Sowa Gwendolyn A, Perera Subashan, Bechara Bernard, Agarwal Vikas, Boardman John, Huang Wan, Camacho-Soto Alejandra, Vo Nam, Kang James, Weiner Debra
Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Ferguson Laboratory for Orthopaedic Research, Department of Orthopaedics, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Am Geriatr Soc. 2014 Nov;62(11):2047-55. doi: 10.1111/jgs.13102. Epub 2014 Nov 3.
To examine the relationship between serum biomarkers and self-reported pain intensity and pain-related function, in addition to the contribution of magnetic resonance imaging (MRI) findings of lumbar spine degenerative changes, in older adults with chronic low back pain.
Single-center cross-sectional cohort study.
Academic medical center.
Individuals aged 60 and older with axial low back pain without radiculopathy or previously diagnosed osteoarthritis of the knee or hip or pain outside the low back that is more severe than the back pain (n = 43).
To examine pain-related impairment, pain was measured on a pain thermometer and the McGill Pain Questionnaire Short Form was administered. To examine pain-related function or activity limitation, the Roland Morris Disability Questionnaire, Short Physical Performance Battery (SPPB), and repetitive trunk rotation were used. Single plasma samples were obtained before and after physical performance tests and analyzed for inflammatory markers (E-selectin and regulated on activation, normal T cell expressed and secreted (RANTES)), inhibitors of catabolic enzymes (tissue inhibitor of metalloproteinases-1 (TIMP-1)), markers of matrix turnover (C- telopeptide of type II collagen (CTX-II) and aggrecan chondroitin sulfate 846 (CS846)), and stress biomarkers (neuropeptide Y (NPY)). Conventional nongadolinium lumbar MRI was performed and analyzed quantitatively and clinically.
Composite MRI measurements did not show significant correlation with pain or pain-related function. Basal levels and changes in serum biomarkers in response to activity, particularly NPY and RANTES, demonstrated associations with pain and pain-related function in addition to the explanatory power of MRI-based results.
Serum biomarkers may be a metric for assessment of active disease in older adults, in whom imaging changes are ubiquitous. In addition, changing levels of biomarkers in response to activity suggests that they may be useful as metrics to measure treatment responses in future studies and may reflect potential targets for use in designing personalized treatment for older adults with low back pain.
研究慢性下腰痛老年患者血清生物标志物与自我报告的疼痛强度及疼痛相关功能之间的关系，以及腰椎退变改变的磁共振成像（MRI）结果的作用。
单中心横断面队列研究。
学术医疗中心。
60岁及以上的个体，患有轴性下腰痛，无神经根病，既往未诊断为膝关节或髋关节骨关节炎，或下背部以外的疼痛不比背痛严重（n = 43）。
为检查疼痛相关损害，用疼痛温度计测量疼痛，并进行麦吉尔疼痛问卷简表评估。为检查疼痛相关功能或活动受限，使用罗兰·莫里斯残疾问卷、简短体能测试电池组（SPPB）和重复性躯干旋转测试。在体能测试前后采集单次血浆样本，分析炎症标志物（E-选择素和正常T细胞激活后表达和分泌的调节因子（RANTES））、分解代谢酶抑制剂（金属蛋白酶组织抑制剂-1（TIMP-1））、基质周转标志物（II型胶原C端肽（CTX-II）和聚集蛋白聚糖硫酸软骨素846（CS846））以及应激生物标志物（神经肽Y（NPY））。进行常规非钆增强腰椎MRI检查，并进行定量和临床分析。
MRI综合测量结果与疼痛或疼痛相关功能无显著相关性。血清生物标志物的基础水平及活动后的变化，特别是NPY和RANTES，除了基于MRI结果的解释力外，还显示出与疼痛及疼痛相关功能的关联。
血清生物标志物可能是评估老年患者活动性疾病的指标，在这些患者中影像学改变普遍存在。此外，生物标志物水平随活动的变化表明，它们可能作为衡量未来研究中治疗反应的指标有用，并且可能反映用于为老年下腰痛患者设计个性化治疗的潜在靶点。
