中华骨科杂志2024，Vol.44Issue(2) ：96-104.DOI:10.3760/cma.j.cn121113-20230721-00022

2型糖尿病及血糖控制程度对腰椎关节突关节骨关节炎发生及等级的影响

Effect of blood glucose control on lumbar facet joint osteoarthritis in patients with type 2 diabetes mellitus

谭利贤 汤润民 戎利民 张良明
中华骨科杂志2024，Vol.44Issue(2) ：96-104.DOI:10.3760/cma.j.cn121113-20230721-00022
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2型糖尿病及血糖控制程度对腰椎关节突关节骨关节炎发生及等级的影响

Effect of blood glucose control on lumbar facet joint osteoarthritis in patients with type 2 diabetes mellitus

谭利贤 1汤润民 2戎利民 2张良明2
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作者信息

  • 1. 中山大学附属第三医院脊柱外科(广东省微创脊柱外科质量控制中心,广东省微创脊柱外科工程技术研究中心),广州 510630;东莞市松山湖中心医院骨科,东莞 523326
  • 2. 中山大学附属第三医院脊柱外科(广东省微创脊柱外科质量控制中心,广东省微创脊柱外科工程技术研究中心),广州 510630
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摘要

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血糖控制程度对脊柱关节突关节骨关节炎(fac-et joint osteoarthritis,FJOA)发生及等级的影响.方法 回顾性收集2021年12月至2022年12月于中山大学附属第三医院脊柱外科诊治的腰椎退行性疾病患者286例,根据入院时是否确诊2型糖尿病分为糖尿病组121例和非糖尿病组165例,记录患者年龄、性别、是否合并高血压、体质指数(body mass index,BMI).糖尿病组记录糖尿病病程,连续3 d监测空腹血糖、餐后血糖峰值,通过血生化结果评估血浆葡萄糖、糖化血红蛋白,根据空腹血糖及糖化血红蛋白水平(HbA1c),将患者分为血糖理想(HbA1c＜6.5％且空腹血糖＜6.1 mmol/L)、良好(6.5％≤HbA1c≤7.5％或6.1 mmol/L≤空腹血糖≤7.0 mmol/L)、不佳(HbA1c＞7.5％且空腹血糖＞7.0 mmol/L)三组.采用视觉模拟评分(visual analogue scale,VAS)评估腰痛程度,按Pathria分级系统于腰椎CT中评估腰椎不同节段FJOA的严重程度.采用Mann-Whitney U检验比较糖尿病组与非糖尿病组L1～S1 FJOA等级的差异,以logistic回归分析糖尿病对FJOA等级的影响;采用Kruskal-Wallis检验比较不同血糖控制程度的糖尿病患者不同节段FJOA等级的差异,以logistic回归分析血糖控制程度对FJOA等级的影响.结果 糖尿病组L4.5 FJOA等级为3(2,3)级,大于非糖尿病组的2(1,3)级,差异有统计学意义(Z=-3.179,P=0.001),糖尿病是L4,5 FJOA的独立危险因素[OR=1.767,95％CI(1.032,3.025),P=0.038].糖尿病患者血糖控制不同程度组的年龄、性别、BMI、合并高血压率及血糖波动值的差异无统计学意义(P＜0.05).血糖不佳组L1.2、L4.5、L5S,节段FJOA等级为2(1,2)、3(3,3)、3(2,4)级,较血糖理想组的 1(1,2)、2(1.5,3)、2(1,2)级更高,差异有统计学意义(H=9.530,P=0.009;H=18.248,P＜0.001;H=27.916,P＜0.001);L4,5、L5S1 FJOA等级较血糖良好组的3(2,3)级、2(1,2)级更高,差异有统计学意义(H=18.248,P＜0.001;H=27.916,P＜0.001).血糖控制不佳是 L4.5、L5S1 FJOA 的独立危险因素[OR=4.963,95％CI(1.095,22.496),P=0.038;OR=6.010,95％CI(1.061,34.049),P=0.043].结论 相较非糖尿病患者,2型糖尿病患者L4,5发生FJOA的风险更高、程度更重;相较血糖控制良好或理想者,血糖控制不佳者L4.5、L5S1FJOA影像学严重程度和腰痛症状更严重.

