本文關(guān)鍵詞： 腰椎間盤突出癥 傾向值匹配法 Modic改變 生化指標　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:隨著社會經(jīng)濟的發(fā)展腰痛(low back pain,LBP)發(fā)病率日漸升高,給個人和國家?guī)淼膫εc損失嚴重[1]。腰椎間盤突出癥(Lumbar Disc Disease,LDD)是引起LBP的主要病種之一,也是導致失能和致殘的重要原因[2]。然而到目前為止,其發(fā)病原因仍不十分清楚,且治療療效不一。本文通過分析腰椎間盤突出癥患者臨床病理的特征,旨在為腰痛的預防與治療提供新思路。另外,學者們對其病因的研究熱點主要集中在遺傳、力學、分子生物學等方面[3],而臨床檢驗資料卻少有關(guān)注。本文通過回顧性病例對照研究,經(jīng)傾向性匹配,排除非隨機化造成的混雜干擾,分析腰椎間盤突出癥患者與健康體檢者外周血生化學指標的差異,旨在闡述其生化指標特點及可能的危害,為腰椎間盤突出癥的預防、治療提供新的思路。方法:本研究分為三部分:第一部分:腰椎間盤突出癥患者與健康體檢者一般臨床資料的傾向值匹配,第二部分腰椎間盤突出癥患者的臨床病理變化,第三部分腰椎間盤突出癥患者的重要生化改變。第一部分:收集空軍總醫(yī)院2008年-2013年LDD住院患者與2013年健康體檢者一般臨床資料進行回顧性病例對照研究,按照納入標準獲得LDD患者494例、健康體檢者8674例。采用傾向值匹配法對兩組協(xié)變量進行校正,獲得LDD患者490例(LDD組)及健康體檢者490例(對照組)。第二部分:使用空軍總醫(yī)院HIS系統(tǒng),檢索納入LDD組腰椎間盤突出癥患者一般臨床資料,生化資料及腰椎MRI圖像。1.分析腰椎間盤突出癥患者腰椎MRI報告椎間盤突出大小與年齡、身高等一般臨床資料的關(guān)系。2.分析腰椎間盤突出癥患者VAS評分與年齡、椎間盤突出大小的關(guān)系。3.將490例患者根據(jù)腰椎Modic改變的有無及類型,分析Modic改變與年齡、身高、體重、BMI(Body Mass Index,體重指數(shù))、血壓的關(guān)系。計量資料采用均數(shù)±標準差((?)±s)表示,計數(shù)資料采用構(gòu)成比表示,組間比較采用Mann-Whiteny U檢驗或χ2檢驗,相關(guān)分析采用Pearson方法。所有計算和統(tǒng)計采用SPSS 22.0軟件完成,檢驗水準α取雙側(cè)0.05,P0.05為差異有統(tǒng)計學意義。第三部分:使用空軍總醫(yī)院LIS系統(tǒng),檢索納入LDD組腰椎間盤突出癥患者與對照組外周血生化資料,分析腰椎間盤突出癥患者與正常體檢者相比外周血生化指標特點及臨床意義。計量資料采用均數(shù)±標準差((?)±s)表示,計數(shù)資料采用構(gòu)成比表示,組間比較采用Mann-Whiteny U檢驗或χ2檢驗,相關(guān)分析采用Pearson方法。所有計算和統(tǒng)計采用SPSS 22.0軟件完成,檢驗水準α取雙側(cè)0.05,P0.05為差異有統(tǒng)計學意義。結(jié)果:第一部分:經(jīng)傾向值匹配后,LDD組與對照組研究對象在性別、年齡、身高、體重、BMI、血壓、高血壓病、糖尿病的差異無統(tǒng)計學意義,表明傾向性匹配后兩組資料的均衡性好,可比性強。第二部分:1.腰椎間盤突出癥患者椎間盤突出大小與年齡呈負相關(guān),與身高呈正相關(guān)。2.腰椎間盤突出癥患者VAS評分與年齡呈正相關(guān),與突出大小無相關(guān)性。3.490例腰椎間盤突出癥患者中,294例患者無Modic改變(男186例,女108例),1型Modic改變患者23例(男12例,女11例),2型Modic改變患者168例(男87例,女81例),3型Modic改變患者5例(男4例,女1例)。經(jīng)統(tǒng)計學分析,2型Modic改變患者年齡(45.72±10.3歲)高于無Modic改變患者(41.82±12.8歲);2型Modic改變患者血壓(122.30±13.6,80.0±7.1)mm Hg高于無Modic改變患者(117.01±14.3,76.63±9.3)mm Hg;2型Modic改變患者椎間盤突出程度(6.76±2.95)高于無Modic改變患者(5.93±2.3),其余指標各組間比較差異無統(tǒng)計學意義。經(jīng)相關(guān)性分析發(fā)現(xiàn):Modic改變發(fā)生率與年齡、血壓、腰椎間盤突出程度呈正相關(guān),與身高呈負相關(guān)。第三部分:1.LDD組患者生化學指標中鐵蛋白水平甘油三酯水平較對照組升高,且差異有統(tǒng)計學意義。LDD組鐵蛋白與高密度脂蛋白呈負相關(guān)(r=-0.261,p0.001),與甘油三酯水平呈正相關(guān)(r=0.329,p0.001),而對照組無此相關(guān)性。2.LDD組高密度脂蛋白水平低于對照組,甘油三酯水平高于對照組,且P0.05,差異有統(tǒng)計學意義。結(jié)論:(1)腰椎間盤突出癥患者椎間盤突出大小與年齡呈負相關(guān)。(2)VAS疼痛評分與年齡呈正相關(guān),與椎間盤突出大小無相關(guān)性。(3)Modic改變發(fā)生率與年齡、血壓、腰椎間盤突出程度呈正相關(guān),與身高呈負相關(guān)。(4)與健康體檢者相比,腰椎間盤突出癥患者出現(xiàn)脂質(zhì)、蛋白質(zhì)代謝異常。
[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闂寸洏紿佸嚭澶у皬涓庡勾榫勫憟璐熺浉鍏，

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