颈椎间盘退变与吸烟的关系研究

Correlation between Cervical Disc Degeneration and Smoking

目的探讨颈椎间盘退变与吸烟的关系。方法选取2014年6月—2016年6月同济大学附属东方医院脊柱外科门诊因颈肩部疼痛就诊的患者320例,根据烟草燃烧物暴露方式分为非吸烟组(n=141)、被动吸烟组(n=55)、吸烟组(n=124)。纳入患者均接受MRI检查,采用Miyazaki分级评价患者颈椎间盘退变程度,采用视觉模拟评分量表(VAS)评价患者颈肩痛程度。根据3组患者Miyazaki分级和VAS评分探讨颈椎间盘退变与吸烟的关系。结果非吸烟组患者C2/3、C3/4、C5/6节段及总体Miyazaki分级优于被动吸烟组,非吸烟组患者C1/2~C6/7节段及总体Miyazaki分级优于吸烟组,差异有统计学意义(P<0.05)。被动吸烟组、吸烟组中,C4/5~C6/7节段Miyazaki分级为Ⅳ、Ⅴ级的椎间盘比例高于C1/2~C3/4节段,差异有统计学意义(P<0.05)。吸烟组中,男性Miyazaki分级为Ⅳ、Ⅴ级的椎间盘比例高于女性,差异有统计学意义(P<0.05)。被动吸烟组、吸烟组中,吸烟5~10年者Miyazaki分级优于吸烟>10年者,差异有统计学意义(P<0.05)。3组患者VAS评分有差异,其中吸烟组患者VAS评分高于非吸烟组,差异有统计学意义(P<0.05)。结论烟草燃烧物可加速颈椎间盘退变进程,同时患者伴随的颈肩痛程度也有所增加;在影响椎间盘退变的程度上,下颈椎间盘较上颈椎间盘明显。

Objective To investigate the correlation between cigarette smoking and cervical disc degeneration. Methods We randomly selected 320 patients who visited Spine Surgery Outpatient, Shanghai East Hospital Affiliated to Tongji University with chief complaint of neck-shoulder pain during June 2014 to June 2016. According to the model of exposure to environmental tobacco smoke,they were divided into never-smoking group（ n = 141）,passive smoking group（ n = 55）,and active smoking group（ n = 124）. Each patient＇s Miyazaki＇s grading for cervical disc degeneration was analyzed based on their MRI films of the cervical spine. In addition,VAS score was applied to evaluate the degree of patients＇ neck-shoulder pain. With the help of statistical techniques,correlation between cigarette smoking and cervical disc degeneration was analyzed. Results Non-smokers had better Miyazaki grade for C2/3,C3/4,C5/6 segments and overall Miyazaki grade than passive smokers（ P 0. 05）. Non-smokers presented better Miyazaki grade for C1/2-C6/7 segments and overall Miyazaki grade than active smokers（ P 0. 05）. The prevalence rate of Miyazaki grade Ⅳ and Ⅴ in C4/5-C6/7 segments was higher than that in C1/2-C3/4 segments in both active and passive smokers（ P 0. 05）. The prevalence rate of Miyazaki grade Ⅳand Ⅴ in males was higher than that in females（ P 0. 05） in active smokers. Active smokers with 5-10 years of exposure to smoking demonstrated better Miyazaki grade compared with those with over 10 years（ P 0. 05）. And a similar thing was observed in passive smokers（ P 0. 05）. The VAS score differed significantly between the groups,in particular,smokers had much higher VAS score than non-smokers（ P 0. 05）. Conclusion Smoking exacerbates cervical disc degeneration,especially the lower cervical disc degeneration. In addition,it increases the degree of neck-shoulder pain.