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膝关节骨关节炎疼痛患者的炎症生物标志物:探索全膝关节置换术后慢性术后疼痛的潜在关联——二次分析。

Inflammatory biomarkers in patients with painful knee osteoarthritis: exploring the potential link to chronic postoperative pain after total knee arthroplasty-a secondary analysis.

机构信息

Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gistrup, Denmark.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

出版信息

Pain. 2024 Feb 1;165(2):337-346. doi: 10.1097/j.pain.0000000000003042. Epub 2023 Sep 6.

Abstract

Total knee arthroplasty (TKA) is the end-stage treatment of knee osteoarthritis (OA), and approximately 20% of patients experience chronic postoperative pain. Studies indicate that inflammatory biomarkers might be associated with pain in OA and potentially linked to the development of chronic postoperative pain after TKA. This study aimed to (1) evaluate preoperative serum levels of inflammatory biomarkers in patients with OA and healthy control subjects, (2) investigate preoperative differences of inflammatory biomarker profiles in subgroups of patients, and (3) compare subgroups of patients with and without postoperative pain 12 months after surgery. Serum samples from patients with OA scheduled for TKA (n = 127) and healthy participants (n = 39) were analyzed. Patients completed the Knee-injury-and-Osteoarthritis-Outcome-Score (KOOS) questionnaire and rated their clinical pain intensity using a visual analog scale (VAS) before and 12 months after TKA. Hierarchical cluster analysis and Orthogonal Partial Least Squares Discriminant Analysis were used to compare groups (patients vs control subjects) and to identify subgroups of patients in relation to postoperative outcomes. Difference in preoperative and postoperative VAS and KOOS scores were compared across subgroups. Twelve inflammatory markers were differentially expressed in patients when compared with control subjects. Cluster analysis identified 2 subgroups of patients with 23 proteins being significantly different ( P < 0.01). The 12-months postoperative VAS and KOOS scores were significantly different between subgroups of patients ( P < 0.05). This study identified differences in specific inflammatory biomarker profiles when comparing patients with OA and control subjects. Cluster analysis identified 2 subgroups of patients with OA, with one subgroup demonstrating comparatively worse 12-month postoperative pain intensity and function scores.

摘要

全膝关节置换术(TKA)是膝关节骨关节炎(OA)的终末期治疗方法,约 20%的患者会出现慢性术后疼痛。研究表明,炎症生物标志物可能与 OA 疼痛有关,并可能与 TKA 后慢性术后疼痛的发展有关。本研究旨在:(1)评估 OA 患者和健康对照者术前血清炎症生物标志物水平;(2)研究患者亚组中炎症生物标志物谱的术前差异;(3)比较术后 12 个月有和无术后疼痛的患者亚组。分析了拟行 TKA 的 OA 患者(n=127)和健康参与者(n=39)的血清样本。患者在 TKA 前后完成膝关节损伤和骨关节炎结局评分(KOOS)问卷,并使用视觉模拟评分(VAS)对其临床疼痛强度进行评分。使用层次聚类分析和正交偏最小二乘判别分析比较组间(患者与对照组)差异,并识别与术后结果相关的患者亚组。比较亚组间术前和术后 VAS 和 KOOS 评分的差异。与对照组相比,患者的 12 种炎症标志物表达存在差异。聚类分析确定了 2 个具有 23 种蛋白显著差异的患者亚组(P<0.01)。患者亚组的 12 个月术后 VAS 和 KOOS 评分存在显著差异(P<0.05)。本研究在比较 OA 患者和对照组时发现了特定炎症生物标志物谱的差异。聚类分析确定了 2 个具有 OA 的患者亚组,其中一个亚组在术后 12 个月时疼痛强度和功能评分较差。

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