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| 60岁以上老年慢性下腰痛和肌肉减少症及维生素D的相关性研究 |
| Study on the correlation between chronic low back pain, muscular dystrophy, and vitamin D in the elderly over 60 years old |
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| DOI：10.3969/j.issn.1006-7108.2020.09.018 |
| 中文关键词: 慢性下腰痛 肌肉减少症 维生素D |
| 英文关键词:chronic low back pain myopenia vitamin D |
| 基金项目:江西省卫生计生委中医药科研课题项目（2018A157） |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| 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 24h. 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. |
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