Medical College of Georgia at Augusta University, Augusta, GA, USA.
Center for Blood Disorders Medical College of Georgia at Augusta University, Augusta, GA, USA.
Eur J Haematol. 2020 Oct;105(4):419-425. doi: 10.1111/ejh.13461. Epub 2020 Jul 1.
In this study, we investigated the evolution of chronic pain in sickle cell patients (SCD) as an age-dependent phenomenon and studied the frequency of vaso-occlusive episode frequency, opioid use, quantitative sensory testing (QST), and biomarkers of chronic pain (CP).
We undertook a cross-sectional study of the evolution of CP in SCD. A total of 72 subjects (age 15-66) were enrolled. VOE frequency, presence of CP hydroxyurea (HU) therapy, opioid use, and laboratory parameters were collected. QST was performed, and plasma tryptase, substance P, and NGF (Nerve Growth Factor) levels were assayed.
There was an age-dependent increase in frequency of CP, VOEs, opioid use, and Von Frey monofilament values. CP patients had significantly higher opioid use (daily morphine equivalents) (52.8 mg vs 6.94 mg, P = .009), suggesting a correlation between opioid use and hyperalgesia. NGF levels were also significantly higher (P = .051). Our results confirm previous observations of an age-dependent increase in the proportion of patients with CP and support the contributing role of mast cell activation and neurogenic inflammation.
This is the first study of NGF as a possible biomarker of CP in SCD. If confirmed, this could provide a diagnostic marker and therapeutic target for CP in SCD.
本研究旨在探讨镰状细胞病（SCD）患者慢性疼痛随年龄增长而演变的现象，并研究血管阻塞性发作频率、阿片类药物使用、定量感觉测试（QST）和慢性疼痛（CP）的生物标志物的频率。
我们进行了一项 SCD 患者 CP 演变的横断面研究。共纳入 72 名年龄在 15-66 岁的受试者。收集 VOE 频率、CP 羟基脲（HU）治疗、阿片类药物使用和实验室参数。进行 QST，并测定血浆胰蛋白酶、P 物质和 NGF（神经生长因子）水平。
CP、VOE、阿片类药物使用和 Von Frey 单丝值随年龄呈依赖性增加。CP 患者阿片类药物使用（每日吗啡当量）显著更高（52.8mg 比 6.94mg，P=0.009），表明阿片类药物使用与痛觉过敏之间存在相关性。NGF 水平也明显更高（P=0.051）。我们的结果证实了以前观察到的 CP 患者比例随年龄增长而增加的观察结果，并支持肥大细胞激活和神经源性炎症的致病作用。
这是首次研究 NGF 作为 SCD 中 CP 的潜在生物标志物。如果得到证实，这可能为 SCD 中的 CP 提供诊断标志物和治疗靶点。
