Spine (Phila Pa 1976). 2009 Oct 1;34(21):2311-7. doi: 10.1097/BRS.0b013e3181af06b6.
Prospective observational cohort.
Correlate epidural inflammatory cytokines with the clinical response to epidural steroid injection in patients with lumbar nerve root irritation.
Some back pain syndromes are thought to be associated with activation of inflammatory pathways and others may be associated with primary mechanical derangements. Human studies providing detailed evidence for the primary inflammatory causation, which may be best treated with anti-inflammatory strategies, are lacking. There are currently no accurate diagnostic tests to predict the response to epidural steroid injection or surgical intervention in back pain and sciatica syndromes. METHODS.: Forty-seven consecutive patients with lumbar degenerative changes and low back and/or leg pain were prospectively enrolled. An epidural lavage was performed, followed by injection of marcaine/depo-medrol. Subjects scored their pain before and 3 months after the procedure. The immunoreactivity of an array of cytokines was measured in lavage samples and compared with clinical response to the therapeutic injection. Ten subjects underwent repeat epidural lavage sampling 3 months after the steroid injection.
Interferon gamma (IFNgamma) was the most consistently detected cytokine. IFNgamma-immunoreactivity also highly correlated with reported reduction of pain 3-months after the epidural steroid injection. In subjects reporting significant pain relief (>50%) from the injection, mean [IFNgamma] was significantly greater compared with patients experiencing no significant relief. The IFNgamma-immunoreactivity in repeat lavage samples decreased to trace residual concentrations in patients who reported pain relief from the steroid injection.
The presence of epidural IFNgamma-immunoreactivity corresponding to >10 pg/mL predicted significant pain relief after epidural steroid injection with >95% accuracy. These results suggest that IFNgamma may be part of a biochemical cascade triggering pain in sciatica; IFNgamma-immunoreactivity may aid as a biomarker for predicting the response to steroid therapy and/or surgical intervention, and may serve as a future therapeutic target.
前瞻性观察队列。
在腰椎神经根刺激的患者中，将硬膜外炎症细胞因子与硬膜外类固醇注射的临床反应相关联。
一些背痛综合征被认为与炎症途径的激活有关，而其他可能与原发性机械紊乱有关。缺乏提供详细证据的人类研究表明，原发性炎症可能是最好的抗炎策略，目前没有准确的诊断测试来预测在腰痛和坐骨神经痛综合征中对硬膜外类固醇注射或手术干预的反应。
前瞻性纳入 47 例腰椎退行性病变和腰背及/或腿痛患者。进行硬膜外灌洗，然后注射盐酸布比卡因/得宝松。受试者在治疗前和治疗后 3 个月对疼痛进行评分。测量灌洗样本中细胞因子的免疫反应性，并与治疗性注射的临床反应进行比较。10 例患者在类固醇注射后 3 个月重复硬膜外灌洗取样。
干扰素γ（IFNgamma）是最一致检测到的细胞因子。IFNgamma-免疫反应性也与硬膜外类固醇注射后 3 个月报告的疼痛减轻高度相关。在报告注射后疼痛明显缓解（>50%）的患者中，与没有明显缓解的患者相比，平均[IFNgamma]显著更高。在报告从类固醇注射中缓解疼痛的患者中，重复灌洗样本中的 IFNgamma 免疫反应性降低至痕量残留浓度。
硬膜外 IFNgamma 免疫反应性大于 10pg/ml 存在，可预测硬膜外类固醇注射后疼痛明显缓解，准确率超过 95%。这些结果表明 IFNgamma 可能是触发坐骨神经痛疼痛的生化级联的一部分；IFNgamma 免疫反应性可能有助于作为预测类固醇治疗和/或手术干预反应的生物标志物，并可能成为未来的治疗靶点。
