Modic改变与腰痛关系的Meta分析

Meta-analysis of the relationship between Modic changes and low back pain

目的:探讨MRI上Modic改变与腰痛(low back pain,LBP)的相关性。方法:通过检索MEDLINE、EMBASE和Cochrane Controlled Clinical Trials Register等电子数据库,搜集符合要求的关于Modic改变的临床研究。提取的主要数据为(1)椎间盘造影术后发生疼痛(与原腰痛症状相似)的椎间盘数和其中发生Modic改变的椎间盘数;(2)椎间盘造影术后未发生疼痛(无腰痛和未发生与原腰痛症状相似的疼痛)的椎间盘数和其中发生Modic改变椎间盘数。将其带入Meta分析软件Review Manager 4.2(下载自Cochrane Libirary)中,在随机效应模型(Random-effect model)下,用优势比(oddsratio,OR)计算结果,并进行敏感性分析。然后对Modic改变的不同亚型进行对比分析。结果:经筛选,共6篇文献纳入Meta分析。6篇文献共纳入患者966例,椎间盘3026个。椎间盘造影术后疼痛组和无疼痛组相比,OR值为3.66(95%CI,1.46～9.15)。椎间盘造影术后疼痛组1型Modic改变与2型Modic改变相比,OR值为1.31(95%CI,0.35～4.96)。结论:和无腰痛患者相比,腰痛患者的Modic改变发生率更高;与2型Modic改变相比,尚没有证据表明1型Modic改变更易引起腰痛。

Objective：To determine the relationship between Modic changes and low back pain（LBP） through Meta-analysis.Method：MEDLINE,EMBASE and Cochrane Controlled Clinical Trials Register databases were carefully searched to determine relevant papers.The parameter index for Meta-analysis included the number of symptomatic lumbar discs which pain call be provoked by discography or not（with pain similar to the primary ） as well as the number with Modic changes among them.The results were brought to Review Manager 4.2 （download from Cochrane Library） and measured using odds ratio（OR） under Random-effect model for sensitivity analysis.Further comparative analysis between the subgroups was performed thereafter.Result：After screening out,a total of 6 papers were meet our inclusion criterion for Meta-analysis.Tbere were 966 cases and 3026 discs.The combined OR value for pain group and painless group after discography was 3.66（95% CI,1.46-9.15）.While the combined OR value for type 1 and type 2 Modic change in pain group after discography was 1.31（95%CI,0.35-4.96）.Conclusion：There is higher incidence rate of Modie changes in LBP patients compared with those in no LBP patients.No evidence available supports type 1 Modic changes is more relevant to low back pain.