目标:大约五分之一的成年人经历慢性疼痛,通常与抑郁症同时发生,失眠,焦虑,和较低的自我评价的健康。细胞因子水平升高,例如肿瘤坏死因子α(TNF-α),白细胞介素6(IL-6),白细胞介素8(IL-8),和白细胞介素10(IL-10),已在慢性疼痛患者中发现。抑郁症,睡眠不足,自评健康状况差,和疼痛强度也与炎症生物标志物相关。本研究旨在探讨炎症生物标志物与抑郁症之间的相互关系,失眠,焦虑,自我评估的健康,疾病行为,慢性疼痛患者的疼痛强度。
方法:收集80例慢性疼痛成年患者的自我报告问卷和血液样本,分析血浆炎症生物标志物水平。炎症生物标志物(TNF-α,IL-6,IL-8,IL-10,C反应蛋白(CRP),红细胞沉降率(ESR))和抑郁,失眠,焦虑,自我评估的健康,疾病行为,和疼痛强度,采用双变量Spearman秩相关系数和回归分析。
结果:参与者主要是女性(72.5%),平均年龄50.8岁,报告的平均疼痛持续时间为16.7年。失眠与CRP(rs=.26,p<.05);性别和ESR(rs=.29,p<.05);年龄和IL-6(rs=.29,p<.05)和IL-8(rs=.30,p<.05);BMI和IL-6(rs=.50,p<.001)之间存在显着相关性。CRP(rs=.63,p<.001)和ESR(rs=.42,p<.001)。抑郁症的评分与疾病行为和焦虑的评分呈正相关且显着相关(分别为β=0.32和β=0.40),解释了抑郁症评级总方差的49%。失眠与疾病行为呈正相关且显着相关(β=.37),占失眠评分总方差的31%。炎性生物标志物,然而,对模型的贡献不大。
结论:参与者报告了高水平的症状,然而,这些评级与炎性生物标志物之间的关联要么缺失,要么较弱.此外,尽管自我报告的疾病行为水平很高,总体炎症状态仍在正常范围内.在解释抑郁症和失眠的评级方面,疾病行为的评级比炎症标志物的贡献更大。目前的结果指出了慢性疼痛的复杂性,以及识别解释症状学的生物标志物的挑战。
OBJECTIVE: Approximately one in five adults experiences chronic pain, often in co-occurrence with depression, insomnia, anxiety, and lower self-rated health. Elevated levels of cytokines, e.g. tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), and interleukin 10 (IL-10), have been identified in patients with chronic pain. Depression, insufficient sleep, poor self-rated health, and pain intensity have also been associated with inflammatory biomarkers. This study aimed to investigate the interrelationships between inflammatory biomarkers and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity in patients with chronic pain.
METHODS: Self-report questionnaires and blood samples analyzed for plasma levels of inflammatory biomarkers were collected from 80 adult patients with chronic pain. Associations between inflammatory biomarkers (TNF-α, IL-6, IL-8, IL-10, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity, were analyzed using bivariate Spearman rank correlation coefficients and regression analyses.
RESULTS: Participants were mainly women (72.5 %), with a mean age of 50.8 years, and a reported mean pain duration of 16.7 years. There were significant correlations between insomnia and CRP (rs =.26, p <.05); sex and ESR (rs =.29, p <.05); age and IL-6 (rs =.29, p <.05) and IL-8 (rs =.30, p <.05); BMI and IL-6 (rs =.50, p <.001), CRP (rs =.63, p <.001) and ESR (rs =.42, p <.001). Ratings of depression were positively and significantly related to ratings of sickness behavior and anxiety (β =.32 and β =.40, respectively), explaining 49 % of the total variance in depression ratings. Insomnia was positively and significantly related to sickness behavior (β =.37) explaining 31 % of the total variance in insomnia ratings. Inflammatory biomarkers, however, did not contribute significantly to the models.
CONCLUSIONS: Participants reported high levels of symptoms, yet the associations between these ratings and the inflammatory biomarkers were either absent or weak. Also, despite high levels of self-reported sickness behavior, overall the inflammatory status remained within the normal range. Ratings of sickness behavior contributed more than inflammatory markers in explaining ratings of depression and insomnia. The present results point to the complexity of chronic pain, and the challenges of identifying biomarkers that explain symptomatology.