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创伤性神经损伤后有痛觉和无痛觉神经病患者的全身炎症与实验性疼痛敏感性之间的关系。

Association between systemic inflammation and experimental pain sensitivity in subjects with pain and painless neuropathy after traumatic nerve injuries.

机构信息

Department Surgical Science, Uppsala University, Uppsala, Sweden.

出版信息

Scand J Pain. 2022 May 9;23(1):184-199. doi: 10.1515/sjpain-2021-0195. Print 2023 Jan 27.


DOI:10.1515/sjpain-2021-0195
PMID:35531763
Abstract

OBJECTIVES: Peripheral neuropathies that occur secondary to nerve injuries may be painful or painless, and including a low-grade inflammation and pro-inflammatory cytokines associated with both regeneration and damage of peripheral nerve cells and fibers. Currently, there are no validated methods that can distinguished between neuropathic pain and painless neuropathy. The aim of this study was to search for proinflammatory and anti-inflammatory proteins associated with pain and experimental pain sensitivity in subjects with surgeon-verified nerve injuries in the upper extremities. METHODS: One hundred and thirty-one subjects [69 with neuropathic pain, NP; 62 with painless neuropathy, nP] underwent a conditioned pain modulation (CPM) test that included a cold pressor task (CPT) conducted with the non-injured hand submerged in cold water (4 °C) until pain was intolerable. CPM was assessed by pain ratings to pressure stimuli before and after applying the CPT. Efficient CPM effect was defined as the ability of the individual's CS to inhibit at least 29% of pain (eCPM). The subjects were assigned to one of two subgroups: pain sensitive (PS) and pain tolerant (PT) after the time they could tolerate their hand in cold water (PS<40 s and PT=60 s) . Plasma samples were analyzed for 92 proteins incorporated in the inflammation panel using multiplex Protein Extension Array Technology (PEA). Differentially expressed proteins were investigated using both univariate and multivariate analysis (principal component analysis-PCA and orthogonal partial least-squares discriminant analysis-OPLS-DA). RESULTS: Significant differences in all protein levels were found between PS and PT subgroups (CV-ANOVA p<0.001), but not between NP and nP groups (p=0.09) or between inefficient CPM (iCPM) and eCPM (p=0.53) subgroups. Several top proteins associated with NP could be detected using multivariate regression analysis such as stromelysin 2 (MMPs), interleukin-2 receptor subunit beta (IL2RB), chemokine (C-X-C motif) ligand 3 (CXCL3), fibroblast growth factor 5 (FGF5), chemokine (C-C motif) ligand 28 (CCL28), CCL25, CCL11, hepatocyte growth factor (HGF), interleukin 4 (IL4), IL13. After adjusting for multiple testing, none of these proteins correlated significantly with pain. Higher levels of CCL20 (p=0.049) and CUB domain-containing protein (CDCP-1; p=0.047) were found to correlate significantly with cold pain sensitivity. CDCP-1 was highly associated with both PS and iCPM (p=0.042). CONCLUSIONS: No significant alterations in systemic proteins were found comparing subjects with neuropathic pain and painless neuropathy. An expression of predominant proinflammatory proteins was associated with experimental cold pain sensitivity in both subjects with pain and painless neuropathy. One these proteins, CDC-1 acted as "molecular fingerprint" overlapping both CPM and CPT. This observation might have implications for the study of pain in general and should be addressed in more detail in future experiments.

摘要

目的:继发于神经损伤的周围神经病变可能是疼痛或无痛的,包括与周围神经细胞和纤维的再生和损伤相关的低度炎症和促炎细胞因子。目前,没有经过验证的方法可以区分神经病理性疼痛和无痛性神经病。本研究的目的是寻找与上肢外科医生证实的神经损伤患者的疼痛和实验性疼痛敏感性相关的促炎和抗炎蛋白。

方法:131 名受试者[69 名患有神经病理性疼痛(NP),62 名患有无痛性神经病(nP)]接受了条件性疼痛调制(CPM)测试,包括用非受伤手浸入冷水中(4°C)进行冷加压任务(CPT),直到疼痛无法忍受。CPM 通过在施加 CPT 前后对压力刺激的疼痛评分进行评估。有效的 CPM 效应定义为个体 CS 抑制疼痛的能力至少为 29%(eCPM)。根据他们能忍受冷水的时间,受试者被分为两个亚组之一:疼痛敏感(PS)和疼痛耐受(PT)(PS<40s,PT=60s)。使用多聚蛋白延伸阵列技术(PEA)分析纳入炎症面板的 92 种蛋白质的血浆样本。使用单变量和多变量分析(主成分分析-PCA 和正交偏最小二乘判别分析-OPLS-DA)研究差异表达的蛋白质。

结果:在 PS 和 PT 亚组之间发现所有蛋白质水平均存在显著差异(CV-ANOVA p<0.001),但在 NP 和 nP 组之间(p=0.09)或在低效 CPM(iCPM)和 eCPM (p=0.53)亚组之间没有发现差异。使用多元回归分析可以检测到一些与 NP 相关的顶级蛋白,例如基质金属蛋白酶 2(MMPs)、白细胞介素 2 受体亚基β(IL2RB)、趋化因子(C-X-C 基序)配体 3(CXCL3)、成纤维细胞生长因子 5(FGF5)、趋化因子(C-C 基序)配体 28(CCL28)、CCL25、CCL11、肝细胞生长因子(HGF)、白细胞介素 4(IL4)、白细胞介素 13。经过多重检验调整后,这些蛋白质均与疼痛无显著相关性。发现 CCL20(p=0.049)和 CUB 结构域蛋白(CDCP-1;p=0.047)水平升高与冷痛敏感性显著相关。CDCP-1 与 PS 和 iCPM 高度相关(p=0.042)。

结论:在比较患有神经病理性疼痛和无痛性神经病的患者时,未发现系统蛋白有明显变化。主要促炎蛋白的表达与疼痛和无痛性神经病患者的实验性冷痛敏感性相关。这些蛋白质之一,CDC-1 作为“分子指纹”,与 CPM 和 CPT 重叠。这一观察结果可能对疼痛的研究具有重要意义,应该在未来的实验中更详细地研究。

相似文献

[1]
Association between systemic inflammation and experimental pain sensitivity in subjects with pain and painless neuropathy after traumatic nerve injuries.

Scand J Pain. 2023-1-27

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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BMC Neurol. 2016-8-5

[10]
Disordered conditioned pain modulation system in patients with posttraumatic cold intolerance.

J Plast Reconstr Aesthet Surg. 2013-9-25

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