椎间盘退变进展中的预后因素：哪些患者应接受再生治疗？
Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies?
作者信息
Rustenburg Christine M E, Faraj Sayf S A, Ket Johannes C F, Emanuel Kaj S, Smit Theodoor H
机构信息
Amsterdam UMC, Department of Orthopedic Surgery Amsterdam Movement Sciences Amsterdam The Netherlands.
Radboud UMC, Department of Orthopedic Surgery Nijmegen The Netherlands.
出版信息
JOR Spine. 2019 Sep 21;2(3):e1063. doi: 10.1002/jsp2.1063. eCollection 2019 Sep.
OBJECTIVE
Possible regenerative treatments for lumbar intervertebral disc degeneration (DD) are rapidly emerging. There is consensus that the patient that would benefit most has early-stage DD, with a predicted deterioration in the near future. To identify this patient, the aim of this study was to identify prognostic factors for progression of DD.
STUDY DESIGN
Systematic review.
METHODS
A systematic search was performed on studies evaluating one or more prognostic factor(s) in the progression of DD. The criteria for inclusion were (a) patients diagnosed with DD on MRI, (b) progression of DD at follow-up, and (c) reporting of one or more prognostic factor(s) in progression of DD. Two authors independently assessed the methodological quality of the included studies. Due to heterogeneity in DD determinants and outcomes, only a best-evidence synthesis could be conducted.
RESULTS
The search generated 3165 references, of which 16 studies met our inclusion criteria, involving 2.423 patients. Within these, a total of 23 clinical and environmental and 12 imaging factors were identified. There was strong evidence that disc herniation at baseline is associated with progression of DD at follow-up. There is limited evidence that IL6 rs1800795 genotype G/C male was associated with no progression of DD. Some clinical or environmental factors such as BMI, occupation and smoking were not associated with progression.
CONCLUSIONS
Disc herniation is strongly associated with the progression of DD. Surprisingly, there was strong evidence that smoking, occupation, and several other factors were not associated with the progression of DD. Only one genetic variant may have a protective effect on progression, otherwise there was conflicting or only limited evidence for most prognostic factors. Future research into these prognostic factors with conflicting and limited evidence is not only needed to determine which patients should be targeted by regenerative therapies, but will also contribute to spinal phenotyping.
目的
针对腰椎间盘退变（DD）的潜在再生治疗方法正在迅速涌现。人们一致认为，受益最大的患者是早期DD患者，其在不久的将来预计会出现病情恶化。为了识别这类患者，本研究的目的是确定DD进展的预后因素。
研究设计
系统评价。
方法
对评估DD进展中一个或多个预后因素的研究进行系统检索。纳入标准为：（a）MRI诊断为DD的患者；（b）随访时DD有进展；（c）报告DD进展中的一个或多个预后因素。两位作者独立评估纳入研究的方法学质量。由于DD决定因素和结果存在异质性，只能进行最佳证据综合分析。
结果
检索产生3165篇参考文献，其中16项研究符合我们的纳入标准，涉及2423例患者。在这些研究中，共确定了23个临床和环境因素以及12个影像因素。有强有力的证据表明，基线时的椎间盘突出与随访时DD的进展相关。有限的证据表明，IL6 rs1800795基因型G/C男性与DD无进展相关。一些临床或环境因素，如BMI、职业和吸烟与进展无关。
结论
椎间盘突出与DD的进展密切相关。令人惊讶的是，有强有力的证据表明，吸烟、职业和其他几个因素与DD的进展无关。只有一种基因变异可能对进展有保护作用，否则大多数预后因素的证据相互矛盾或仅有限。未来对这些证据相互矛盾和有限的预后因素进行研究，不仅有助于确定哪些患者应接受再生治疗，还将有助于脊柱表型分析。
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