骶髂关节CT不同分级标准在强直性脊柱炎诊断和随访中应用价值的比较  

Comparative study of different grading criteria of sacroiliac joint computed tomogrphy in ankylosing spondylitis

作　　者：高岱[1] 李坤鹏[1] 文琼芳 朱剑[1] 张江林[1] 黄烽[1] 

机构地区：[1]解放军总医院风湿病科,北京100853

出　　处：《中华医学杂志》2016年第39期3137-3141,共5页National Medical Journal of China

基　　金：国家科技部“十二五”支撑计划（2014BA107805）;国家“973”重点基础研究发展规划项目（2014CB541806）

摘　　要：目的 通过对比不同骶髂关节CT分级标准评价骶髂关节炎的差异,分析各标准在强直性脊柱炎（AS）诊断及随访中的应用价值.方法 纳入解放军总医院数据库2012年6月至2015年12月间的骶髂关节CT影像,采集临床资料并阅片.先后应用骶髂关节病变性质评价及1984年修订的AS纽约分类标准骶髂关节炎X线分级标准（NY标准）、Lee等制订的骶髂关节炎螺旋CT分级标准（Lee标准）和因斯布鲁克骶髂关节炎高分辨率CT分级标准（Innsbruck标准）进行评价,比较各标准间的分级差异.结果 纳入2 714例患者,其中509例可见骶髂关节异常.在509例患者的1 018例关节中,NY标准和Lee标准的评价一致性较高（k=0.767,P＜0.01）,Innsbruck标准与另外两种标准间的评价相关性较好（r值分别为0.866和0.839,P＜0.01）;Lee标准特异性较高,45例NY标准1～3级关节Lee标准评价0级;Innsbruck标准区分度较好,Ⅱ（A）级到Ⅳ（A）级关节各有109例（10.71％）、91例（8.94％）、273例（26.82％）、213例（20.92％）和103例（10.12％）,而另2种标准3级关节各有620例（60.90％）和656例（64.44％）.结论 Lee标准可提高诊断特异度、降低分级难度,有利于AS早期诊断;Innsbruck标准分级更细致且符合AS骶髂关节炎发展规律,有利于临床随访.但已有标准均存在不足,仍需积极探索以制定更切合临床需求的分级评价标准.Objective To assess the value of different grading criteria of sacroiliac joint （SIJ） computed tomogrphy （CT） in ankylosing spondylitis （AS）.Methods Patients who had received SIJ CT examinations from June 2012 to December 2015 were enrolled.The CT scans were read by one rheumatologist.The difference between patients with sacroiliitis or without sacroiliitis was compared.The 1984 revision of modified New York （mNY） criteria,the criteria established by Lee （Lee criteria） and the Innsbruck criteria were used to evaluate SIJs on CT in patients with sacroiliitis.Results Totally 2 714 patients were enrolled in this study.Thereinto 509 patients including 324 male and 185 female were detected with SIJs abnormality.The proportions of SIJs graded 3 or 4 by these three criteria were 79.37%,82.91% and 76.32%,respectively.The consistency of grading between mNY criteria and Lee criteria was good （k =0.767,P 〈0.01）.The correlation between Innsbruck criteria and other two criteria were satisfactory （r =0.866 and 0.839,respectively）.There were more SIJs graded 3 by Lee criteria （64.44%）,comparing with mNY criteria （60.90%）.Forty five SIJs graded 1-3 by mNY criteria were graded 0 by Lee criteria,indicating that the latter criteria may have a better specificity.When evaluating the severity of SIJs,Innsbruck criteria has a better discrimination capability and the proportions of SIJs graded Ⅱ （A） to Ⅳ （B）were 10.71%,8.94%,26.82%,20.92%,10.12%,respectively.Conclusions Lee criteria has a better diagnostic specificity with a reduction of difficulty in assessing procedure,while Innsbruck criteria is a more detailed grading system with a possibility to reflect the development of sacroiliitis.

关 键 词：强直性脊柱炎 骶髂关节 体层摄影术 X线计算机 

分 类 号：R593.23[医药卫生—内科学]