Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany Department of Trauma Surgery and Orthopedics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany Department of Neurology, University of Würzburg, Germany.
Pain. 2011 Feb;152(2):285-290. doi: 10.1016/j.pain.2010.09.024. Epub 2010 Oct 13.
Posttraumatic TNF-alpha signaling may be one of the factors responsible for pain and hyperalgesia in complex regional pain syndromes (CRPS). In order to further specify the role of TNF-alpha we investigated tissue (skin) and serum concentrations in three different patient groups: patients with osteoarthritis and planned surgery, with acute traumatic upper limb bone fracture waiting for surgery, and with CRPS I. Thirty patients (10 in each group) were recruited. Mean CRPS duration was 36.1 ± 8.1 weeks (range 8- 90 weeks). Skin punch biopsies were taken at the beginning of the surgery in osteoarthritis and fracture patients and from the affected side in CRPS patients. Blood samples were taken before the respective procedures. Skin and serum TNF-alpha levels were quantified by ELISA. Compared to patients with osteoarthritis, skin TNF-alpha was significantly elevated in CRPS (p<0.001) and fracture patients (p<0.04). Skin TNF-alpha in CRPS patients was higher than in patients with acute bone fracture (p<0.02). In contrast, serum TNF-alpha values were the same in osteoarthritis and CRPS, and lower in fracture patients (p<0.03). Our results indicate a local but not systemic increase of TNF-alpha in CRPS patients. This increase persists for months after limb trauma and may offer the opportunity for targeted treatment.
创伤后 TNF-α 信号可能是复杂性区域疼痛综合征（CRPS）中疼痛和痛觉过敏的原因之一。为了进一步明确 TNF-α 的作用，我们研究了三个不同患者组的组织（皮肤）和血清浓度：计划接受手术的骨关节炎患者、等待手术的急性创伤性上肢骨骨折患者和 CRPS I 患者。招募了 30 名患者（每组 10 名）。CRPS 的平均持续时间为 36.1 ± 8.1 周（范围 8-90 周）。在骨关节炎和骨折患者的手术开始时以及 CRPS 患者的患病侧取皮肤穿刺活检。在各自的手术前采集血样。通过 ELISA 定量测定皮肤和血清 TNF-α 水平。与骨关节炎患者相比，CRPS（p<0.001）和骨折患者（p<0.04）的皮肤 TNF-α 显着升高。CRPS 患者的皮肤 TNF-α高于急性骨折患者（p<0.02）。相比之下，骨关节炎和 CRPS 患者的血清 TNF-α值相同，骨折患者的血清 TNF-α值较低（p<0.03）。我们的结果表明 CRPS 患者存在局部而非全身性 TNF-α 增加。这种增加在肢体创伤后持续数月，可能为靶向治疗提供机会。
