Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: An exploratory prospective cohort study

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-05-05 DOI:10.1016/j.jclinane.2025.111855

Mary Yurashevich MD, MPH , Michael Devinney MD, PhD , Matthew W. Foster PhD , Rachel Myers PhD , Nicholas O'Grady MS , Ru-Rong Ji PhD , Ashraf S. Habib MBBCh, MSc, MHSc, FRCA , Miles Berger MD, PhD

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引用次数: 0

Abstract

Background

Persistent pain (>2 months) after cesarean delivery (CD) can affect up to 20 % of patients, and is associated with increased risk for postpartum depression (PPD). Preoperative identification of patients at risk for persistent pain and PPD remains a challenge due to poorly understood underlying mechanisms. To better understand these potential mechanisms, here, we examined the preoperative cerebrospinal (CSF) proteome for changes associated with persistent pain or PPD at 3 months post-CD.

Methods

Eighty patients undergoing elective CD under neuraxial anesthesia were recruited. We collected baseline demographics, obstetric data, and Edinburgh Postnatal Depression Scale (EPDS) scores. EPDS and pain scores were also obtained at 3 months post-CD. CSF was collected before spinal anesthetic placement. Liquid chromatography coupled with tandem mass spectrometry was used to study the CSF proteome.

Results

63 patients completed clinical follow-up, however only 61 of the patients had adequate preoperative CSF sample for analysis. Of these 61 patients, 21 developed pain or PPD at 3 months post-CD (14 had persistent pain alone and 7 had PPD alone). Over 1600 proteins were quantified in each CSF sample. Forty-three of these proteins were nominally differentially expressed in patients with persistent pain and/or PPD vs those with neither disorder.

Pathway analysis showed a downregulation of the complement and coagulation cascades in the preoperative CSF of patients who later developed persistent pain or PPD 3 months after CD.

Conclusions

These results suggest that the CSF complement and coagulation cascades may play a role in patients who develop postpartum pain or PPD 3 months later.

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选择性剖宫产后持续性疼痛和/或产后抑郁患者的脑脊液蛋白质组：一项探索性前瞻性队列研究

背景：剖宫产（CD）后持续疼痛（2个月）可影响高达20%的患者，并与产后抑郁症（PPD）的风险增加有关。由于对潜在的机制知之甚少，术前识别有持续性疼痛和PPD风险的患者仍然是一个挑战。为了更好地了解这些潜在的机制，我们检查了术前脑脊液（CSF）蛋白质组在cd后3个月与持续性疼痛或PPD相关的变化。方法选取80例在轴向麻醉下行选择性CD的患者。我们收集了基线人口统计学、产科数据和爱丁堡产后抑郁量表（EPDS）评分。在cd后3个月获得EPDS和疼痛评分。脊髓麻醉前采集脑脊液。采用液相色谱-串联质谱法研究脑脊液蛋白质组。结果63例患者完成了临床随访，但只有61例患者术前有足够的脑脊液样本进行分析。在这61例患者中，21例在cd后3个月出现疼痛或PPD（14例仅存在持续性疼痛，7例仅存在PPD）。在每个脑脊液样本中，超过1600种蛋白质被量化。其中43种蛋白在患有持续性疼痛和/或PPD的患者与没有疾病的患者中名义上存在差异表达。途径分析显示，产后3个月后出现持续疼痛或PPD的患者，术前CSF补体和凝血级联反应下调。结论这些结果提示，CSF补体和凝血级联反应可能在产后3个月后出现产后疼痛或PPD的患者中起作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.