Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Epidemiology, Ludwig-Maximilians-University München, Munich, Germany.
J Cachexia Sarcopenia Muscle. 2023 Jun;14(3):1249-1258. doi: 10.1002/jcsm.13192. Epub 2023 Mar 9.
Intervertebral disc degeneration (IVDD) may be linked to dysregulations of skeletal muscle glucose metabolism and fatty alterations of muscle composition (Myosteatosis). Our aim was to evaluate the different associations of magnetic resonance imaging (MRI)-based paravertebral myosteatosis with lumbar disc degeneration in individuals with impaired glucose metabolism and normoglycaemic controls.
In total, 304 individuals (mean age: 56.3 ± 9.1 years, 53.6% male sex, mean body mass index [BMI]: 27.6 ± 4.7 kg/m ) from a population-based cohort study who underwent 3-Tesla whole-body chemical-shift-encoded (six echo times) and T2-weighted single-shot-fast-spin-echo MRI were included. Lumbar disc degeneration was assessed at motion segments L1 to L5, categorized according to the Pfirrmann score and defined as Pfirrmann grade > 2 and/or disc bulging/herniation on at least one segment. Fat content of the autochthonous back muscles and the quadratus lumborum muscle was quantified as proton density fat fraction (PDFF ). Logistic regression models adjusted for age, sex, BMI and regular physical activity were calculated to evaluate the association between PDFF and outcome IVDD.
The overall prevalence of IVDD was 79.6%. There was no significant difference in the prevalence or severity distribution of IVDD between participants with or without impaired glucose metabolism (77.7% vs. 80.7%, P = 0.63 and P = 0.71, respectively). PDFF was significantly and positively associated with an increased risk for the presence of IVDD in participants with impaired glycaemia when adjusted for age, sex and BMI (PDFF : odds ratio [OR] 2.16, 95% confidence interval [CI] [1.09, 4.3], P = 0.03; PDFF : OR 2.01, 95% CI [1.04, 3.85], P = 0.04). After further adjustment for regular physical activity, the results attenuated, albeit approaching statistical significance (PDFF : OR 1.97, 95% CI [0.97, 3.99], P = 0.06; PDFF : OR 1.86, 95% CI [0.92, 3.76], P = 0.09). No significant associations were shown in healthy controls (PDFF : OR 0.62, 95% CI [0.34, 1.14], P = 0.13; PDFF : OR 1.06, 95% CI [0.6, 1.89], P = 0.83).
Paravertebral myosteatosis is positively associated with intervertebral disc disease in individuals with impaired glucose metabolism, independent of age, sex and BMI. Regular physical activity may confound these associations. Longitudinal studies will help to better understand the pathophysiological role of skeletal muscle in those with concomitant disturbed glucose haemostasis and intervertebral disc disease, as well as possible underlying causal relationships.
椎间盘退变（IVDD）可能与骨骼肌葡萄糖代谢失调和肌肉成分的脂肪改变（肌内脂肪增多症）有关。我们的目的是评估基于磁共振成像（MRI）的椎旁肌内脂肪增多症与葡萄糖代谢受损个体和血糖正常对照者的腰椎间盘退变之间的不同关联。
本研究共纳入了 304 名来自基于人群的队列研究的个体（平均年龄：56.3±9.1 岁，53.6%为男性，平均体重指数 [BMI]：27.6±4.7kg/m ），他们接受了 3-Tesla 全身化学位移编码（六个回波时间）和 T2 加权单次快速自旋回波 MRI 检查。腰椎间盘退变在 L1 到 L5 运动节段进行评估，根据 Pfirrmann 评分进行分类，并定义为至少一个节段的 Pfirrmann 分级>2 和/或椎间盘膨出/突出。自体背部肌肉和腰方肌的脂肪含量作为质子密度脂肪分数（PDFF）进行量化。计算调整年龄、性别、BMI 和规律体力活动的逻辑回归模型，以评估 PDFF 与 IVDD 结局之间的关系。
总体 IVDD 患病率为 79.6%。在葡萄糖代谢受损和血糖正常的参与者中，IVDD 的患病率或严重程度分布没有显著差异（分别为 77.7%和 80.7%，P=0.63 和 P=0.71）。调整年龄、性别和 BMI 后，PDFF 与葡萄糖代谢受损者 IVDD 的存在呈显著正相关（PDFF：比值比 [OR] 2.16，95%置信区间 [CI] [1.09，4.3]，P=0.03；PDFF：OR 2.01，95% CI [1.04，3.85]，P=0.04）。进一步调整规律体力活动后，结果虽有所减弱，但仍接近统计学意义（PDFF：OR 1.97，95% CI [0.97，3.99]，P=0.06；PDFF：OR 1.86，95% CI [0.92，3.76]，P=0.09）。在健康对照组中未显示出显著相关性（PDFF：OR 0.62，95% CI [0.34，1.14]，P=0.13；PDFF：OR 1.06，95% CI [0.6，1.89]，P=0.83）。
椎旁肌内脂肪增多症与葡萄糖代谢受损个体的椎间盘疾病呈正相关，独立于年龄、性别和 BMI。规律的体力活动可能会混淆这些关联。纵向研究将有助于更好地了解伴有葡萄糖稳态紊乱和椎间盘疾病的个体中骨骼肌的病理生理学作用，以及可能的潜在因果关系。
