慢性下背痛的家族聚集是否会影响康复？一项基于人群的双胞胎研究。

Does Familial Aggregation of Chronic Low Back Pain Affect Recovery?: A Population-Based Twin Study.

机构信息

Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.

Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain.

出版信息

Spine (Phila Pa 1976). 2017 Sep 1;42(17):1295-1301. doi: 10.1097/BRS.0000000000002075.

DOI:10.1097/BRS.0000000000002075

PMID:28098741

Abstract

STUDY DESIGN

Longitudinal twin-cohort study.

OBJECTIVE

To investigate the effect familial aggregation of chronic low back pain (LBP) has on the recovery from chronic LBP.

SUMMARY OF BACKGROUND DATA

LBP is a worldwide problem, with pain and disability often becoming chronic. Genetics and familial behaviors could significantly affect the recovery from chronic LBP but have not been extensively investigated.

METHODS

A total of 624 Spanish twins from the Murcia Twin Registry reported experiencing chronic LBP within the past 2 years during the 2009/11 data collection wave and were followed up in 2013. Familial aggregation of chronic LBP was determined by the co-twin experiencing chronic LBP within the past 2 years at baseline. Twins reporting LBP "within the past 4 weeks" at follow-up were considered to have not recovered.

RESULTS

There were 455 twins with available data on LBP at follow-up and available data on LBP from their co-twin at baseline. Twins with an affected co-twin at baseline were significantly more likely to have not recovered from chronic LBP at follow-up (odds ratio [OR] = 1.6, 95% confidence interval [CI]: 1.0-2.4, P = 0.046). This relationship was stronger for monozygotic twins (OR = 2.5, 95% CI: 1.3-4.8, P = 0.006) (n = 172) but disappeared when considering only dizygotic twins (OR = 1.1, 95% CI: 0.6-2.0, P = 0.668) (n = 283). Sibling-relative recurrence risk (λ s) was 1.2 for the total sample, 1.5 for monozygotic twins, and 1.1 for dizygotic twins.

CONCLUSION

Having a sibling with chronic LBP at baseline increased the likelihood of LBP at follow-up by 20%, with this likelihood increasing to 50% if the sibling was an identical twin. These results are novel and highlight the important influence genetics have on people's recovery from chronic LBP. Information regarding the presence of chronic LBP within a family is easy to obtain and has the potential to inform clinicians on which patients are less likely to recover when treatment implementation is not considered.

LEVEL OF EVIDENCE

摘要

研究设计

纵向双胞胎队列研究。

目的

探讨慢性下背痛（LBP）家族聚集对慢性 LBP 恢复的影响。

背景资料概要

LBP 是一个全球性问题，疼痛和残疾常常变成慢性。遗传和家族行为可能会显著影响慢性 LBP 的恢复，但尚未得到广泛研究。

方法

2009/11 年数据收集期间，共有 624 名来自穆尔西亚双胞胎登记处的西班牙双胞胎报告在过去 2 年内经历过慢性 LBP，并在 2013 年进行了随访。通过基线时同卵双胞胎在过去 2 年内经历慢性 LBP 来确定慢性 LBP 的家族聚集。在随访时报告“过去 4 周”内 LBP 的双胞胎被认为没有从慢性 LBP 中恢复。

结果

共有 455 对双胞胎在随访时具有 LBP 数据，并且在基线时具有同卵双胞胎的 LBP 数据。与基线时受影响的同卵双胞胎相比，双胞胎在随访时从慢性 LBP 中恢复的可能性显著降低（比值比[OR] = 1.6，95%置信区间[CI]：1.0-2.4，P = 0.046）。这种关系在同卵双胞胎中更强（OR = 2.5，95%CI：1.3-4.8，P = 0.006）（n = 172），但当仅考虑异卵双胞胎时，这种关系消失（OR = 1.1，95%CI：0.6-2.0，P = 0.668）（n = 283）。总样本的同胞相对复发风险（λ s）为 1.2，同卵双胞胎为 1.5，异卵双胞胎为 1.1。

结论

基线时兄弟姐妹患有慢性 LBP 会使 LBP 在随访时的可能性增加 20%，如果兄弟姐妹是同卵双胞胎，则可能性增加到 50%。这些结果是新颖的，强调了遗传对人们从慢性 LBP 中恢复的重要影响。关于家族中存在慢性 LBP 的信息很容易获得，并且有可能告知临床医生在不考虑治疗实施的情况下，哪些患者不太可能康复。