生物标志物与急性和亚急性腰痛疼痛和功能的相关性：一项 RCT 的二次分析。
The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT.
机构信息
Ferguson Laboratory for Orthopaedic and Spine Research, Department of Orthopaedic Surgery, University of Pittsburgh, 200 Lothrop Street, Room E1612, BST, Pittsburgh, PA, 15261, USA.
Department of Physical Therapy, University of Pittsburgh, 100 Technology Dr, Pittsburgh, PA, 15219, USA.
出版信息
BMC Musculoskelet Disord. 2022 Dec 5;23(1):1059. doi: 10.1186/s12891-022-06027-9.
BACKGROUND
Low back pain (LBP) is a common musculoskeletal condition and a major cause of disability worldwide. Previous studies have found associations of biomarkers with pain and pain-related disability in LBP patients. This study aimed to explore the association between serum biomarkers and pain and disability in patients with acute or subacute axial LBP.
METHODS
This study was ancillary to a parent randomized controlled trial. Enrolled participants were randomized into three intervention groups: one of two types of spinal manipulation or medical care. In the parent study, 107 adults who experienced a new episode of LBP within 3 months prior to enrollment were recruited. For this study, 90 of these 107 participants consented to have blood samples obtained, which were drawn immediately before the beginning of treatment. Seven biomarkers were chosen based on previous literature and analyzed. Clinical outcomes were pain and Oswestry Disability Index (ODI) evaluated at baseline and 4 weeks. Spearman's |r| was used to study the association of initial levels of each biomarker with pain and ODI scores at baseline and with changes in outcome scores from baseline to 4 weeks (end of treatment) within each intervention group.
RESULTS
At baseline, 4 of 7 biomarkers had an association with pain that was |r| ≥ .20: neuropeptide Y (NPY) (r = 0.23, p = .028), E-Selectin (r = 0.22, p = .043), vitamin D ((r = - 0.32, p = .002), and c-reactive protein (CRP) (r = 0.37, p = .001). No baseline biomarker had an association with disability that was |r| ≥ 0.20. For the correlations of baseline biomarkers with 4-week change in outcomes, vitamin D showed a correlation with change in disability and/or pain (|r| ≥ 0.20, p > .05) in manipulation-related groups, while CRP, NPY, and E-selectin along with TNFα, Substance P and RANTES showed at least one correlation with change in pain or disability (|r| ≥ 0.20, p > .05) in at least one of the treatment groups.
CONCLUSIONS
In 90 LBP patients, the analyzed biomarkers, especially vitamin D, represent a small set of potential candidates for further research aimed at individualizing patient care. Overall, the associations investigated in the current study are an initial step in identifying the direct mechanisms of LBP and predicting outcomes of manipulation-related treatments or medical care.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01211613, Date of Registration: September 29, 2010, https://clinicaltrials.gov/ct2/show/NCT01211613?term=schneider&cond=Low+Back+Pain&cntry=US&state=US%3APA&draw=2&rank=1.
背景
下腰痛（LBP）是一种常见的肌肉骨骼疾病，也是全球残疾的主要原因。先前的研究发现生物标志物与 LBP 患者的疼痛和与疼痛相关的残疾有关。本研究旨在探讨血清生物标志物与急性或亚急性轴向 LBP 患者疼痛和残疾之间的关系。
方法
本研究是一项父母随机对照试验的辅助研究。纳入的参与者被随机分为三组干预组：两种类型的脊柱推拿或医疗护理之一。在父母研究中，招募了 107 名在入组前 3 个月内经历新的 LBP 发作的成年人。在这项研究中，这 107 名参与者中有 90 名同意抽取血液样本，这些样本是在治疗开始前立即抽取的。根据先前的文献选择了 7 种生物标志物进行分析。临床结果是基线和 4 周时的疼痛和 Oswestry 残疾指数（ODI）。Spearman's |r| 用于研究每个生物标志物的初始水平与基线时疼痛和 ODI 评分的相关性，以及每个干预组中从基线到 4 周（治疗结束）的结局评分变化的相关性。
结果
在基线时，有 4 种生物标志物的疼痛相关性为 |r|≥.20：神经肽 Y（NPY）（r=0.23，p=0.028）、E-选择素（r=0.22，p=0.043）、维生素 D（r=−0.32，p=0.002）和 C 反应蛋白（CRP）（r=0.37，p=0.001）。没有基线生物标志物与残疾的相关性达到 |r|≥0.20。对于基线生物标志物与 4 周结局变化的相关性，维生素 D 与推拿相关组的残疾和/或疼痛变化呈相关性（|r|≥0.20，p>.05），而 CRP、NPY 和 E-选择素以及 TNFα、P 物质和 RANTES 则显示出至少有一种相关性与疼痛或残疾的变化（|r|≥0.20，p>.05）至少一种治疗组。
结论
在 90 名 LBP 患者中，分析的生物标志物，尤其是维生素 D，代表了一组潜在的候选者，用于进一步研究旨在实现个体化患者护理。总体而言，当前研究中调查的关联是识别 LBP 直接机制并预测推拿相关治疗或医疗护理结果的初始步骤。
试验注册
ClinicalTrials.gov 标识符：NCT01211613，注册日期：2010 年 9 月 29 日，https://clinicaltrials.gov/ct2/show/NCT01211613？term=schneider&cond=Low+Back+Pain&cntry=US&state=US%3APA&draw=2&rank=1。
Zotero 插件