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

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D25(OH) D]水平。结果 CLBP组患者的年龄、CRP高于无CLBP组(P0.05); BMI、MNA-SF、25(OH) D、GS、CC低于无CLBP组(P0.05)。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(P0.05)。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(P0.05); MNA-SF低于无肌肉减少症组(P0.05)。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。

Study on the correlation between chronic low back pain, muscular dystrophy, and vitamin D in the elderly over 60 years old

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.