腰椎间盘突出症患者的临床病理及血液生化特征

发布时间：2018-02-01 21:54

  本文关键词： 腰椎间盘突出症 倾向值匹配法 Modic改变 生化指标　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:随着社会经济的发展腰痛(low back pain,LBP)发病率日渐升高,给个人和国家带来的伤害与损失严重[1]。腰椎间盘突出症(Lumbar Disc Disease,LDD)是引起LBP的主要病种之一,也是导致失能和致残的重要原因[2]。然而到目前为止,其发病原因仍不十分清楚,且治疗疗效不一。本文通过分析腰椎间盘突出症患者临床病理的特征,旨在为腰痛的预防与治疗提供新思路。另外,学者们对其病因的研究热点主要集中在遗传、力学、分子生物学等方面[3],而临床检验资料却少有关注。本文通过回顾性病例对照研究,经倾向性匹配,排除非随机化造成的混杂干扰,分析腰椎间盘突出症患者与健康体检者外周血生化学指标的差异,旨在阐述其生化指标特点及可能的危害,为腰椎间盘突出症的预防、治疗提供新的思路。方法:本研究分为三部分:第一部分:腰椎间盘突出症患者与健康体检者一般临床资料的倾向值匹配,第二部分腰椎间盘突出症患者的临床病理变化,第三部分腰椎间盘突出症患者的重要生化改变。第一部分:收集空军总医院2008年-2013年LDD住院患者与2013年健康体检者一般临床资料进行回顾性病例对照研究,按照纳入标准获得LDD患者494例、健康体检者8674例。采用倾向值匹配法对两组协变量进行校正,获得LDD患者490例(LDD组)及健康体检者490例(对照组)。第二部分:使用空军总医院HIS系统,检索纳入LDD组腰椎间盘突出症患者一般临床资料,生化资料及腰椎MRI图像。1.分析腰椎间盘突出症患者腰椎MRI报告椎间盘突出大小与年龄、身高等一般临床资料的关系。2.分析腰椎间盘突出症患者VAS评分与年龄、椎间盘突出大小的关系。3.将490例患者根据腰椎Modic改变的有无及类型,分析Modic改变与年龄、身高、体重、BMI(Body Mass Index,体重指数)、血压的关系。计量资料采用均数±标准差((?)±s)表示,计数资料采用构成比表示,组间比较采用Mann-Whiteny U检验或χ2检验,相关分析采用Pearson方法。所有计算和统计采用SPSS 22.0软件完成,检验水准α取双侧0.05,P0.05为差异有统计学意义。第三部分:使用空军总医院LIS系统,检索纳入LDD组腰椎间盘突出症患者与对照组外周血生化资料,分析腰椎间盘突出症患者与正常体检者相比外周血生化指标特点及临床意义。计量资料采用均数±标准差((?)±s)表示,计数资料采用构成比表示,组间比较采用Mann-Whiteny U检验或χ2检验,相关分析采用Pearson方法。所有计算和统计采用SPSS 22.0软件完成,检验水准α取双侧0.05,P0.05为差异有统计学意义。结果:第一部分:经倾向值匹配后,LDD组与对照组研究对象在性别、年龄、身高、体重、BMI、血压、高血压病、糖尿病的差异无统计学意义,表明倾向性匹配后两组资料的均衡性好,可比性强。第二部分:1.腰椎间盘突出症患者椎间盘突出大小与年龄呈负相关,与身高呈正相关。2.腰椎间盘突出症患者VAS评分与年龄呈正相关,与突出大小无相关性。3.490例腰椎间盘突出症患者中,294例患者无Modic改变(男186例,女108例),1型Modic改变患者23例(男12例,女11例),2型Modic改变患者168例(男87例,女81例),3型Modic改变患者5例(男4例,女1例)。经统计学分析,2型Modic改变患者年龄(45.72±10.3岁)高于无Modic改变患者(41.82±12.8岁);2型Modic改变患者血压(122.30±13.6,80.0±7.1)mm Hg高于无Modic改变患者(117.01±14.3,76.63±9.3)mm Hg;2型Modic改变患者椎间盘突出程度(6.76±2.95)高于无Modic改变患者(5.93±2.3),其余指标各组间比较差异无统计学意义。经相关性分析发现:Modic改变发生率与年龄、血压、腰椎间盘突出程度呈正相关,与身高呈负相关。第三部分:1.LDD组患者生化学指标中铁蛋白水平甘油三酯水平较对照组升高,且差异有统计学意义。LDD组铁蛋白与高密度脂蛋白呈负相关(r=-0.261,p0.001),与甘油三酯水平呈正相关(r=0.329,p0.001),而对照组无此相关性。2.LDD组高密度脂蛋白水平低于对照组,甘油三酯水平高于对照组,且P0.05,差异有统计学意义。结论:(1)腰椎间盘突出症患者椎间盘突出大小与年龄呈负相关。(2)VAS疼痛评分与年龄呈正相关,与椎间盘突出大小无相关性。(3)Modic改变发生率与年龄、血压、腰椎间盘突出程度呈正相关,与身高呈负相关。(4)与健康体检者相比,腰椎间盘突出症患者出现脂质、蛋白质代谢异常。
[Abstract]:Objective: with the development of social and economic pain (low back pain, LBP) higher incidence of serious injury and loss of lumbar [1]. brings to individual and national lumbar disc herniation (Lumbar Disc Disease, LDD) is one of the main diseases caused by LBP, is the leading cause of disability and disability is an important cause of [2]. however so far, the etiology is not very clear, and the curative effect in the treatment of a feature. Through the analysis of the patients with Lumbar Disc Herniation Clinical Pathology, in order to provide new ideas for the prevention and treatment of low back pain. In addition, the research of the etiology of scholars mainly focused on the genetic, mechanics, molecular biology and other aspects of [3] the clinical test data, but little attention. In this paper, through a retrospective case-control study, the tendency of the match, the confounding interference caused by non randomized, analysis of patients with lumbar disc herniation and healthy peripheral blood Differences in biochemical