回顾性研究脑卒中后复杂性区域疼痛综合征与细胞因子的相关性

Correlation between cytokines and post-stroke complex regional pain syndrome:a retrospective study

目的探索静脉血细胞因子与脑卒中后复杂性区域疼痛综合征(complex regional pain syndrome,CRPS)的相关性,探讨细胞因子检测在辅助脑卒中后CRPS诊断中的应用价值。方法连续收集2017年1月至2020年12月首次因脑卒中于华山医院北院康复医学科住院患者的临床资料,将脑卒中病程6个月以内的患者纳入研究。根据是否发生CRPS,将患者分为CRPS组及非CRPS组,通过病例对照研究,探索脑卒中后两组患者静脉血细胞因子(包括IL-1β、IL-2R、IL-6、IL-8、IL-10)及TNF-α的检测值及细胞因子升高率是否有差异。在CRPS组中对细胞因子是否异常与CRPS严重程度评分及NRS疼痛评分进行相关性分析。结果201例脑卒中患者中,31例发生CRPS,170例未发生CRPS。性别、病灶性质与是否发生CRPS无明显相关性。年龄越大,越容易发生CRPS(相关系数0.253,P<0.05)。与非CRPS组相比,CRPS组IL-1β(22.6%vs.8.2%)、IL-8(9.1%vs.0.6%)及TNF-α(67.7%vs.48.2%)升高率更显著(P<0.05)。CRPS组细胞因子IL-2R、IL-6、IL-8、TNF-α水平均高于非CRPS组,但差异无统计学意义。TNF-α升高者CRPS严重程度更高(相关系数0.489,P<0.05)。IL-2R升高者NRS疼痛评分更高(相关系数0.442,P<0.05)。结论脑卒中后静脉血细胞因子IL-1β、IL-8、TNF-α升高可能与CRPS发病相关,TNF-α升高可能与CRPS严重程度相关,IL-2R升高可能与NRS疼痛评分相关。

Objective To investigate the correlation between plasma cytokine and the presence of post-stroke complex regional pain syndrome(CRPS),and to investigate the application value of cytokine in the diagnosis of post-stroke CRPS.Methods The patients admitted to Department of Rehabilitation,Huashan Hospital North for first stroke from Jan 2017 to Dec 2020 were collected consecutively,and the patients with stroke course less than 6 months were included in the study.Patients were divided into CRPS group and non-CRPS group according to the occurrence of CRPS.A retrospective case-control study was conducted to analyze the changes of plasma cytokines including IL-1,IL-2R,IL-6,IL-8,IL-10 and TNF-α.Meanwhile,the correlation between abnormal cytokines and CRPS severity score(CSS)and NRS pain score was analyzed in CRPS group.Results In a total of 201 cases,31 cases were diagnosed with CRPS and 170 cases were not.There was no significant correlation between gender,nature of lesion and the occurrence of CRPS.CRPS was weakly correlated with age(correlation coefficient 0.253,P<0.05).The elevated rates of plasma IL-1β(22.6%vs.8.2%),IL-8(9.1%vs.0.6%)and TNF-α(67.7%vs.48.2%)in CRPS group were higher than those in non-CRPS group(all P<0.05).The levels of IL-2R,IL-6,IL-8 and TNF-αin CRPS group were higher than those in non-CRPS group without statistical difference.CSS was higher when TNF-αelevated(correlation coefficient 0.489,P<0.05).NRS was higher when IL-2R elevated(correlation coefficient 0.442,P<0.05).Conclusion The increase of plasma pro-inflammatory cytokines IL-1β,IL-8 and TNF-αmay be correlated with the incidence of CRPS.The increase of TNF-αmay be correlated with the severity of CRPS,and the increase of IL-2R may be correlated with NRS pain score.