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

作　　者：谭利贤 汤润民 戎利民[1] 张良明[1] Tan Lixian;Tang Runmin;Rong Limin;Zhang Liangming(Department of Spine Surgery,the Third Affiliated Hospital of Sun Yat-sen University(Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery),Guangzhou 510630,China;Department of Orthopaedics,Songshan Lake Central Hospital,Dongguan 523326,China)

机构地区：[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 [2]东莞市松山湖中心医院骨科,东莞523326

出　　处：《中华骨科杂志》2024年第2期96-104,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目(81972111);广东省自然科学基金项目(2020A1515010050)。

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(facet 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、L5S1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�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 glucose were monitored for 3 consecutive days.Plasma glucose and glycosylated hemoglobin were assessed by blood biochemical results.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/L).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 different 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=

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 

分 类 号：R587.2[医药卫生—内分泌] R684.3[医药卫生—内科学]