细胞因子在椎间盘源性疼痛中的作用及其机制

Role and mechanism of cytokine in discogenic pain

学术背景:椎间盘源性疼痛是慢性腰背痛的一个主要原因,其炎性机制的作用越来越受到人们的重视。在炎症机制里有许多细胞因子参与,这些细胞因子在疼痛的发生、发展中起着怎样的作用,应如何利用这些细胞因子来治疗疼痛,说法不一。目的:全面认识椎间盘突出的发病机制,认识各种细胞因子在疾病发生发展中的作用以及利用细胞因子治疗慢性疼痛的进展。检索策略:应用计算机检索CNKD期刊全文数据库医药卫生类1994-01/2007-06关于椎间盘源性疼痛方面的文献,检索词"生物因子,疼痛",限定文献语言种类为中文,获得文章153篇。同时计算机检索PubMed数据库2002-01/2007-06关于椎间盘源性疼痛方面的文章,检索词"gene,chronic pain",限定文献语言种类为English,获得文章36篇。检索应用CAJViewer6.0软件。对资料进行初审,纳入标准:从基础到临床与细胞因子密切相关的文章。排除标准:重复性研究。对所得文献进行提炼,按上述标准纳入中文6篇,英文24篇。文献评价:30篇文章中10篇侧重于基础研究和动物实验,20篇为临床研究文献。其中RCT文章7篇,循证医学系统综述1篇、汇总分析10篇、个例报道2篇、经验交流10篇。资料综合:椎间盘源性疼痛除传统的机械压迫外,还包括炎症机制和免疫机制。炎症机制在椎间盘源性慢性疼痛中的作用越来越受到重视,其中有P物质、磷脂酶A2、肿瘤坏死因子、白细胞介素、生长因子、一氧化氮等多种细胞因子参与。免疫机制的作用也不容忽视。了解了慢性疼痛的发生机制,进而将白细胞介素1受体拮抗剂、血管内皮生长因子等应用于临床,疗效显著,应用前景广阔。结论:疼痛的发生以及对于镇痛药物的不同反应有其一定的基因基础,细胞因子在椎间盘源性疼痛的发生、发展以及治疗中都起着非常重要的作用。

BACKGROUND： Discogenic pain is a major cause of chronic low back pain, and its inflammation mechanism that is participated by many cytokines is well known by more and more people. However, what is the role of these cytokines in the occurrence and development of pain and how we use them to control pain are still not consistent. OBJECTIVE： To completely learn about the pathogenesis of intervertebral disk herniation, the relative cytokines in the occurrence and development of pain and the advances in the treatment of chronic pain with cytokines. RETRIEVE STRATEGY： A computer-based online search of CNKD was undertaken to identify the relevant articles dated from January 1994 to June 2007 with the Chinese keywords of ＂cytokine, pain＂. And totally 153 articles were collected. Meanwhile, PubMed database was searched for English articles published from January 2002 to June 2007 with the keywords of ＂gene, chronic pain＂ and 36 were collected. The articles that involved the basic and clinical researches closely related with cytokine were selected. Repetitive articles were excluded. After the trail, 6 Chinese and 24 English articles were involved. LITERATURE EVALUATION： Of the 30 articles, 10 were focused on the basic research and animal experiment, and 20 were about clinical research. There were 7 of RCT, 1 of EBM review, 10 of summary analysis, 2 of case report, and 10 of experience exchange. DATA SYNTHESIS： The mechanisms of discogenic pain include inflammation and immune ones besides mechanical pressure. Inflammation mechanism of discogenic pain is well known by more and more people, in which many cytokines such as substance P, phospholipase A2, tumor necrosis factor, interleukin, growth factor and NO participate. Meanwhile, the role of immunities should not be ignored. Some researchers have used some cytokines （interleukin 1 receptor antagonist, vascular endothelial growth factor, etc） in clinic to treat pains and got good effect. CONCLUSION： The mechanism of pain and various effects of pain-killer are based on gene. Cytokines play important roles in the occurrence, development and treatment of discogenic pain.