摘要
目的探讨慢性下腰痛(chronic low back pain,CLBP)患者与肌肉减少症及维生素D之间的相互关系。明确CLBP的发病机制。方法选取我院在2015年10月至2018年12月收治的疑似CLBP患者341例。根据CLBP诊断标准将疑似CLBP患者分为无CLBP组(n=235)及CLBP组(n=106)。根据肌肉减少症诊断标准将确诊的CLBP患者分为无肌肉减少症组(n=62)及肌肉减少症组(n=44)。24 h内收集患者临床资料[年龄、性别、体质指数(BMI)、危险因素(吸烟、心血管疾病、呼吸系统疾病)、微型营养评估精法(MNA-SF)];血液指标[总蛋白(TP)、C-反应蛋白(CRP)];采用VAS评分评估CLBP疼痛程度。采用酶联免疫吸附试验(ELISA)来测定血清中25-羟维生素D[25(OH)D]水平。结果CLBP组患者的年龄、CRP高于无CLBP组(P<0.05);BMI、MNA-SF、25(OH)D、GS、CC低于无CLBP组(P<0.05)。CLBP组患者中的25(OH)D不足、25(OH)D缺乏及肌肉减少症比例高于无CLBP组(P<0.05)。CLBP组患者VAS与25(OH)D、握力(GS)、小腿围(CC)呈现负相关性(r=-0.523、-0.343、-0.584,P均<0.05)。年龄(OR:1.640,95%CI:1.008~2.147)、肌肉减少症(OR:3.575,95%CI:2.196~5.819)、维生素D不足(OR:2.034,95%CI:1.228~4.352)、维生素D缺乏(OR:6.969,95%CI:3.702~13.120)是CLBP发生的独立危险因素,MNA-SF(OR:0.349,95%CI:0.211~0.578)是CLBP发生的独立保护因素。肌肉减少症组患者年龄、吸烟比例、CRP、维生素D不足、维生素D缺乏高于无肌肉减少症组(P<0.05);MNA-SF低于无肌肉减少症组(P<0.05)。维生素D不足(OR:2.070,95%CI:1.009~3.861)、维生素D缺乏(OR:7.122,95%CI:3.776~13.434)是肌肉减少症发生的独立危险因素,MNA-SF(OR:0.257,95%CI:0.135~0.487)是CLBP发生的独立保护因素。结论通过临床观察发现维生素D水平降低可能是肌肉减少症导致CLBP发生的潜在机制。该研究强化了常规评估CLBP患者的维生素D水平并补充至正常的重要。
Objective To investigate the relationship between chronic low back pain(CLBP),myopenia,and vitamin D,and to clarify the pathogenesis of CLBP.Methods Three hundred and forty-one CLBP-suspected patients admitted to our hospital from October 2015 to December 2018 were selected.According to the CLBP diagnostic criteria,CLBP-suspected patients were divided into CLBP-free group(n=235)and CLBP group(n=106).According to the diagnostic criteria of myopenia,the confirmed CBLP patients were divided into non-myopenia group(n=62)and myopenia group(n=44).The clinical data,including age,sex,body mass index(BMI),risk factors(smoking,cardiovascular disease,respiratory disease),micro nutritional assessment(MNA-SF),and blood index including total protein(TP)and C-reactive protein(CRP)were collected in 24 h.The pain degree of CLBP was assessed with VAS score.The serum 25-hydroxyvitamin D[25(OH)D]level was determined with enzyme-linked immunosorbent assay(ELISA).Results The age and CRP in CLBP group were higher than those in CLBP-free group(P<0.05).BMI,MNA-SF,25(OH)D,Grip strength(GS),and calf circumference(CC)were lower than those in CLBP-free group(P<0.05).The proportion of 25(OH)D-deficiency,25(OH)D-deficiency and myopenia in CLBP group was higher than that in CLBP-free group(P<0.05).VAS was negatively correlated with 25(OH)D,GS,and CC in CLBP group(r=-0.523,-0.343,-0.584,P<0.05).Age(OR:1.640,95%CI:1.008-2.147),myopenia(OR:3.575,95%CI:2.196-5.819),vitamin D insufficiency(OR:2.034,95%CI:1.228-4.352),and vitamin D deficiency(OR:6.969,95%CI:3.702-13.120)were independent risk factors for CLBP.MNA-SF(OR:0.349,95%CI:0.211-0.578)was independent protective factors for CLBP.Age,smoking rate,CRP,vitamin D-insufficiency,and vitamin D-deficiency in patients with myopenia were higher than those without myopenia(P<0.05),and MNA-SF was lower than those without myopenia(P<0.05).Vitamin D-insufficiency(OR:2.070,95%CI:1.009-3.861)and vitamin D-deficiency(OR:7.122,95%CI:3.776-13.434)were independent risk factors for myopenia.MNA-SF(OR:0.257,95%CI:0.135-0.487)was an independent protective factor for CLBP.Conclusion This study explores that the decrease of vitamin D level may be a potential mechanism of CLBP induced by myopenia.This study reinforces the importance of routine assessment of vitamin D levels and supplementation of vitamin D to the normal level in CLBP patients.
作者
江共涛
程毅
胡和军
魏星星
徐南云
JIANG Gongtao;CHENG Yi;HU Hejun;WEI Xingxing;XU Nanyun(Hongdu Chinese Medicine Hospital,Nanchang 330008,China)
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2020年第9期1333-1339,共7页
Chinese Journal of Osteoporosis
基金
江西省卫生计生委中医药科研课题项目(2018A157)。
