帕金森病患者下腰痛发生及加重的危险因素分析

Analysis of risk factors for the occurrence and aggravation of lower back pain in Parkinson′s disease patients

目的探讨帕金森病(PD)患者下腰痛(LBP)发生及加重的独立危险因素,以对临床诊治提供参考。方法回顾性分析2018年6月至2020年5月在江苏大学附属宜兴医院就诊的309例PD患者病例资料,采用KING帕金森病疼痛量表(KPPS)对PD患者LBP进行量化评估,分为LBP组及Non-LBP组,比较分析两组患者一般临床资料、PD相关资料及影像学资料。采用二元logistic回归分析评估PD患者发生LBP的独立危险因素。将KPPS评分与各因素之间进行Pearson相关性分析,采用线性回归分析得出导致PD患者LBP加重的相关危险因素。结果与Non-LBP组患者相比,LBP组患者骨密度(BMD)较低,且进行日常锻炼患者比例较低,两组间差异有统计学意义(均P<0.05)。与Non-LBP组相比,LBP组患者病程更长,强直评分更高,症状波动患者比例更高,帕金森病评定量表第三部分(UPDRS-Ⅲ)评分更高,合并胸腰背部筋膜损伤(TLFI)及合并腰椎矢状位失衡比例更高,两组间差异有统计学意义(均P<0.05)。二元logistic回归分析结果显示合并TLFI(OR=2.773,95%CI:1.219~6.309,P=0.015)、合并腰椎矢状位失衡(OR=4.835,95%CI:2.244~10.421,P<0.001)、较低BMD(OR=2.818,95%CI:1.767~4.493,P<0.001)是PD患者发生LBP的危险因素。KPPS评分与BMD及TLFI均存在相关(r=-0.146,0.294,均P<0.05)。线性回归结果显示合并TLFI(B=2.271,β=0.285,P<0.001)与KPPS评分呈正相关,为危险因素。结论合并TLFI、合并腰椎矢状位失衡及较低BMD与PD患者发生LBP密切相关,而合并TLFI是导致LBP症状加重的独立危险因素,临床需高度重视PD患者TLFI防治。

Objective To explore the independent risk factors for the occurrence and aggravation of lower back pain(LBP)in patients with Parkinson′s disease(PD),in order to provide reference for clinical diagnosis and treatment.Methods A retrospective analysis was conducted on the case data of 309 PD patients who visited the Affiliated Yixing Hospital of Jiangsu University from June 2018 to May 2020.The KING Parkinson′s Disease Pain Scale(KPPS)was used to quantitatively evaluate the LBP of PD patients,who were divided into LBP group and Non LBP group.The general clinical data,PD related data,and imaging data of the two groups were compared and analyzed.Binary logistic regression analysis was used to evaluate independent risk factors for LBP in PD patients.Pearson correlation analysis was conducted between KPPS scores and various factors,and linear regression analysis was used to identify the relevant risk factors that exacerbate LBP in PD patients.Results Compared with the Non LBP group,the LBP group had lower bone mineral density(BMD)and a lower proportion of patients who engaged in daily exercise.The difference between the two groups was statistically significant(all P<0.05).Compared with the Non LBP group,patients in the LBP group had a longer course of illness,higher stiffness scores,a higher proportion of patients with fluctuating symptoms,higher UPDRS-Ⅲscores,and a higher proportion of patients with thoracolumbar fascial injury(TLFI)and lumbar sagittal imbalance.The differences between the two groups were statistically significant(all P<0.05).The results of binary logistic regression analysis showed that combined TLFI(OR=2.773,95%CI:1.219-6.309,P=0.015),combined lumbar sagittal imbalance(OR=4.835,95%CI:2.244-10.421,P<0.001),and lower BMD(OR=2.818,95%CI:1.767-4.493,P<0.001)were risk factors for LBP in PD patients.The KPPS score was correlated with BMD and TLFI(r=-0.146,0.294,all P<0.05).The linear regression results showed that the merged TLFI(B=2.271,β=0.285,P<0.001)was positively correlated with KPPS score,indicating a risk factor.Conclusions The combination of TLFI,lumbar sagittal imbalance,and lower BMD is closely related to the occurrence of LBP in PD patients,and the combination of TLFI is an independent risk factor for exacerbating LBP symptoms.Clinical attention should be paid to the prevention and treatment of TLFI in PD patients.