| Part Ⅰ Preliminary analysis of the correlation between the Pfirrmann grading,T2 value of intervertebral disc degeneration and the curative effect of acupuncture treatment of lumbar disc herniationObjective:To evaluate the Pfirrmann grade of intervertebral disc degeneration(referred to as Pfirrmann grading)of lumbar intervertebral disc herniation(LDH)cases,compare the T2 value of intervertebral disc nucleus pulposus measured before treatment,compare the clinical efficacy of herniated intervertebral disc after acupuncture treatment[Pfirrmann grade(III-V)cases],and analyze the correlation between T2 value of nucleus pulposus before treatment,T2 value difference of nucleus pulposus and protruding part before and after acupuncture treatment and clinical curative effect,finally to preliminarily explore the significance ofT2 value in the evaluation of curative effect of acupuncture treatment of LDH.Materials and Methods:Data collection:The patients who came to Kunshan traditional Chinese medicine hospital for diagnosis and treatment due to low back pain from October 2019 to September 2020and met the inclusion criteria of this study were collected.All included cases underwent lumbar MRI(plain scan+T2 mapping sequence),evaluated the low back pain scale[Japanese Orthopaedic Association scores(JOA score),Oswestry disability index(ODI score)],and began acupuncture treatment(20 times of acupuncture in a course of treatment,3 times/week)within 5 days after lumbar MRI.After treatment,the curative effect was evaluated(JOA score improvement rate before and after treatment,referred to as JOA improvement rate;ODI score difference before and after treatment,referred to as ODI difference),and recheck lumbar MRI within 5 days after a course of acupuncture treatment.On the MR images of the lumbar spine before treatment,the intervertebral discs(L3/4,L4/5 and L5/S1)were graded by Pfirrmann.According to whether the intervertebral disc was protruded,they were divided into non protrusion group and protrusion group.The T2 values of intervertebral disc nucleus pulposus in the two groups and the T2 values of intervertebral disc protrusion in the protrusion group were measured before acupuncture treatment;the T2 values of nucleus pulposus and protrusion of intervertebral disc in the protrusion group after acupuncture treatment were measured,and the T2 value difference between the two before and after treatment was calculated.Statistical analysis:1.The comparative analysis of T2 value of intervertebral disc nucleus pulposus between non protrusion group and protrusion group before acupuncture treatment was statistically significant(P<0.05)1.1.Using one-way ANOVA:①the difference of T2 value between Pfirrmann Ⅰ-Ⅳintervertebral disc nucleus pulposus in non protrusion group before treatment;②The difference of T2 value between Pfirrmann grade Ⅲ-Ⅴ intervertebral disc nucleus pulposus in protrusion group before treatment.1.2 t-test was used to compare the T2 values of Pfirrmann grade Ⅲ and Ⅳ intervertebral disc nucleus pulposus between non protrusion and protrusion groups before treatment.2.The difference of JOA improvement rate between Pfirrmann Ⅲ,Ⅳ and Ⅴ in the protrusion group was analyzed by H-Test(P<0.05)3.Correlation analysisSpearman test was used to analyze:① the correlation between T2 value of intervertebral disc nucleus pulposus and JOA improvement rate before treatment in protrusion group;②the correlation between T2 value of intervertebral disc nucleus pulposus and JOA improvement rate before treatment in non protrusion group;③the correlation between T2 value difference of intervertebral disc nucleus pulposus before and after treatment,JOA improvement rate and ODI difference in protrusion group;④the correlation between T2 value difference of intervertebral disc herniation before and after treatment,JOA improvement rate and ODI difference in protrusion group.Correlation analysis reference standard(r value):|r|>0.8,showing high correlation;0.5<|r|≤0.8,showing moderate correlation;0.3<|r|≤0.5,showing low correlation;|r|≤0.3,there is no linear correlation.Results:1.1 Before treatment,there was significant difference in T2 value of Pfirrmann Ⅰ-Ⅳintervertebral disc nucleus pulposus in non protrusion group(F=170.690,P<0.001);There was significant difference in T2 value of intervertebral disc nucleus pulposus between Pfirrmann grade Ⅲ,Ⅳ and Ⅴ in protrusion group before treatment(F=42.677,P<0.001).1.2 Before treatment,there was significant difference in T2 value of Pfirrmann Ⅲintervertebral disc nucleus pulposus between non protrusion and protrusion groups(t=-3.751,P<0.001);before treatment,there was no significant difference in T2 value between non protrusion and protrusion groups(t=-0.551,P=0.584).2 There was significant difference in JOA improvement rate between Pfirrmann gradeⅢ,Ⅳ and Ⅴ in the protrusion group(H=22.087,P<0.001).3.1There was a moderate correlation between T2 value of intervertebral disc nucleus pulposus and JOA improvement rate in protrusion group before treatment(r=0.697).3.2 There was no correlation between T2 value of intervertebral disc nucleus pulposus and JOA improvement rate in non protrusion group before treatment(r=0.157).3.3 There was a moderate correlation between T2 value difference of intervertebral disc nucleus pulposus and JOA improvement rate and ODI difference in protrusion group before and after treatment(r=0.661,r=0.575).3.4 There was a low correlation between the T2 value difference of intervertebral disc herniation and JOA improvement rate and ODI difference in protrusion group before and after treatment(r=0.413,r=0.406)Conclusions:There is a certain correlation between the T2 value of intervertebral disc nucleus pulposus measured by T2 mapping technology and the clinical efficacy of LDH acupuncture treatment,which has a certain clinical reference value in the efficacy evaluation of LDH acupuncture treatment after one course of treatment,T2 