体质指数对腰椎小关节骨性关节炎发病及严重度分级的影响

Influence of body mass index on occurrence and severity classification of lumbar facet joint osteoarthritis

目的研究体质指数（BMI）在腰椎小关节骨性关节炎（LFOA）发生发展中的影响。方法对佳木斯大学附属第一医院CT室于2013年10月至2015年11月因下腰痛行CT检查的129例患者的临床资料进行回顾性分析。其中男71例,女58例;年龄25-65（50.6±8.3）岁。按照BMI分类方法将患者分成正常组（n=53）、超重组（n=44）和肥胖组（n=32）三组,比较三组患者L1/2-L5/S1节段LFOA（影像学表现为关节间隙狭窄、骨赘形成及骨质变化）的发生率及LFOA分级情况的差异性。统计学分析检验水准取α=0.05,采用χ2检验的分割法时,检验水准调整为α＇=0.0125。结果 129例患者共计1 290个腰椎小关节和645椎间盘,415个椎间盘退变（真空征、膨出、突出）,占64.3%（415/645）;631个腰椎小关节病变,发生率约48.9%（631/1 290）。三组患者性别、年龄差异无统计学意义（P均〉0.05）。正常组530个腰椎小关节中238个（44.9%）腰椎小关节病变;超重组440个腰椎小关节中225个（51.1%）腰椎小关节病变;肥胖组320个腰椎小关节中168个（52.5%）腰椎小关节病变。腰椎小关节病变发生率在L4/5最高,占62.8%。LFOA发生率三组间两两比较,正常组分别稍低于超重组、肥胖组,但差异均无统计学意义（P均〉0.0125）。LFOA严重度分级随BMI的递增（正常组→超重组→肥胖组）而增高,差异有统计学意义（P〈0.05）。结论肥胖是LFOA严重度分级的影响因素,BMI对LFOA的发生率能否获有统计学意义的影响,有待扩大样本量进一步观察。

Objective To investigate the influence of body mass index（ BMI） on occurrence and development of lumbar facet joint osteoarthritis（ LFOA）. Methods Retrospective analysis was performed on the clinical data of 129 patients with low back pain who underwent CT examination in the CT Room,First Affiliated Hospital of Jiamusi University between October 2013 and November 2015. Out of 129 cases,71 were men; 58 were women; ages were 25- 65（ 50. 6 ± 8. 3） years. The patients were divided into normal group（ n = 53）,overweight group（ n = 44） and obese group（ n = 32） according to BMI classification method. The incidence and classifying of LFOA（ imaging findings included the stricture of articular space,osteophyte formation and osseous changes） of L1 /2- L5/ S1 segments in three groups were compared. The criterion for statistical test was difined as α = 0. 05,when using partitioning chi-square test,the criterion was adjusted for α＇ = 0. 0125. Results Out of 1 290 lumbar facet joints and 645 intervertebral discs in 129 patients,415 intervertebral discs（ 64. 3%） were intervertebral disc degeneration（ vacuum sign,bulging,prominent）,631 lumbar facet joints（ 48. 9%） had pathological changes of LFOA. There were no statistical differences in sex and age in three groups（ all P〈0. 05）. Out of 530 lumbar facet joints in normal group,238 lumbar facet joints（ 44. 9%） had pathological changes of LFOA. Out of 440 lumbar facet joints in overweight group,225 lumbar facet joints（ 51. 1%） had pathological changes of LFOA. Out of 320 lumbar facet joints in obese group,168 lumbar facet joints（ 52. 5%） had pathological changes of LFOA. The incidence of LFOA was the highest（ 62. 8%） in L4 /5segments. By pairwise comparison in three groups,the incidence of LFOA in normal group was slightly lower than those in overweight group and obese group respectively,but there were no significant differences（ all P〈0. 0125）. With the progressive increase of BMI,the severity classification of LFOA increased in turn by the order of normal group,overweight group and obese group（ P〈0. 05）. Conclusion Obeseness is an influencing factor of severity classification of LFOA. It will need to be further observed by expanding sample size that whether the BMI has an influence of statistical significance.