indicators, this paper mainly elaborates the characteristics and biochemical indicators of possible hazards for the prevention of lumbar disc herniation, and provide new ideas for treatment. Methods: This study is divided into three parts: the first part: the lumbar disc herniation patients and healthy subjects of general clinical data of the tendency of value, second part of the patients with lumbar disc herniation clinical pathological changes, third patients with lumbar disc herniation important biochemical changes. The first part: the collection of General Hospital of the Air Force PLA in 2008 -2013 LDD patients and healthy persons in 2013 the general clinical data were retrospective case-control study according to the inclusion criteria for 494 LDD patients, 8674 healthy physical examination. The tendency value matching method for correction of two groups of covariates, 490 Cases of LDD patients (LDD group) and 490 Cases of healthy subjects (control group). The second part: the use of HIS Department of General Hospital of the Air Force PLA The search included in the LDD group of patients with lumbar disc herniation clinical data, biochemical analysis data and MRI images of lumbar.1. patients with lumbar disc herniation of lumbar intervertebral disc herniation report MRI age and the size of.2., height and other clinical data analysis of lumbar disc herniation patients VAS score and age,.3. size intervertebral disc herniation in 490 patients according to lumbar Modic changes and the existence of types, analysis of Modic changes with age, height, weight, BMI (Body Mass Index, body mass index, blood pressure). The relationship between the measurement data using the mean and standard deviation ((?) + s) said, count data using proportion and compared between groups using Mann-Whiteny U test or 2 test, correlation analysis using Pearson method. All the calculations and statistics by SPSS 22 software, the significant level was 0.05 for bilateral P0.05, the difference was statistically significant. The third part: General Hospital of the Air Force PLA LIS system, search into the LDD group of patients with lumbar disc herniation and control group peripheral blood biochemical data, analysis of patients with lumbar disc herniation compared with normal controls and the clinical significance of peripheral blood biochemical indexes. The measurement data using the mean and standard deviation ((?) + s) said the count data the constituent ratio, the groups were compared using Mann-Whiteny U test or 2 test, correlation analysis using Pearson method. All the calculations and statistics by SPSS 22 software, the significant level was 0.05 P0.05 bilateral, the difference was statistically significant. Results: the first part: the propensity score matching, LDD group and control group study on gender, age, height, weight, BMI, blood pressure, hypertension, diabetes, no statistically significant differences showed that the equilibrium tendency after the matching of two sets of data, strong comparability. The second part: 1. lumbar disc herniation patients 鑰呮�庨棿鐩樼獊鍑哄ぇ灏忎笌骞撮緞鍛堣礋鐩稿叄�

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