Concentrações plasmáticas de citocinas em pacientes com lombalgia crônica por hérnia de disco
estudo transversal analítico
Palavras-chave:
Citocinas, Dor lombar, Fator de necrose tumoral alfa, Interleucinas, Interleucina-6Resumo
CONTEXTO E OBJETIVO: A função da resposta imunológica e das citocinas pró-inflamatórias na patogênese da dor crônica tem tido interesse crescente. Para avaliar se há correlação entre hérnia de disco e aumento de citocinas, foi medida a concentração de citocinas em pacientes com lombalgia crônica e em indivíduos sadios. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico realizado na Clínica de Dor da Universidade Federal da Bahia (UFBA). MÉTODO: As concentrações de citocinas foram medidas pela técnica de ELISA (enzyme linked immunosorbent assay) em 23 pacientes com lombalgia (G1) e 10 sadios (G2). RESULTADOS: As concentrações de fator-alfa de necrose tumoral [TNF-alpha] (G1 = 5.6 ± 2.3 pg/ml; G2 = 1.6 ± 0.5 pg/ml; P = 0,01) e interleucina-6 [IL-6] (G1 = 4.1 ± 3.0 pg/ml; G2 = 0.9 ± 0.4 pg/ml; P = 0,01) foram maiores no G1. Não houve diferença estatisticamente significante para interleucina-1 [IL-1] (G1 = 0.5 ± 0.3 pg/ml; G2 = 0.5 ± 0.1 pg/ml; P = 1) e receptor solúvel do factor de necrose tumoral [sTNF-R] (G1 = 572 pg/ml ± 36; G2 = 581 ± 50 pg/ml; P = 0,87). CONCLUSÃO: Os pacientes com lombalgia crônica por hérnia de disco apresentam concentrações maiores de TNF-alpha e IL-6, mas não de IL-1 ou sTNF-R.
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Referências
Waddell G. Low back pain: a twentieth century health care enigma. Spine (Phila Pa 1976). 1996;21(24):2820-5.
Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22(2):263-71.
Frymoyer JW. Lumbar disk disease: epidemiology. Instr Course Lect. 1992;41:217-23.
Long DM. Decision making in lumbar disc disease. Clin Neurosurg. 1992;39:36-51.
Heliövaara M, Impivaara O, Sievers K, et al. Lumbar disc syndrome in Finland. J Epidemiol Community Health 1987;41(3):251-8.
Hicks GS, Duddleston DN, Russell LD, et al. Low back pain. Am J Med Sci. 2002;324(4):207- 11.
Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760-5.
Kelsey JL, White AA 3rd. Epidemiology and impact of low-back pain. Spine (Phila Pa 1976). 1980;5(2):133-42.
Younes M, Béjia I, Aguir Z, et al. Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia. Joint Bone Spine. 2006;73(5):538-42.
Balagué F, Nordin M, Sheikhzadeh A, et al. Recovery of severe sciatica. Spine (Phila Pa 1976). 1999;24(23):2516-24.
Homma Y, Brull SJ, Zhang JM. A comparison of chronic pain behavior following local appli- cation of tumor necrosis factor alpha to the normal and mechanically compressed lumbar ganglia in the rat. Pain. 2002;95(3):239-46.
Omarker K, Myers RR. Pathogenesis of sciatic pain: role of herniated nucleus pulposus and deformation of spinal nerve root and dorsal root ganglion. Pain. 1998;78(2):99-105.
Schäfers M, Geis C, Svensson CI, Luo ZD, Sommer C. Selective increase of tumour necrosis factor-alpha in injured and spared myelinated primary afferents after chronic constrictive injury of rat sciatic nerve. Eur J Neurosci. 2003;17(4):791-804.
Shafer DM, Assael L, White LB, Rossomando EF. Tumor necrosis factor-alpha as a biochemi- cal marker of pain and outcome in temporomandibular joints with internal derangements. J Oral Maxillofac Surg. 1994;52(8):786-91; discussion 791-2.
