Communication and Research Unit for Musculoskeletal Disorders, Oslo universitetssykehus Ulleval, Oslo, Norway
Faculty of Medicine, University of Oslo, Oslo, Norway.
RMD Open. 2021 Aug;7(2). doi: 10.1136/rmdopen-2021-001726.
Low back pain (LBP) is a leading cause of disability worldwide, but the aetiology remains poorly understood. Finding relevant biomarkers may lead to better understanding of disease mechanisms. Patients with vertebral endplate bone marrow lesions visualised on MRI as Modic changes (MCs) have been proposed as a distinct LBP phenotype, and inflammatory mediators may be involved in the development of MCs.
To identify possible serum biomarkers for LBP in patients with MCs.
In this case control study serum levels of 40 cytokines were compared between patients with LBP and MC type 1 (n=46) or type 2 (n=37) and healthy controls (n=50).
Analyses identified significantly higher levels of six out of 40 cytokines in the MC type 1 group (MC1), and five in the MC type 2 group (MC2) compared with healthy controls. Six cytokines were moderately correlated with pain. Principal component analyses revealed clustering and separation of patients with LBP and controls, capturing 40.8% of the total variance, with 10 cytokines contributing to the separation. Macrophage migration inhibitory factor (MIF) alone accounted for 92% of the total contribution. Further, receiver operating characteristics analysis revealed that MIF showed an acceptable ability to distinguish between patients and controls (area under the curve=0.79).
These results suggest that cytokines may play a role in LBP with MCs. The clinical significance of the findings is unknown. MIF strongly contributed to clustering of patients with LBP with MCs and controls, and might be a biomarker for MCs. Ultimately, these results may guide future research on novel treatments for this patient group.
下腰痛（LBP）是全球导致残疾的主要原因，但病因仍知之甚少。寻找相关的生物标志物可能有助于更好地了解疾病机制。在 MRI 上观察到的椎体终板骨髓病变（Modic 改变，MCs）的患者被认为是一种独特的 LBP 表型，炎症介质可能参与了 MCs 的发展。
确定 MCs 患者的 LBP 潜在血清生物标志物。
在这项病例对照研究中，比较了 46 例 MC 1 型和 37 例 MC 2 型 LBP 患者与 50 例健康对照者的 40 种细胞因子的血清水平。
分析发现，与健康对照组相比，MC1 组有 6 种细胞因子水平显著升高，MC2 组有 5 种细胞因子水平显著升高。有 6 种细胞因子与疼痛中度相关。主成分分析显示，LBP 患者和对照组聚类和分离，捕捉到总方差的 40.8%，有 10 种细胞因子有助于分离。单独的巨噬细胞移动抑制因子（MIF）占总贡献的 92%。此外，接受者操作特征分析显示，MIF 区分患者和对照组具有可接受的能力（曲线下面积=0.79）。
这些结果表明细胞因子可能在伴有 MCs 的 LBP 中发挥作用。这些发现的临床意义尚不清楚。MIF 强烈促进了伴有 MCs 的 LBP 患者和对照组的聚类，可能是 MCs 的生物标志物。最终，这些结果可能为该患者群体的新型治疗方法的未来研究提供指导。
