Zeng Qing Yu, Chen Ren, Xiao Zheng Yu, Huang Shao-Bi, Liu Yuan, Xu Jing Cai, Chen Shun Le, Darmawan John, Couchman Kenneth G, Wigley Richard D, Muirden Kenneth D
Rheumatology Department, Shantou University Medical College, Shantou, China.
J Rheumatol. 2004 Dec;31(12):2439-43.
To determine whether the previously noted low prevalence of knee pain (KP) and lumbar pain (LP) in rural southern China compared with the high prevalence observed in North China was also true in a southern urban population.
A population based sample of 2040 adults > or = 16 years of age was studied in Chenghai City, close to the rural area previously studied on the southeast coast of China. Primary healthcare workers administered the COPCORD Phase I and II questionnaires. Those with rheumatic symptoms were recalled for medical examination, with a response rate at examination (phase III) of 98.4%. Those suspected of having arthritis had radiographs and laboratory tests. Prevalences were age and sex adjusted to the total of populations previously reported.
(1) The prevalence for all rheumatic symptoms at phase III was 18.1%. Of the 7.5% with KP, 55% had osteoarthritic changes on radiograph (KOA) compared with 29% of a sample with no KP (p < 0.001). Of the 11.5% with LP, 69% had degenerative changes on lumbar spine radiograph (LOA). (2) Of residents in single-level houses the prevalence was 5.6% for KP and 7.9% for LP, whereas in 4 to 6-level apartment buildings these rates were significantly higher, 9.1% and 16.2%, respectively. All these pain rates were significantly lower than noted in rural North China. The prevalence of pain together with radiographic OA changes in the knee (KOA) was half the rate in single-floor residents (2.7%) compared to apartment residents (5.3%), as was lumbar spine degenerative disease (5.3% vs 11.5%).
The prevalence of knee and lumbar spine pain in this southern urban sample was confirmed to be much lower than in the rural sample in the North, although higher than in the rural sample in the South. Comparing COPCORD studies of Han Chinese in Shanghai and Malaysia there was a decrease in prevalence of knee and back pain with latitude, suggesting an association with climate. Knee and back pain and radiological degenerative changes in the knee and lumbar spine were twice as prevalent in apartment residents than in those living in older single-level houses. Further study is needed to explain these observations.
确定中国南方农村地区先前观察到的膝关节疼痛（KP）和腰椎疼痛（LP）低患病率与中国北方高患病率相比，在南方城市人群中是否同样如此。
在中国东南沿海先前研究过的农村地区附近的澄海市，对2040名年龄≥16岁的成年人进行了基于人群的抽样研究。基层医疗工作者发放了COPCORD第一阶段和第二阶段问卷。有风湿症状的人被召回进行医学检查，检查阶段（第三阶段）的应答率为98.4%。疑似患有关节炎的人进行了X光检查和实验室检测。患病率按年龄和性别调整为先前报告的总人口数。
（1）第三阶段所有风湿症状的患病率为18.1%。在患有KP的7.5%的人中，55%在X光片上有骨关节炎改变（KOA），而在无KP的样本中这一比例为29%（p<0.001）。在患有LP的11.5%的人中，69%在腰椎X光片上有退行性改变（LOA）。（2）居住在单层房屋中的居民，KP患病率为5.6%，LP患病率为7.9%，而在4至6层公寓楼中，这些患病率显著更高，分别为9.1%和16.2%。所有这些疼痛患病率均显著低于中国北方农村地区。与公寓居民（占5.3%）相比，膝关节疼痛伴X光片显示膝关节骨关节炎改变（KOA）的患病率在单层房屋居民中（占2.7%）仅为一半，腰椎退行性疾病患病率情况相同（分别为5.3%和11.5%）。
该南方城市样本中膝关节和腰椎疼痛的患病率经证实远低于北方农村样本，尽管高于南方农村样本。比较上海和马来西亚汉族人群的COPCORD研究发现，膝关节和背部疼痛的患病率随纬度降低，提示与气候有关。公寓居民中膝关节和背部疼痛以及膝关节和腰椎的放射学退行性改变的患病率是居住在老式单层房屋居民的两倍。需要进一步研究来解释这些观察结果。