value is expected to become a potential quantitative evaluation index of clinical efficacy of LDH acupuncture.Part Ⅱ The Value of T2 value of lumbar intervertebral disc nucleus pulposus in predicting the curative effect of LDH acupuncture treatmentObjective:Through the univariate and multivariate analysis of the observation indexes of LDH cases,the statistically significant observation indexes were obtained.The area under the ROC curve was used to analyze the efficacy prediction efficiency of the above observation indexes after one course of LDH acupuncture treatment and half a year later,and to explore the value of T2 value of herniated intervertebral disc nucleus pulposus and other observation indexes in the efficacy prediction of LDH acupuncture treatment.Materials and Methods:Data collection:The enrolled cases were the same as the first part.After a course of acupuncture treatment and after half a year,the curative effect of the enrolled cases was evaluated,and they were divided into effective group and ineffective group according to the curative effect.Outcome measures:Gender,age,course of disease,previous history of intervertebral disc herniation,with intervertebral disc herniation,nerve root compression,clinical classification of intervertebral disc herniation(referred to as clinical classification),intervertebral disc herniation segment(referred to as herniated segment),T2 value of herniated intervertebral disc nucleus pulposus before treatment(referred to as T2 value),area of intervertebral disc herniation(referred to as herniated area).The nerve root compression,clinical classification,T2 value and herniated area were independently evaluated and measured by two attending physicians(more than 10 years of diagnostic experience).Statistical analysis:1.Predictive analysis of curative effect after one course of LDH acupuncture treatment:Kappa consistency analysis was used to test the consistency of two doctors’ evaluation results of nerve root compression and clinical classification;Intraclass correlation coefficient(ICC)was used to test the consistency of T2 value and protrusion area measured by the two doctors.Reference standard for consistency analysis:0～0.20,poor consistency;0.21～0.40,with weak consistency;0.41～0.60 medium consistency;0.61～0.80,with strong consistency;0.81～1.00,highly consistent.The t-test and U-test were used to analyze the observation indexes of effective group and ineffective group of acupuncture treatment,and the statistical significance observation indexes were obtained by logistic regression analysis.The area under ROC curve was used to analyze the diagnostic efficacy of the above observation indexes alone and combined in the prediction of curative effect after one course of LDH acupuncture treatment.2.Predictive analysis of curative effect of LDH acupuncture treatment after half a year:The observation indexes and analysis methods were the same as the prediction and analysis of the curative effect after one course of acupuncture treatment.Results:1.Predictive analysis of curative effect after one course of LDH acupuncture treatment:Consistency analysis:the kappa value of the evaluation results of nerve root compression of the two doctors was 0.89,with good consistency;the kappa value of the clinical classification evaluation results of the two doctors was 0.90,with good consistency;the ICC value of the measurement results of herniated area of the two doctors was 0.99,with good consistency;the ICC value of T2 measured by the two doctors was 0.93,with good consistency.Univariate analysis:there were significant differences in age,previous history of disc herniation,with disc herniation,nerve root compression,protruding segment,T2 value and herniated area between the effective group and the ineffective group(P<0.05).Multivariate analysis:the differences of age,T2 value,herniated area and protruding segment between effective group and ineffective group were statistically significant(P<0.05).The diagnostic efficacy of efficacy prediction of single observation index:①The area under ROC curve(AUC)of age was 0.706,P=0.002;②AUC value of herniated area is 0.649,P=0.027;③AUC value of protruding segment is 0.658,P=0.019;④AUC value of T2 value is 0.882,P<0.001.The combined diagnostic efficacy of outcome measures:①age+herniated area+protruding segment:AUC=0.836,P<0.001;②age+T2 value+herniated area:AUC=0.950,P<0.001;③T2 value+herniatedarea+protruding segment:AUC=0.939,P<0.001;④age+T2 value+protruding segment:AUC=0.932,P<0.001.2.Predictive analysis of curative effect of LDH acupuncture treatment after half a year:Consistency analysis:the kappa value of the evaluation results of nerve root compression of the two doctors was 0.88,with good consistency;the kappa value of the clinical classification evaluation results of the two doctors was 0.91,with good consistency;the ICC value of the measurement results of the herniated area of the two doctors was 0.99,with good consistency;the ICC value of T2 measured by the two doctors was 0.99,with good consistency.Univariate analysis:there were significant differences in age,previous history of disc herniation,with disc herniation and T2 between the effective group and the ineffective group(P<0.05)Multivariate analysis:the difference of T2 value between effective group and ineffective group was statistically significant(P=0.022).Diagnostic efficacy of efficacy prediction of single observation index:the AUC value ofT2 value is 0.933,P<0.001.Conclusions:The T2 value of herniated intervertebral disc nucleus pulposus before treatment measured by T2 mapping technology has certain clinical value in the prediction of the therapeutic effect of acupuncture treatment of LDH cases after one course of treatment and half a year,to provide auxiliary diagnostic indexes with certain reference value for the selection of conservative treatment of LDH. |
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