脊柱关节病骶髂关节的病理表现  

Pathological manifestation of sacroiliitis in spondyloarthropathies

作　　者：王庆文[1] 曾庆馀[1] 吴名耀[2] 陈肃标[1] 蓝辉耀[3] 

机构地区：[1]汕头大学医学院风湿病研究室,515031 [2]汕头大学医学院病理教研室,515031 [3]香港大学医学院

出　　处：《中华风湿病学杂志》2001年第6期358-362,T002,共6页Chinese Journal of Rheumatology

基　　金：广东省医学科研基金资助项目 ( 2 0 0 0 10 0 )

摘　　要：目的　了解不同阶段骶髂关节 (SIJ)炎的病理变化 ,提高脊柱关节病 (SpA)的早期诊断水平。方法　 8例强直性脊柱炎 (AS)及 5例未分化脊柱关节病 (uSpA)患者行CT导引下SIJ关节内激素治疗前 ,先取SIJ组织。所得标本行HE染色 ,普通光学显微镜观察。结果　CT 0～Ⅰ级SIJ炎的uSpA病人 ,SIJ可见滑膜炎症 (包括衬里层细胞肥大增生、疏松结缔组织炎症细胞浸润 ) ,局灶性软骨基质减少、变性、纤维化 ,软骨下骨板炎症细胞浸润。CTⅡ～Ⅲ级SIJ炎病理变化主要为软骨严重变性、破坏 ,血管翳形成 ,大量炎症细胞浸润 ,软骨下骨板破坏 ;CTⅣ级SIJ炎的病理改变则以软骨下骨板破坏 ,大量死骨形成 ,钙盐沉着为主要特点。 3份标本的滑膜和软骨下骨板可见嗜酸性粒细胞(EO)比例增高。结论　滑膜衬里细胞肥大增生、疏松结缔组织炎症细胞浸润等滑膜炎表现 ,局灶性软骨基质减少、变性、纤维化和软骨下骨板炎症细胞浸润、破坏 ,是早期SIJ炎的病理特点 ;在CT未出现改变以前 ,病理学检查有助于早期诊断。Objective To study pathological feature of sacroiliitis of spondyloarthropathies (SpA) in different stages,and improve the threshold of early diagnosis of SpA.Method Samples of sacroiliac joints (SIJ) of 8 patients with ankylosing spondylitis (AS) and 5 patients with undifferential spondyloarthropathies (uSpA) were taken when SIJ steroid injection was performed.The pathological feature was studied.Results Synovitis,including lining cell hyperplasia and inflammatory cell infiltration in looseconnective tissue,local cartilage degeneration,fibrosis and inflammatory cell infiltration in subchondral bony plate and marrow cave were found in 6 (86%,6/7) samples in patients with normal/suspectable SIJ CT scan.In the CT Ⅱ and Ⅲ degree sacroiliitis,marked degeneration and fibrosis of cartilage,inflammatory cell infiltration,pannus formation and subchondral bony plate destruction were increasingly prominent.In the advanced sacroiliitis (CT Ⅳ degree),destruction and calcification of cartilage and subchondral bony plate were the major feature.Eosinopil (EO) was increased in the infiltration cells of synovium and subchrodral bony plate in 3 samples.Conclusion Synovitis,including hyperplasia of lining cell and the infiltration of inflammatory cell in loose connective tissue,and local cartilage degeneration and inflammatory cell infiltration,and destruction of subchondral bony plate are the early changes identified in sacroiliitis.Pathological examination can improve the threshold of early diagnosis of sacroiliitis in case it cannot be confirmed with CT scan.

关 键 词：脊柱疾病 骶髂关节 关节炎 病理学 SIJ SPA AS 强直性脊柱炎 

分 类 号：R593.23[医药卫生—内科学]