CAJ | 학술논문

目的：系统评价腰椎间盘MRI高信号区（HIZ）与椎间盘造影阳性的相关性。方法：计算机检索1973年1月~2013年4月MEDLINE、EMBASE、Cochrane CENTRAL（First Quarter 2013）、ScienceDirect、OVID、Springer-Link、中国生物医学文献数据库。纳入文献为腰痛患者接受腰椎MRI和椎间盘造影检查、并对MRI所观察到的HIZ与椎间盘造影检查椎间盘形态学变化和疼痛复制现象进行相关性比较的临床观察性研究，筛选出符合纳入标准的文献，评价纳入研究的方法学质量。利用RevMan 5.1.1（下载于Cochrane Library）对提取数据进行Meta分析。结果：经过筛选，11篇文献符合纳入标准。Meta分析结果显示：HIZ阳性与椎间盘造影中椎间盘形态不正常存在显著相关性，有统计学意义[OR=47.79，95%CI（17.07，133.77），P<0.00001]；HIZ阳性的椎间盘在造影中产生一致性疼痛的发生率（79%，309/393）高，与HIZ 阴性（29%，237/805）比较有统计学差异[OR=8.65，95%CI （4.92，15.23），P<0.00001]；HIZ 阳性且椎间盘形态异常的节段产生一致性疼痛的发生率高（90%，211/235），与HIZ阴性（34%，87/257）比较有统计学差异[OR=8.65，95%CI（4.92，15.23），P=0.007]。结论：腰椎间盘MRI HIZ的出现预示着椎间盘形态的异常，HIZ阳性与椎间盘造影疼痛复制之间存在明显的相关性，HIZ可作为临床责任间隙判断及椎间盘源性腰痛诊断的一个有效指标。
목적：계통평개요추간반MRI고신호구（HIZ）여추간반조영양성적상관성。방법：계산궤검색1973년1월~2013년4월MEDLINE、EMBASE、Cochrane CENTRAL（First Quarter 2013）、ScienceDirect、OVID、Springer-Link、중국생물의학문헌수거고。납입문헌위요통환자접수요추MRI화추간반조영검사、병대MRI소관찰도적HIZ여추간반조영검사추간반형태학변화화동통복제현상진행상관성비교적림상관찰성연구，사선출부합납입표준적문헌，평개납입연구적방법학질량。이용RevMan 5.1.1（하재우Cochrane Library）대제취수거진행Meta분석。결과：경과사선，11편문헌부합납입표준。Meta분석결과현시：HIZ양성여추간반조영중추간반형태불정상존재현저상관성，유통계학의의[OR=47.79，95%CI（17.07，133.77），P<0.00001]；HIZ양성적추간반재조영중산생일치성동통적발생솔（79%，309/393）고，여HIZ 음성（29%，237/805）비교유통계학차이[OR=8.65，95%CI （4.92，15.23），P<0.00001]；HIZ 양성차추간반형태이상적절단산생일치성동통적발생솔고（90%，211/235），여HIZ음성（34%，87/257）비교유통계학차이[OR=8.65，95%CI（4.92，15.23），P=0.007]。결론：요추간반MRI HIZ적출현예시착추간반형태적이상，HIZ양성여추간반조영동통복제지간존재명현적상관성，HIZ가작위림상책임간극판단급추간반원성요통진단적일개유효지표。
Objectives: To assess the correlation between high intensity zone (HIZ) of lumbar MRI and discography. Methods: A computer-based online search of Medline, EMBASE, Cochrane CENTRAL (1st Quarter 2013), ScienceDirect, OVID, SpringerLink and The China Biological Medicine Database (from January 1973 to April 2013). The included trials were lumbar pain patient undergoing discography and MRI, and the correlation between HIZ and discography positive was observed. The literature was screened out according to the included standard. The quality of included trials was evaluated. RevMan 5.1.1 was used for data analysis. Results: Eleven studies were included. The results of Meta-analysis indicated that outstanding relativity and statistically significant difference were observed between HIZ and abnormal morphology of disc [OR=47.79, 95%CI(17.07, 133.77), P<0.00001], HIZ and pain reproduction[OR=8.65, 95%CI(4.92, 15.23),P<0.00001], HIZ and abnormal morphology pain reproduction [OR=8.65, 95%CI (4.92, 15.23), P=0.007]. Conclusions: The oc-curence of HIZ on lumbar MRI T2-weighted image indicates abnormal morphology of the disc. There is obvi-ous relationship between HIZ and pain reproduction. HIZ can be a very effective index to determine respon-sible level discogenic low back pain.