Alghadir Ahmad H, Gabr Sami A, Al-Eisa Einas S
Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
J Pain Res. 2017 Apr 11;10:855-865. doi: 10.2147/JPR.S124859. eCollection 2017.
OBJECTIVE: This study was designed to evaluate the role of vitamin D, muscle fatigue biomarkers, and mechanical factors in the progression of low back pain (LBP) in schoolchildren. BACKGROUND: Children and adolescents frequently suffer from LBP with no clear clinical causes, and >71% of schoolchildren aged 12-17 years will show at least one episode of LBP. MATERIALS AND METHODS: A total of 250 schoolchildren aged 12-16 years were randomly enrolled in this study. For all schoolchildren height, weight, percentage of daily sun exposure and and areas of skin exposed to sun, method of carrying the bag, and bag weight and type were recorded over a typical school week. Pain scores, physical activity (PA), LBP, serum vitamin 25(OH)D level, serum bone-specific alkaline phosphatase, creatine kinase (CK), and lactate dehydrogenase (LDH) activities and calcium (Ca) concentrations were estimated using prevalidated Pain Rating Scale, modified Oswestry Low Back Pain Disability Questionnaire, short-form PA questionnaire, and colorimetric and immunoassay techniques. RESULTS: During the period of October 2013-May 2014, LBP was estimated in 52.2% of the schoolchildren. It was classified into moderate (34%) and severe (18%). Girls showed a higher LBP (36%) compared with boys (24%). In schoolchildren with moderate and severe LBP significantly higher (=0.01) body mass index, waist, hip, and waist-to-hip ratio measurements were observed compared with normal schoolchildren. LBP significantly correlated with less sun exposure, lower PA, sedentary activity (TV/computer use), and overloaded school bags. In addition, schoolchildren with severe LBP showed lower levels of vitamin 25(OH)D and Ca and higher levels of CK, LDH, and serum bone-specific alkaline phosphatase compared with moderate and healthy schoolchildren. Stepwise regression analysis revealed that age, gender, demographic parameters, PA, vitamin D levels, Ca, CK, and LDH associated with ~56.8%-86.7% of the incidence of LBP among schoolchildren. CONCLUSION: In children and adolescents, LBP was shown to be linked with limited sun exposure, inadequate vitamin D diets, adiposity, lower PA, sedentary lifestyles, vitamin 25 (OH) D deficiency, and lower levels of Ca, CK, and LDH.
目的：本研究旨在评估维生素D、肌肉疲劳生物标志物和力学因素在学龄儿童下背痛（LBP）进展中的作用。 背景：儿童和青少年经常遭受不明临床病因的下背痛，12 - 17岁的学龄儿童中超过71%会出现至少一次下背痛发作。 材料与方法：本研究共随机纳入250名12 - 16岁的学龄儿童。在一个典型的上学周内，记录所有学龄儿童的身高、体重、每日阳光暴露百分比和暴露于阳光的皮肤面积、背书包的方式以及书包重量和类型。使用预先验证的疼痛评分量表、改良的奥斯维斯特下背痛残疾问卷、简短的身体活动问卷以及比色法和免疫测定技术评估疼痛评分、身体活动（PA）、下背痛、血清维生素25(OH)D水平、血清骨特异性碱性磷酸酶、肌酸激酶（CK）、乳酸脱氢酶（LDH）活性和钙（Ca）浓度。 结果：在2013年10月至2014年5月期间，52.2%的学龄儿童被评估为患有下背痛。其中中度下背痛占34%，重度下背痛占18%。女孩的下背痛发生率（36%）高于男孩（24%）。与正常学龄儿童相比，患有中度和重度下背痛的学龄儿童的体重指数、腰围、臀围和腰臀比测量值显著更高（P = 0.01）。下背痛与阳光暴露较少、身体活动水平较低、久坐活动（看电视/使用电脑）以及书包过重显著相关。此外，与中度和健康学龄儿童相比，患有重度下背痛的学龄儿童的维生素25(OH)D和钙水平较低，而CK、LDH和血清骨特异性碱性磷酸酶水平较高。逐步回归分析显示，年龄、性别、人口统计学参数、身体活动、维生素D水平、钙、CK和LDH与学龄儿童下背痛发生率的56.8% - 86.7%相关。 结论：在儿童和青少年中，下背痛与阳光暴露有限、维生素D饮食不足、肥胖、身体活动水平较低、久坐生活方式、维生素25(OH)D缺乏以及钙、CK和LDH水平较低有关。
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