糖尿病对腰椎间盘退变的影响：一项基于 MRI 的研究。

The effect of diabetes mellitus on lumbar disc degeneration: an MRI-based study.

机构信息

Department of Spinal Surgery, Hebei Medical University Third Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.

Department of Joint Surgery, Hebei Medical University Third Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.

出版信息

Eur Spine J. 2024 May;33(5):1999-2006. doi: 10.1007/s00586-024-08150-8. Epub 2024 Feb 15.

DOI:10.1007/s00586-024-08150-8

PMID:38361008

Abstract

PURPOSE

This study aims to analyse the effect of diabetes mellitus (DM) on the radiological changes of Magnetic Resonance Imaging (MRI) on the intervertebral discs and paravertebral muscle to investigate the effect of DM on spinal degeneration.

METHODS

This retrospective study initially included 262 patients who underwent treatment between January 2020 and December 2021 because of lumbar disc herniation. Amongst these patients, 98 patients suffered from type 2 diabetes mellitus (T2DM) for more than five years; this is the poorly controlled group (haemoglobin A1c (HbA1c) ≥ 6.5%; BMI: 26.28 ± 3.60; HbA1c: 7.5, IQR = 1.3). Another 164 patients without T2DM are included in the control group. The data collected and analysed include gender, age, smoking, alcohol use, disease course, Charlson Comorbidity Index, BMI, and radiological parameters including disc height, modified Pfirrmann grading scores, percentage of fat infiltration area of paravertebral muscle, and pathological changes of the endplate.

RESULTS

After propensity score-matched analysis, the difference in general data between the control and T2DM groups was eliminated, and 186 patients were analysed. The modified Pfirrmann grading scores showed statistical differences in every lumbar segment, suggesting that the T2DM group suffered from greater disc degeneration at all L1-S1 segments compared with the control group. The disc height from L1/2 to L5/S1 was not statistically different between the two groups. Compared to the T2DM group, the control group had a lower percentage of fat infiltration areas in L4/5 and L5/S1 paravertebral muscle, whereas L1/2 to L3/4 showed no statistical difference. The T2DM group had more pathological changes of cartilage endplate compared with the control group.

CONCLUSIONS

Prolonged uncontrolled hyperglycaemia may contribute to lumbar disc degeneration, fatty infiltration of the paraspinal muscles in the lower lumbar segments, and increased incidence of endplate cartilage pathological changes in patients with degenerative disc disease.

摘要

目的

本研究旨在分析糖尿病（DM）对磁共振成像（MRI）椎间盘和椎旁肌肉影像学改变的影响，以探讨 DM 对脊柱退变的影响。

方法

本回顾性研究最初纳入了 262 例 2020 年 1 月至 2021 年 12 月因腰椎间盘突出症接受治疗的患者。其中 98 例为 2 型糖尿病（T2DM）患者，患病时间超过 5 年，这些患者血糖控制较差（糖化血红蛋白（HbA1c）≥6.5%；BMI：26.28±3.60；HbA1c：7.5，IQR=1.3），归为观察组。另 164 例无 T2DM 的患者归为对照组。收集并分析的数据包括性别、年龄、吸烟、饮酒、病程、Charlson 合并症指数、BMI 以及影像学参数，包括椎间盘高度、改良 Pfirrmann 分级评分、椎旁肌肉脂肪浸润面积百分比和终板病理变化。

结果

经过倾向评分匹配分析，消除了对照组和 T2DM 组一般资料的差异，共分析了 186 例患者。改良 Pfirrmann 分级评分显示各腰椎节段存在统计学差异，提示 T2DM 组各 L1-S1 节段椎间盘退变程度较对照组更为严重。L1/2 至 L5/S1 椎间盘高度两组间无统计学差异。与 T2DM 组相比，对照组 L4/5 和 L5/S1 椎旁肌肉的脂肪浸润面积百分比较低，而 L1/2 至 L3/4 节段无统计学差异。T2DM 组终板软骨病理变化较对照组多见。