Abstract

Objective To investigate the effect of blood glucose control on the imaging severity and clinical symptoms of facet joint osteoarthritis(FJOA)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 286 patients with lumbar degenerative diseases who were diagnosed and treated in the Department of Spinal Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2021 to December 2022 were retrospectively collected.Patients were divided into diabetic and non-diabetic groups according to whether T2DM was diagnosed at admission.Age,gender,presence of hypertension,and body mass index(BMI)were recorded.The duration of diabetes was recorded.Fasting blood glucose and peak postprandial blood glu-cose were monitored for 3 consecutive days.Plasma glucose and glycosylated hemoglobin were assessed by blood biochemical re-sults.Diabetic patients were divided into three sub-groups according to fasting blood glucose and glycosylated hemoglobin levels(HbA1c):ideal blood glucose control(HbA1c＜6.5％and fasting blood glucose＜6.1 mmol/L),good(6.5％≤HbA1c≤7.5％or 6.1 mmol/L≤fasting blood glucose≤7.0 mmol/L),and poor(HbA1c＞7.5％and fasting blood glucose＞7.0 mmol几).Visual analogue scale(VAS)was used to assess the degree of low back pain.Pathria grading system was used to assess the severity of FJOA at dif-ferent levels of the lumbar spine on lumbar CT.Mann-whitney U test was used to compare the difference of FJOA between L1-S1 segments in diabetic and non-diabetic patients.Logistic regression was used to analyze the effect of diabetes on FJOA.Kruskal-Wallis test was used to compare the difference of FJOA between different segments in diabetic patients among different sub-groups.Logistic regression was used to analyze the effect of blood glucose control on FJOA.Results A total of 121 patients in the diabetic group and 165 patients in the non-diabetic group were included.L4,5 FJOA grade 3(2,3)in diabetic patients was greater than grade 2(1,3)in non-diabetic patients with significant difference(Z=-3.179,P=0.001),and diabetes was an independent risk factor for L4.5 FJOA[OR=1.767,95％CI(1.032,3.025),P=0.038].There was no significant difference in age,BMI,sex ratio,preva-lence of hypertension and blood glucose fluctuation values among different subgroups of glycemic control in the diabetic group.Pa-tients in the poor glucose group had higher FJOA grades 2(1,2),3(3,3)and 3(2,4)at L1,2,L4,5 and L5S1 than those in the ideal glu-cose group at grades 1(1,2),2(1.5,3)and 2(1,2)with significant differences(H=9.530,P=0.009;H=18.248,P＜0.001;H=27.916,P＜0.001).Patients in the poor glucose group had higher grades 3(3,3)and 3(2,4)of osteoarthritis of the L4.5 and L5S1 facet joints than those in the good glucose group,grades 3(2,3)and 2(1,2)with significant differences(H=18.248,P＜0.001;H=27.916,P＜0.001).Low back pain was positively correlated with poor glycemic control,L4.5 and L5S1 FJOA(r=0.512,P＜0.001;r=0.383,P＜0.001;r=0.484,P＜0.001).Poor glycemic control was an independent risk factor for FJOA at L4,5 and L5S1[OR=4.963,95％CI(1.095,22.496),P=0.038;OR=6.010,95％CI(1.061,34.049),P=0.043].Conclusion Compared with non-diabetic patients,pa-tients with type 2 diabetes have a higher risk of osteoarthritis in the facet joints of L4,5.Compared with diabetic patients with good or ideal glycemic control.Patients with poor glycemic control had more severe osteoarthritis of the L4.5 and L5S1 facet joints.Pa-tients with severe facet joint degeneration and poor glycemic control often suffered more from severe low back pain.

关键词

骨关节炎,脊柱/椎关节突关节/糖尿病,2型/血糖控制/腰痛

Key words

Osteoarthritis,Spine/Zygapophyseal joint/Diabetes mellitus,type 2/Glycemic control/Low back pain

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基金项目

国家自然科学基金(81972111)

广东省自然科学基金(2020A1515010050)

出版年

2024
中华骨科杂志
中华医学会

中华骨科杂志

CSTPCDCSCD北大核心
影响因子：2.137
ISSN：0253-2352
参考文献量28
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