中老年腰椎间盘退变程度与椎旁肌退变及维生素D水平的相关性研究

Correlation between paravertebral muscle degeneration, lumbar disc degeneration and serum vitamin D level in elderly patients

中文关键词:  腰椎间盘退变  椎旁肌  脂肪浸润  血清维生素D

英文关键词:Lumbar disc degeneration  Paravertebral Muscle  Fat Infiltration  Serum vitamin D

中文摘要:

  【摘要】 目的：研究腰椎间盘退变程度与椎旁肌群退变及血清维生素D水平之间的关系。方法：回顾性分析我院中老年腰椎间盘退变患者150例，其中女性105例，男性45例，年龄41~93（67.0±10.1）岁，所有患者行腰椎MRI检查和血清维生素D水平测定，按Pfirrmann标准，通过对髓核结构、髓核信号强度、髓核与纤维环界限及椎间盘高度等评估，对腰椎间盘退变程度分级，并根据Pfirrmann等级进行分组，纳入病例中无Ⅰ级患者，Ⅱ~Ⅴ级病例数分别为：L4/5节段，n=17、59、60及14；L5/S1节段，n=22、46、55及27。在MRI T2加权像上测量L4/5及L5/S1节段椎旁肌群（腰肌、竖脊肌及多裂肌）的标准横截面积值。根据Goutallier分级，通过评估椎旁肌脂肪浸润量多少，对椎旁肌脂肪浸润程度分级。根据内分泌学会临床实践指南将血清维生素D水平分为正常（＞30ng/ml）、不足（20~30ng/ml）及缺乏（＜20ng/ml）。分类数据的分析通过秩和检验，定量数据的分析通过单因素方差分析或Kruskal-Wallis检验，变量间相关性分析通过Spearman相关系数。结果：L4/5节段腰肌、竖脊肌及多裂肌的横截面积与腰椎间盘退变程度呈负相关（r=-0.294、-0.250及-0.182）；L5/S1节段腰肌及多裂肌的横截面积与腰椎间盘退变程度呈负相关（r=-0.344及-0.346）。竖脊肌及多裂肌的脂肪浸润程度与腰椎间盘退变程度具有相关性（L4/5节段：r=0.174及0.188；L5/S1节段：r=0.193及0.283）。腰椎间盘退变分级Ⅲ~Ⅴ级患者中维生素D缺乏者与Ⅱ级患者比较，所占比例更高（Ⅱ~Ⅴ级：L4/5，47.06%、59.32%、60.00%及57.14%；L5/S1，45.45%、58.70%、56.36%及70.37%）。维生素D不足或缺乏者与正常者比较，竖脊肌及多裂肌的脂肪浸润Goutallier 2~4级所占比例更高。98%以上腰肌无或仅轻度脂肪浸润，几乎不受腰椎间盘退变程度及维生素D水平的影响。结论：椎旁肌横截面积随腰椎间盘退变程度加重而缩小，竖脊肌及多裂肌的脂肪浸润程度与腰椎间盘退变程度存在相关性。腰椎间盘退变程度较重者，维生素D缺乏的可能性更大。而维生素D缺乏者，竖脊肌及多裂肌的脂肪浸润程度可能更重。

英文摘要:

  【Abstract】 Objectives: To study the relationship between the degeneration of paraspinal muscles, the degree of lumbar disc degeneration with serum vitamin D levels. Methods: 150 elderly patients [105 females, 45 males, aged 41 to 93 (67.0±10.1) years old] with lumbar disc degenerative diseases underwent lumbar MRI and serum vitamin D levels test. According to the Pfirrmann standard, the degree of lumbar disc degeneration was graded by evaluating the structure of the nucleus pulposus, the signal strength of the nucleus pulposus, the boundary of the nucleus pulposus and the annulus fibrosus, and the height of the intervertebral disc. There were no patients with grade Ⅰ, and the number of cases with grades Ⅱ to Ⅴ were as follows: L4/5, n=17, 59, 60 and 14; L5/S1, n=22, 46, 55 and 27. The standard cross-sectional area of the paravertebral muscles (psoas, erector spinae, and multifidus) were measured on the T2 phase of the L4/5 and L5/S1 segments. The degree of muscle fat infiltration was graded according to the Goutallier classification by evaluating the amount of fat infiltration. According to the Endocrine Society clinical practice guideline, serum vitamin D levels were classified as normal(≥30ng/ml), insufficiency(20-30ng/ml) and deficiency(＜20ng/ml). Classification data was analyzed using rank sum test, quantitative data was analyzed using one-way ANOVA or Kruskal-Wallis test, and correlation analysis between variables was performed using Spearman correlation coefficient. Results: In the L4/5 segment, the cross-sectional areas of psoas, erector spinae and multifidus were negatively correlated with the degree of lumbar disc degeneration(r=-0.294, -0.250, -0.182). In the L5/S1 segment, the cross-sectional areas of the psoas and multifidus were negatively correlated with the degree of lumbar disc degeneration(r=-0.344, -0.346). The stage of fat infiltration of the erector spinae and multifidus were correlated with the degree of lumbar disc degeneration(L4/5: r=0.174, 0.188; L5/S1: r=0.193, 0.283). The proportion of patients with lumbar disc degeneration accompanied by vitamin D deficiency were higher in Pfirrmann Ⅲ-Ⅴ than those in Pfirrmann Ⅱ (Grade Ⅱ-Ⅴ: L4/5, 47.06%, 59.32%, 60.00% and 57.14%; L5/S1, 45.45%, 58.70%, 56.36% and 70.37%). Compared with those with normal vitamin D levels, patients with vitamin D insufficiency or deficiency presented higher proportions of erector spinae and multifidus Goutallier grade 2-4. There was no or only slight fat infiltration in more than 98% psoas, and the psoas was hardly affected by the degree of lumbar disc degeneration and vitamin D level. Conclusions: The cross-sectional area of the paravertebral muscles decreased with the degree of lumbar disc degeneration. The severity of fat infiltration of the erector spinae and multifidus were related to the degree of lumbar disc degeneration. Patients with more severe lumbar disc degeneration were more likely to have vitamin D deficiency. Patients with vitamin D deficiency may have more severe fat infiltration in the erector spinae and multifidus.