School of Nursing, Northern Illinois University, DeKalb, IL, USA.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
Biol Res Nurs. 2023 Oct;25(4):571-585. doi: 10.1177/10998004231171146. Epub 2023 May 4.
Proinflammatory cytokines play a critical role in chronic inflammation and pain and contribute to behavioral symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and comorbidities (diabetes, cardiac diseases, cancer). Evidence is lacking on the specific proinflammatory cytokines associated with these behavioral symptoms/comorbidities co-occurring with axial low back pain (aLBP). This review aimed to systematically analyze the following: (1) specific proinflammatory cytokines associated with aLBP in adults, (2) associations among proinflammatory cytokines and behavioral symptoms in aLBP, and (3) relationships among proinflammatory cytokines and comorbidities in aLBP, to develop a new clinical framework for future diagnostic and intervention targets for patients with aLBP.
Electronic databases, including PubMed/MEDLINE, ProQuest Nursing & Allied Health Source, and CINAHL Complete (EBSCO) were searched for the period January 2012 to February 2023. Eligible studies included cross-sectional, case-control, longitudinal, and cohort studies in which proinflammatory cytokines were reported in adults above 18 years with aLBP. Intervention studies and randomized controlled trails were excluded. The Joanna Briggs Institute (JBI) criteria were used for quality evaluation.
Findings from 11 studies showed 3 proinflammatory cytokines associated with pain intensity in adult patients with aLBP: C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), and Interleukin (IL-6). Some studies assessed associations between proinflammatory cytokines and depressive symptoms; none explored the association of proinflammatory cytokines with fatigue, anxiety, sleep disturbance, or comorbidities (diabetes, cardiac diseases, and cancer) in aLBP.
Proinflammatory cytokines in aLBP can serve as composite biomarkers for pain, associated symptoms, and comorbidities and may serve as a target for future interventions. There is need for well-designed studies assessing associations among chronic inflammation, behavioral symptoms, and comorbidities.
促炎细胞因子在慢性炎症和疼痛中起着关键作用，并导致行为症状（抑郁症状、焦虑、疲劳、睡眠障碍）和合并症（糖尿病、心脏病、癌症）。目前缺乏与轴性下腰痛（aLBP）同时发生的这些行为症状/合并症相关的特定促炎细胞因子的证据。本综述旨在系统分析以下内容：（1）与成人 aLBP 相关的特定促炎细胞因子，（2）aLBP 中促炎细胞因子与行为症状之间的关系，以及（3）aLBP 中促炎细胞因子与合并症之间的关系，为未来 aLBP 患者的诊断和干预目标开发新的临床框架。
检索了电子数据库，包括 PubMed/MEDLINE、ProQuest Nursing & Allied Health Source 和 CINAHL Complete（EBSCO），检索时间为 2012 年 1 月至 2023 年 2 月。纳入的研究包括横断面研究、病例对照研究、纵向研究和队列研究，这些研究报告了年龄在 18 岁以上的 aLBP 患者的促炎细胞因子。排除了干预研究和随机对照试验。采用 Joanna Briggs 研究所（JBI）标准进行质量评估。
11 项研究的结果表明，3 种促炎细胞因子与 aLBP 成年患者的疼痛强度相关：C 反应蛋白（CRP）、肿瘤坏死因子（TNF-α）和白细胞介素（IL-6）。一些研究评估了促炎细胞因子与抑郁症状之间的关系；没有研究探讨促炎细胞因子与 aLBP 中的疲劳、焦虑、睡眠障碍或合并症（糖尿病、心脏病和癌症）之间的关系。
aLBP 中的促炎细胞因子可以作为疼痛、相关症状和合并症的综合生物标志物，并可能成为未来干预的目标。需要设计良好的研究来评估慢性炎症、行为症状和合并症之间的关系。
