(中德康复技术培训课件)2506 康复技术培训 转化医学

Translationalresearchin

rehabilitationmedicine:Whatwecanlearnfrombiomedicalresearch?

康复医学中的转化医学研究

从生物医学科研中的心得Dr.rer.biol.hum.BoyaNugraha,MSPostCongress-9thISPRM2015Hanover,25June2015Translationalresearchin

rehContent

Chronicpainsyndromes:epidemiologyandcharacteristics慢性疼痛特征Mechanismsofpainchronification(Fibromyalgiaasmodelofchronicpain)疼痛的慢性损伤肌肉纤维疼痛

◦Neuroplasticity神经重塑 ◦Painmediators疼痛因子Conclusion

andFutureDirection

讨论及未来展望ContentChronicpainsyndromChronicpain(characteristicsandepidemiology)Paininmusculoskeletalsystemisveryfrequentsymptom: 肌肉骨骼系统疼痛为主

◦withtissuedamage:e.g.Osteoarthritis,discherniation

实质性损伤 ◦without(specific)tissuedamage:jointdysfunction, irritationcausedbyoverstrain,muscle hypertensionandothers Manyofthesesyndromearenotverysevere(ordangerous)andselflimitingbutinsomecasestheycanbecomechronic Theimpactofmusculoskeletalpainonqualityoflife,andhealthexpensesisveryhighImportantquestion:howtoprevent(andtreat)chronicpainsyndromes

无特殊性损伤关节功能丧失

其中一些并不危险，并且有自身受限，但某些情况下会变成慢性重要问题-如何预防并治疗转化成慢性疼痛Chronicpain(characteristicsSymptoms症状

Decreasedoverallpainthresholds ◦increasedsensitivityofmusclesandtendonstopressure肌肉及肢体对压力的敏感性增加Autonomousdysfunction

(Fibromyalgia) 自主神经功能紊乱 ◦sleepdisturbances, 睡眠终止

◦fatigue疲劳 ◦andothers其他Psycho-socialaspects ◦highintensityofsuffering集中病痛感同身受

◦strongfocusofattentiontosymptoms高度关注◦highdemandforhealthinterventions高度健康关注Symptoms症状Decreasedoverall(中德康复技术培训课件)2506康复技术培训转化医学CountryPrevalence(%)ReferenceUSA2.0Lawrenceetal.1998Canada3.3Whiteetal.1999Germany3.0Raspeetal.1992Poland4.5GaglieseandKatz.2000Spain2.4Carmonaetal.2001Italy2.2Salaffietal.2005Sweden2.5Cösteretal.2008France1.6Perrotetal.2011Finland0.8MäkeläandHeliovaara,1991Denmark0.7Prescottetal.1993PrevalenceofFMSinseveralwesterncountriesCountryPrevalence(%)ReferenceMechanismsofpainchronificationMay,Pain2008;137:7–15DifferentlevelofplasticityinchronicpainNeuroplasticity:AlterationFunction功能Structure结构Chemicalprofile化学指标MechanismsofpainchronificatCentralsensitization

(CoghillRC2005)中枢patientwithchronicpain

慢性疼痛

normalsubject正常人Centralsensitization(CoghillCentralsensitization:functionalimagingGuedjetal.:JNuclMed2008;49:1798–1803Centralsensitization:functioMay,2008May,2008May,2011.TheNeuroscientistMay,2011.TheNeuroscientisChemicalprofile(painmediators)

化学剖面（疼痛因子）Chemicalprofile(painmediatoPainmediators:BrainDerivedNeurotropicFactor,BDNF

脑源性神经营养因子CorrelationofBDNFandageinHealthyControlsandFMSpatientsPainmediators:BrainDerivedPainmediators:BrainDerivedNeurotropicFactor,BDNFNugrahaetal.2013:NeurochemIntNugrahaetal.2012RheumatolIntPainmediators:BrainDerivedPainmediators:BrainDerivedNeurotropicFactor,BDNF(ntotal=39;HADS-Dscore<8:n=21;8–10:n=10;>10:n=8;Dataareshowninmean±SEM;TheJocnkheere–Terpstratest:p<0.05)(ntotal=39;HADS-Ascore<8:n=9;8–10:n=12;>10:n=18;Dataareshowninmean±SEM;TheJocnkheere–Terpstratest:p>0.05).LevelofserumBDNFinFMSpatientsbasedondepressionscoregroupLevelofserumBDNFinFMSpatientsbasedonanxietyscoregroupCorrelation:R=0.434;p=0.006Painmediators:BrainDerivedPainMediators:

CD3+CD56+NKTCells:FMSanddepression%CD3+CD56+NKTCellsHADS-DScoreR=-0.297;p=0.03ANOVA:p=0.02Post-hoc:Bonferronitest:HADS-D<8and>10(p=0.018)CorrelationNugrahaetal.2013ClinExpRheumPainMediators:

CD3+CD56+NKTPainmediators:Anandamide花生四烯酸乙醇胺Kaufmanetal.:Psychoneuroendocrinology2008;33,676–685Painmediators:Anandamide花生四烯Howtomanagechronicpain?如何处理慢性疼痛Howtomanagechronicpain?****************ExerciseandbiomediatorsBiomediatorsEffectofExerciseHumanAnimalAnandamideIncreasedafterrunningandcycling(Sparlingetal.,2003;Raichelnetal.2012)Increasedafterrunning(Raichelnetal.2012)BDNFIncreasedBDNFmRNAinhippocampusvoluntaryrunningwheel(Neeperetal.,1995)SerotoninIncreseadinhumansIncreasedinrathippocampus(Bequetetal.,2008)CytokinesincreasedofIL-1ß,IL-6andTNF-α(Ostrowskietal.,1999;Vassilakopoulosetal.,2003)ExerciseandbiomediatorsBiomeConclusionTranslationalresearchinrehabilitationmedicinecanhelpelucidatethepathomechanismsofdiseaseswhichcanbeusedtodiagnose,monitorthetreatment在康复中的转化医学研究可以帮助疾病的诊断及治疗Morestudiesareneededtoinvestigatetheeffectivenessoftreatmentsinrehabilitionmedicinethroughbiomedicine通过生化方式研究康复医学治疗的影响有更多内容需要进行ConclusionTranslationalresearThankyouBoyaNugraha,MS,PhDNugraha.Boya@mh-hannover.de

Dept.RehabilitationMedicine,HannoverMedicalSchoolHannover,GermanyThankyouBoyaNugraha,MS,PhDENVIRONMENTALFACTORS,GENETICSPERIPHERALCENTRALHPA–AXIS:Cortisol,etcPAINImmunesystemandinflammatorymediators:cytokinesMuscledysfunctionMood-relateddisorderFatigueAninter-relatednetworkofFMSclinicalsymptomswithinflammatoryandmolecularmediatorsFibromyalgiaSyndrome.NugrahaandGutenbrunner,2013ENVIRON