腰背痛的相关危险因素研究

Study on risk factors related to lower back pain

关键词: 腰背痛(LBP)  病例-对照研究  危险因素  交互作用

Keywords: low back pain (LBP)  case-control study  risk factors  interaction

摘 要: 目的 探讨腰背痛(low back pain, LBP)发生的危险因素,分析职业因素和生活因素之间的交互作用,为 LBP 的预防与控制提供科学依据。方法 采用病例-对照研究方法,通过问卷调查,收集两组患者的个体、职业、生活及社会心理因素等信息,通过单因素和多因素 logistic 回归分析,探讨发生 LBP 的独立危险因素, 采用相乘和相加交互作用模型对多因素分析筛选出的职业及生活因素进行交互作用分析。结果 本次调查共纳入病例组和对照组各 601 例,平均年龄分别为病例组(49.19±13.53)岁、对照组(48.05±13.47)岁。多因素 logistic 回归分析结果显示,职业因素中经常/频繁长时间坐姿工作、经常/频繁以不舒服的姿势工作、背部弯曲、工作压力、无充分工间休息、单调工作、自己无法控制工作进度是 LBP 的危险因素;经常/频繁多次重复性操作、经常/频繁使用振动工具是 LBP 的保护因素。职业因素与生活因素间的交互作用分析结果显示, 以不舒服的姿势工作与业余时间经常使用电脑(OR=2.317, 95%CI:1.121~4.788)、以不舒服的姿势工作与经常做家务(OR=2.672,95%CI:1.405~5.080)对 LBP 的发生存在相乘交互作用;长时间坐姿工作与业余时间经常使用电脑(RERI=2.943, 95%CI:0.841~5.045)、长时间坐姿工作与经常做家务(RERI=2.009,95%CI:0.137~3.881)、以不舒服姿势工作与经常做家务(RERI=4.757,95%CI:2.779~6.734)对 LBP 的发生风险存在相加交互作用。结论 LBP 的发生与个体、职业、生活和社会心理等综合因素相关,职业因素和生活因素对 LBP 的发生存在叠加效应。

Abstract: Objective To explore the risk factors of low back pain (LBP), analyze the interaction between occupational and lifestyle factors, thereby provide a scientific basis for the prevention and control of LBP. Methods Using a case-control study method, a questionnaire survey was conducted to collect information on individual, occupational, lifestyle and psychosocial factors of two groups of the subjects, through univariate and multivariate logistic regression analyses to explore the independent risk factors of LBP, and use multiplication and addition interaction models to analyze the interaction between occupational and lifestyle factors. Results The results showed that this survey included 601 cases both in case group and control group, with an average age 49. 19±13. 53 years (case group)and 48.05±13.47 years (control group), respectively. The multivariate conditional logistic regression analysis showed that among occupational factors, frequently working in a sitting posture, often/frequently working in an uncomfortable position, bent back posture, work pressure, lack of sufficient rest breaks, monotonous work, and inability to control own work progress were the risk factors of LBP; while the often/frequently repetitive operations and the use of vibration tools during often/frequently work were the protective factors for LBP. The results of interaction analysis between occupational factors and life factors showed that working in an uncomfortable posture and using computer in spare time (OR=2.317, 95% CI:1.121—4.788), working in an uncomfortable posture and often doing housework (OR=2.672, 95% CI:1.405—5.080)had a multiplication interaction with the occurrence of LBP; long term sitting work and frequent use of computer in spare time (RERI=2.943, 95%CI:0.841—5.045), long term sitting work and often doing housework (RERI=2.009, 95%CI:0.137—3.881), and working in uncomfortable postures and often doing housework (RERI=4.757, 95% CI:2.779—6.734) showed an additive interactive effect on the risk of LBP. Conclusion The results suggested that the occurrence of LBP was related to a combination of individual, occupational, lifestyle and psychosocial factors, and there was a superimposed effect of occupational and lifestyle factors on the occurrence of LBP.