School of Medicine, Department of Physical Medicine and Rehabilitation, Bahçeşehir University, Istanbul, Turkey.
Taksim Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
Curr Med Res Opin. 2024 Jan;40(1):77-85. doi: 10.1080/03007995.2023.2282646. Epub 2024 Jan 3.
Mechanical and inflammatory factors were suggested as the causes of spine degeneration and low back pain (LBP). Previous studies partly reported the association of LBP with inflammation. However, none of them compared patients with LBP and asymptomatic subjects in terms of complete blood count and inflammatory markers in detail. We aimed to analyze the association of serum white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with chronic LBP by comparing the patients with chronic LBP and age- and gender-matched asymptomatic subjects.
Lumbar intervertebral disc degeneration and vertebral end-plates were evaluated using Pfirrmann grading and Modic classification on lumbar spine magnetic resonance images, respectively. Serum WBC counts, CRP levels, and ESRs were recorded from chart reviews.
We included 147 patients with chronic LBP and 101 asymptomatic subjects. Patients with chronic LBP had significantly higher serum neutrophil, monocyte, and basophil counts, higher neutrophil-to-lymphocyte ratio, higher ESR, and lower serum CRP levels compared to the asymptomatic subjects. Serum monocyte and basophil cell counts and ESR were the most remarkable predictive factors for chronic LBP, severe IVDD, and Modic changes. Higher serum monocyte and basophil cell counts and higher serum ESR above cut-off values of 0.42 × 103/μL, 0.025 × 103/μL, and 3.5 mm/hour could be used as screening tools for subjects with persistent LBP in primary care.
Higher serum monocyte and basophil counts and serum ESR above new cut-off values should highlight the need to obtain early spinal imaging to prevent chronicity in patients with LBP.
机械和炎症因素被认为是脊柱退化和下腰痛（LBP）的原因。先前的研究部分报告了 LBP 与炎症之间的关联。然而，它们都没有详细比较 LBP 患者和无症状受试者的全血细胞计数和炎症标志物。我们旨在通过比较慢性 LBP 患者和年龄、性别匹配的无症状受试者，分析血清白细胞（WBC）计数、C 反应蛋白（CRP）和红细胞沉降率（ESR）与慢性 LBP 的关系。
使用腰椎磁共振图像分别对腰椎间盘退变和椎体终板进行 Pfirrmann 分级和 Modic 分类评估。从病历记录中记录血清 WBC 计数、CRP 水平和 ESR。
我们纳入了 147 名慢性 LBP 患者和 101 名无症状受试者。与无症状受试者相比，慢性 LBP 患者的血清中性粒细胞、单核细胞和嗜碱性粒细胞计数明显较高，中性粒细胞与淋巴细胞比值较高，ESR 较高，血清 CRP 水平较低。血清单核细胞和嗜碱性粒细胞计数和 ESR 是慢性 LBP、严重 IVDD 和 Modic 改变的最显著预测因子。高于 0.42×103/μL、0.025×103/μL 和 3.5mm/hour 的血清单核细胞和嗜碱性粒细胞计数和较高的血清 ESR 可作为基层医疗中持续性 LBP 患者的筛查工具。
高于新临界值的血清单核细胞和嗜碱性粒细胞计数和 ESR 应强调需要及早获得脊柱影像学检查，以防止 LBP 患者病情持续。
