Duchenne型肌营养不良合并脊柱侧凸的危险因素分析

Analysis of risk facters for Duchenne muscular dystrophy associated with scoliosis

目的：探讨 Duchenne型肌营养不良（Duchenne muscular dystrophy，DMD）合并脊柱侧凸的相关危险因素。方法选取DMD患者200例，其中并发脊柱侧凸79例为病例组，而121例未并发脊柱侧凸为对照组，采用单因素χ2检验和多因素Logistic回归分析DMD合并脊柱侧凸的相关危险因素。结果多因素分析显示下肢肌力不对称（ OR＝3．545，95CI：1．242～10．115）、独立行走困难（OR＝16．688，95CI：5．036～55．297）、未坚持康复锻炼（OR＝0．068，95CI：0．015～0．305）、跟腱挛缩形成马蹄内翻足（OR＝1．597，95CI：0．462～5．524）、未使用激素治疗（OR＝1．464，95CI：1．437～5．439）是DMD合并脊柱侧凸的相关危险因素。结论对有下肢肌力不对称、独立行走困难、未坚持康复锻炼、跟腱挛缩形成马蹄内翻足、未使用激素治疗等危险因素的DMD患者，应注意预防以避免发生脊柱侧凸。

Objective To study the risk factors for Duchenne muscular dystrophy associated with scoliosis,providing criteria for disease diagnosing.Methods 200 patients with diagnosis of Duchenne muscular dystrophy were recruited;79 of them having com-plication of scoliosis was assigned to the study group, and the rest to the control group.The related risk factorsfor Duchenne muscular dystrophy with scoliosis were analyzed using the single factor chi-square test and the multi-factor Logistic regression.Results Multi-ple-factor analysis results showed asymmetry of lower limb strength （OR=3.545,95CI：1.242-10.115）, difficulty of working inde-pendently （OR=16.688,95CI：5.036-55.297）, inconsistency of physical therapy （OR=0.068,95CI：0.015-0.305）, contracture of achilles tendon that formed clubfoot （OR=1.597,95CI：0.462-5.524）, and notreatment with hormone therapy （OR=1.464,95CI：1.437-5.439） .Conclusions Asymmetry of lower limb strength, difficulty of working independently, inconsistency of physical thera-py, contracture of achilles tendon that formed clubfoot, and notreatment with hormone therapy are the risk factors of Duchenne muscular dystrophy.Patients who have Duchenne muscular dystrophy associated with these risk factors should be monitored closely to prevent a-void the occurrence of scoliosis.