Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Clin Neurol Neurosurg. 2020 May;192:105725. doi: 10.1016/j.clineuro.2020.105725. Epub 2020 Feb 6.
There have not been any longitudinal studies reported that chronic low back pain (CLBP) patients are at risk for stroke. Thus, in this study, we explored the association between CLBP and strokes.
Data (2000∼2010) from the Taiwan National Health Insurance database were analyzed. We matched 10,308 CLBP patients with 20,616 propensity score-matched non-low back pain (NLBP) patients according to age, gender, index year and comorbidities. Covariates of age, gender, comorbidities, and usage of non-steroidal anti-inflammatory drugs (NSAIDs) were adjusted and analyzed.
The mean follow-up duration was 8 years. CLBP patients had higher risks of all stroke, hemorrhagic stroke, and ischemic stroke. The adjusted hazard ratios (aHRs) were 2.35 (95 % confidence interval (CI): 2.14-2.57, p < 0.001), 1.55 (95 % CI: 1.16-2.06, p = 0.003), and 2.41 (95 % CI: 2.18-2.66, p < 0.001), respectively. After adjusting and analyzing the NSAIDs used for the varied duration in the CLBP patients, we did not observe any impacts of such NSAIDs used on the association of CLBP with strokes. The association between CLBP and ischemic stroke was most prominent in the patients less than 50 years old with aHR: 3.56 (CI: 2.74∼4.61, p < 0.001).
CLBP was associated with increased risk of strokes, especially ischemic stroke, and the association was most prominent in patients less than 50 years old. Further large prospective studies on detailed lifestyle-related factors and qualitative pain assessment are needed to clarify the causal relationship between CLBP and stroke.
目前尚无研究报道慢性下背痛（CLBP）患者存在中风风险。因此，本研究旨在探讨 CLBP 与中风之间的关系。
分析了台湾全民健康保险数据库（2000∼2010 年）的数据。我们根据年龄、性别、指数年和合并症，将 10308 例 CLBP 患者与 20616 例匹配的非下背痛（NLBP）患者进行匹配。调整并分析了年龄、性别、合并症和非甾体抗炎药（NSAIDs）使用等混杂因素。
平均随访时间为 8 年。CLBP 患者发生所有类型中风、出血性中风和缺血性中风的风险均较高。调整后的风险比（aHR）分别为 2.35（95%置信区间[CI]：2.14-2.57，p<0.001）、1.55（95%CI：1.16-2.06，p=0.003）和 2.41（95%CI：2.18-2.66，p<0.001）。在调整和分析 CLBP 患者使用不同时长的 NSAIDs 后，我们没有观察到这些 NSAIDs 的使用对 CLBP 与中风之间关联的任何影响。CLBP 与缺血性中风的关联在年龄小于 50 岁的患者中最为显著，aHR：3.56（CI：2.74∼4.61，p<0.001）。
CLBP 与中风风险增加相关，尤其是缺血性中风，且该关联在年龄小于 50 岁的患者中最为显著。需要进一步开展大型前瞻性研究，以探讨详细的生活方式相关因素和定性疼痛评估与 CLBP 和中风之间的因果关系。
