Nyman T, Mulder M, Iliadou A, Svartengren M, Wiktorin C
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Occup Environ Med. 2009 Jun;66(6):395-401. doi: 10.1136/oem.2008.042168. Epub 2008 Dec 5.
To investigate if high physical workload is associated with low back pain (LBP) and/or neck-shoulder pain (NSP) when taking into account the influence of genetic and shared environmental factors. Further, the study aims to explore the potential influence of genetic and shared environmental factors in the associations between high physical workload and the three disorder subgroups: solely LBP, solely NSP, and concurrent LBP and NSP.
Data on 16,107 monozygotic and dizygotic twins, born during 1959-1985, were obtained from a cross-sectional study, performed in 2005-2006 by the Swedish Twin Registry. Odds ratios (ORs) calculated in cohort analyses and co-twin control analyses were used to assess the associations between high physical workload and LBP and NSP when controlling for genetic and shared environmental factors.
In the cohort analysis, the association between high physical workload and the group with any one symptom (LBP and/or NSP) was OR 1.47 (95% CI 1.37 to 1.57). The co-twin control analyses indicated that the association was not confounded by genetic and shared environmental factors with OR 1.34 (95% CI 1.02 to 1.75) for dizygotic twins and OR 1.44 (95% CI 1.06 to 1.95) for monozygotic twins. In the cohort analyses the association with high physical workload was higher for concurrent LBP and NSP (OR 1.80 (95% CI 1.62 to 1.99)) than for solely LBP (OR 1.41 (95% CI 1.27 to 1.57)) and solely NSP (OR 1.31 (95% CI 1.20 to 1.43)). Concurrent LBP and NSP was the only group that showed a stepwise decrease of the point estimates between the cohort analysis and the co-twin control analyses, OR 1.71 (95% CI 1.00 to 2.94) for dizygotic twins, and OR 1.29 (95% CI 0.64 to 2.59) for monozygotic twins indicating confounding by genetic and shared environmental factors.
High physical workload was associated with LBP and/or NSP even after adjusting for genetic or shared environmental factors. Only for concurrent LBP and NSP, genetic and shared environmental factors seemed to have an influence on the association with high physical workload.
在考虑遗传和共同环境因素影响的情况下，调查高强度体力工作负荷是否与腰痛（LBP）和/或颈肩痛（NSP）相关。此外，本研究旨在探讨遗传和共同环境因素在高强度体力工作负荷与三个疾病亚组（单纯LBP、单纯NSP以及同时存在LBP和NSP）之间关联中的潜在影响。
从瑞典双胞胎登记处2005 - 2006年进行的一项横断面研究中获取了1959 - 1985年出生的16107对同卵和异卵双胞胎的数据。在队列分析和双胞胎对照分析中计算的优势比（OR）用于评估在控制遗传和共同环境因素时高强度体力工作负荷与LBP和NSP之间的关联。
在队列分析中，高强度体力工作负荷与有任何一种症状（LBP和/或NSP）的组之间的关联为OR 1.47（95%可信区间1.37至1.57）。双胞胎对照分析表明，该关联不受遗传和共同环境因素的混淆，异卵双胞胎的OR为1.34（95%可信区间1.02至1.75），同卵双胞胎的OR为1.44（95%可信区间1.06至1.95）。在队列分析中，同时存在LBP和NSP与高强度体力工作负荷的关联（OR 1.80（95%可信区间1.62至1.99））高于单纯LBP（OR 1.41（95%可信区间1.27至1.57））和单纯NSP（OR 1.31（95%可信区间1.20至1.43））。同时存在LBP和NSP是唯一在队列分析和双胞胎对照分析之间点估计值呈逐步下降的组，异卵双胞胎的OR为1.71（95%可信区间1.00至2.94），同卵双胞胎的OR为1.29（95%可信区间0.64至2.59），表明存在遗传和共同环境因素的混淆。
即使在调整遗传或共同环境因素后，高强度体力工作负荷仍与LBP和/或NSP相关。仅对于同时存在LBP和NSP的情况，遗传和共同环境因素似乎对与高强度体力工作负荷的关联有影响。