Geiss A, Varadi E, Steinbach K, Bauer HW, Anton F. Psychoneuroimmunological correlates of persisting sciatic pain in patients who underwent discectomy. Neurosci Lett. 1997;237(2- 3):65-8.
Brisby H, Olmarker K, Larsson K, Nutu M, Rydevik B. Proinflammatory cytokines in cere- brospinal fluid and serum in patients with disc herniation and sciatica. Eur Spine J. 2002;11(1):62-6.
Koch A, Zacharowski K, Boehm O, et al. Nitric oxide and pro-inflammatory cytokines correla- te with pain intensity in chronic pain patients. Inflamm Res. 2007;56(1):32-7.
Backonja MM, Coe CL, Muller DA, Schell K. Altered cytokine levels in the blood and cere- brospinal fluid of chronic pain patients. J Neuroimmunol. 2008;195(1-2):157-63.
Alexander GM, van Rijn MA, van Hilten JJ, Perreault MJ, Schwartzman RJ. Changes in cere- brospinal fluid levels of pro-inflammatory cytokines in CRPS. Pain. 2005;116(3):213-9.
van de Beek WJ, Remarque EJ, Westendorp RG, van Hilten JJ. Innate cytokine profile in patients with complex regional pain syndrome is normal. Pain. 2001;91(3):259-61.
Winkelstein BA, Rutkowski MD, Weinstein JN, DeLeo JA. Quantification of neural tissue injury in a rat radiculopathy model: comparison of local deformation, behavioral outcomes, and spinal cytokine mRNA for two surgeons. J Neurosci Methods. 2001;111(1):49-57.
Burke JG, Watson RW, McCormack D, et al. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002;84(2):196- 201.
Specchia N, Pagnotta A, Toesca A, Greco F. Cytokines and growth factors in the protruded intervertebral disc of the lumbar spine. Eur Spine J. 2002;11(2):145-51.
Watkins LR, Maier SF, Goehler LE. Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain. 1995;63(3):289-302.
Junger H, Sorkin LS. Nociceptive and inflammatory effects of subcutaneous TNFalpha. Pain. 2000;85(1-2):145-51.
Brydon L, Edwards S, Mohamed-Ali V, Steptoe A. Socioeconomic status and stress-induced increases in interleukin-6. Brain Behav Immun. 2004;18(3):281-90.
Cunha FQ, Poole S, Lorenzetti BB, Ferreira SH. The pivotal role of tumour necrosis factor alpha in the development of inflammatory hyperalgesia. Br J Pharmacol. 1992;107(3):660-4.
Solari R, Smithers N, Kennard N, Ray K, Grenfell S. Receptor mediated endocytosis and intracellular fate of interleukin 1. Biochem Pharmacol. 1994;47(1):93-101.
Spangelo BL, Judd AM, Isakson PC, MacLeod RM. Interleukin-6 stimulates anterior pituitary hormone release in vitro. Endocrinology. 1989;125(1):575-7.
Nygaard OP, Mellgren SI, Osterud B. The inflammatory properties of contained and noncon- tained lumbar disc herniation. Spine (Phila Pa 1976). 1997;22(21):2484-8.
Yoshida M, Nakamura T, Sei A, et al. Intervertebral disc cells produce tumor necrosis fac- tor alpha, interleukin-1beta and monocyte chemoattractant protein-1 immediately after herniation: an experimental study using a new hernia model. Spine (Phila Pa 1976). 2005;30(1):55-61.
Aderka D, Wysenbeek A, Engelmann H, et al. Correlation between serum levels of soluble tu- mor necrosis factor receptor and disease activity in systemic lupus erythematosus. Arthritis Rheum. 1993;36(8):1111-20.
Kalinkovitch A, Engelmann H, Harpaz N, et al. Elevated serum levels of soluble tumour necrosis factor receptors (sTNF-R) in patients with HIV infection. Clin Exp Immunol. 1992;89(3):351-5.
Huygen FJ, Niehof S, Zijlstra FJ, van Hagen PM, van Daele PL. Successful treatment of CRPS 1 with anti-TNF. J Pain Symptom Manage. 2004;27(2):101-3.
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