退行性腰椎滑脱症中医治疗方案临床疗效的影响因素分析

Analysis of influencing factors of clinical effect of TCM treatment for degenerative lumbar spondylolisthesis

目的:探讨可能影响中医方案治疗退行性腰椎滑脱症(DLS)获得显著疗效的相关因素。方法:选取前期多中心RCT研究中通过中医方案治疗的DLS患者267例,剔除数据缺失病例36例,观察患者JOA评分及其疗效指数变化情况,根据治疗结束后JOA疗效指数划分为疗效显著(≥50%)和疗效欠佳(<50%)。采用单因素筛选和多因素Logistic回归分析方法分析影响DLS疗效的因素。结果:单因素Logistic回归分析表明病程、平卧翻身-计分、洗漱动作-计分、长时间久坐-计分、举重物并保持-计分对纳入患者获得显著疗效的影响有统计学意义(P<0.05);多因素logistic回归分析示治疗前JOA评分总分、平卧翻身-计分对患者疗效的影响有统计学意义(P<0.05)。中医方案治疗DLS疗效影响因素较多,患者治疗前JOA评分总分及平卧翻身-计分每增加1分获得显著疗效的概率分别增加1.167和0.410倍。结论:临床采用中医方案治疗DLS时JOA评分越高或平卧翻身受限程度越小的患者疗效更佳。

Objective To explore the related factors that may affect the significant therapeutic effect of traditional Chinese medicine(TCM)on degenerative lumbar spondylolisthesis.Methods Totally 267 multi-center DLS patients treated with traditional Chinese medicine regimen were selected to observe the changes of JOA score and therapeutic effect index of patients,and 36 cases with missing data were excluded.According to the therapeutic effect index of JOA after treatment,the patients were divided into two groups significant therapeutic effect(≥50%)and poor therapeutic effect(<50%).Univariate screening and multivariate Logistic regression analyses were used.ResultsUnivariate Logistic regression analysis showed that the course of disease,scores of recumbent roll over,washing movement,long-time sitting,weight lifting and maintenance had statistically significant influence on the significant efficacy of the included patients(P<0.05).Multivariate logistic regression analysis showed that the total JOA score and the supine roll-over score before treatment had a statistically significant effect on the efficacy of the patients(P<0.05).There were many influencing factors on the effect of traditional Chinese medicine regimen on DLS.Before treatment,the total score of JOA score and the probability of achieving significant effect increased by 1.167 and 0.410 times for each increase of 1 point in supine roll-over score.ConclusionThe higher the JOA scores or the less the limitation of supine roll in the treatment of DLS with traditional Chinese medicine are,the better the effect it could be.