背景:磁共振成像(MRI)检测到的腰椎间盘退变(LDD)与LBP之间的关联通常不大。这种关联在特定患者亚组中可能更大。
目的:研究LDD和LBP之间的关联是否因潜在的遗传易感性而改变。
方法:英国生物银行(UKB)和TwinsUK的横断面研究。
方法:在347,538名UKB参与者中进行了解剖学慢性疼痛位置的全基因组关联研究(GWAS)。GWAS用于在30,000UKB参与者的保留样本中开发全基因组多基因风险评分(PRS)。然后将PRS模型用于对645名TwinsUK参与者进行标准化LDDMRI评估的分析。
方法:曾有LBP伴残疾持续≥1个月(LBP1)。
方法:使用PRS作为“遗传预测的疼痛倾向”的代理,我们将TwinsUK参与者分为PRS四分位数.“基本”模型检查了LDD汇总评分(LSUM)和LBP1之间的关联,并针对协变量进行了调整。“完全调整”模型还针对PRS四分位数和LSUMxPRS四分位数相互作用项进行了调整。
结果:在基本模型中,LBP1的比值比(OR)为1.8/LSUM的标准差(95%置信区间[CI]1.4-2.3).在完全调整的模型中,四分位数4中LSUM-LBP1的关联具有统计学意义(OR=2.5[95%CI1.7-3.7],p=2.6×10-6),在四分位数3中(OR=2.0,[95%CI1.3-3.0];p=0.002),在最低的两个PRS四分位数中具有小幅度和/或不显着的关联。PRS四分位数是LSUM-LBP1关联的显着影响修饰符(相互作用p≤0.05)。
结论:遗传预测的疼痛倾向改变了LDD-LBP关联,在遗传倾向于疼痛的人中存在最强的关联。在特定的人群亚组中,腰椎MRI发现可能与LBP有更强的联系。
BACKGROUND: Associations between magnetic resonance imaging (MRI)-detected lumbar intervertebral disc degeneration (LDD) and LBP are often of modest magnitude. This association may be larger in specific patient subgroups.
OBJECTIVE: To examine whether the association between LDD and LBP is modified by underlying genetic predispositions to pain.
METHODS: Cross-sectional study in UK Biobank (UKB) and TwinsUK.
METHODS: A genome-wide association study (GWAS) of the number of anatomical chronic pain locations was conducted in 347,538 UKB participants. The GWAS was used to develop a genome-wide polygenic risk score (PRS) in a holdout sample of 30,000 UKB participants. The PRS model was then used in analyses of 645 TwinsUK participants with standardized LDD MRI assessments.
METHODS: Ever having had LBP associated with disability lasting ≥1 month (LBP1).
METHODS: Using the PRS as a proxy for \"genetically-predicted propensity to pain\", we stratified TwinsUK participants into PRS quartiles. A \"basic\" model examined the association between an LDD summary score (LSUM) and LBP1, adjusting for covariates. A \"fully-adjusted\" model also adjusted for PRS quartile and LSUM x PRS quartile interaction terms.
RESULTS: In the basic model, the odds ratio (OR) of LBP1 was 1.8 per standard deviation of LSUM (95% confidence interval [CI] 1.4 -2.3). In the fully-adjusted model, there was a statistically significant LSUM-LBP1 association in quartile 4, the highest PRS quartile (OR = 2.5 [95% CI 1.7-3.7], p=2.6×10-6), and in quartile 3 (OR=2.0, [95% CI 1.3-3.0]; p=0.002), with small-magnitude and/or non-significant associations in the lowest two PRS quartiles. PRS quartile was a significant effect modifier of the LSUM-LBP1 association (interaction p≤0.05).
CONCLUSIONS: Genetically-predicted propensity to pain modifies the LDD-LBP association, with the strongest association present in people with the highest genetic propensity to pain. Lumbar MRI findings may have stronger connections to LBP in specific subgroups of people.