绝经后腰痛女性骨密度及骨转换标志物与腰椎Modic改变的相关性研究

Correlation between bone turnover markers and bone mineral density and Modic changes in Postmenopausal women with low back pain

目的探讨绝经后慢性腰痛女性骨密度(BMD)及骨转换标志物(BTMs)与腰椎Modic改变的相关性。方法回顾性分析2017年1月至2019年12月因慢性腰痛伴或不伴下肢放射痛在本院就诊的200例绝经后女性患者,采用双能X线测定腰椎BMD;采用罗氏化学发光法测定空腹静脉血Ⅰ型原胶原N末端前肽(PINP)、Ⅰ型胶原C末端肽特殊序列(β-CTX)水平;通过MRI检查患者腰椎Modic改变情况;采用二分类Logistic回归分析患者BTMs与腰椎BMD和腰椎Modic改变的相关性。结果200例绝经后慢性腰痛女性腰椎Modic改变发生率为51.5%,Modic改变患者腰椎BMD低于无Modic改变患者,二者差异具有统计学意义,而PINP和β-CTX水平高于无Modic改变患者,二者差异具有统计学意义(P<0.05)。β-CTX和PINP与Modic改变呈正相关,关联具有统计学意义(P<0.05),而腰椎BMD与Modic改变呈负相关,关联具有统计学意义(P<0.05)。结论绝经后慢性腰痛女性腰椎BMD及BTMs与腰椎Modic改变有相关性;随着BTMs升高或者BMD降低,腰椎Modic改变的发生率升高,提示临床上应早期监测绝经后慢性腰痛女性BTMs和腰椎BMD的变化,早期给予抗骨质疏松治疗,为治疗绝经后女性腰椎Modic改变引起的背痛患者提供了新的思路。

Objective To investigate the correlation between bone turnover markers(BTMs)and bone mineral density(BMD)and Modic changes in Postmenopausal women with chronic low back pain.Methods 200 Postmenopausal women with chronic low back pain were selected from January 2017 to December 2019 in our department.BMD of all patients were measured by dual energy X-ray absorptiometry.The procollagen type-1 N-terminal propeptide(PINP)and C-terminal crosslinking telopeptides of type I collagen(beta-CTX)were analyzed from fasting morning blood samples.Modic changes was analyzed by MRI examination.Correlation between BTMs and BMD with Modic changes were evaluated through statistical analysis.Results The incidence of Modic changes in 200 Postmenopausal women with chronic low back pain was 51.5%.BMD in patients with lumbar Modic changes was lower than that in patients with no lumbar Modic changes,the difference was statistically significant(P<0.05).PINP andβ-CTX in patients with lumbar Modic changes were higher than those in patients with no lumbar Modic changes,the difference was statistically significant(P<0.05).β-CTX and PINP were positively correlated with lumbar Modic changes,while BMD was negatively correlated with lumbar Modic changes,the correlation was statistically significant(P<0.05).Conclusion BMD were negatively correlated with lumbar Modic changes,andβ-CTX and PINP were positively correlated with lumbar Modic changes in Postmenopausal women with chronic low back pain.Bone turnover markers and bone mineral density may helpful in assessing lumbar Modic changes and chronic low back pain in Postmenopausal women.