组为4.64±3.09 mg/升，Modic II组为1.75±1.30 mg/升。三组患者临床参数的唯一差异（P = 0.001）是，所有Modic I患者在前24小时内最疼痛的时刻出现在深夜和清晨（与Modic 0组相比，P = 0.001；与Modic II组相比，P = 0.002）。
慢性下腰痛患者血清hsCRP水平升高所提示的低度炎症可能与Modic I信号改变有关。这一结果可帮助医生预测Modic I信号患者，以便更准确地为这类患者开具正确的成像检查程序和局部抗炎治疗。
