强直性脊柱炎应用生物制剂联合来氟米特治疗前后的影像学变化研究  

Study on the Imaging Changes of Ankylosing Spondylitis Before and After Treatment of Biologics Combined with Leflunomide

作　　者：丁勇[1] 张佳楠 林华波[1] 孟宪志[1] 韩新勇 DING Yong;ZHANG Jia-nan;LIN Hua-bo(department of Orthopedics,the Sixth People＇s Hospital of Anyang City,Anyang 455000,Henan Province,China)

机构地区：[1]河南省安阳市第六人民医院骨科,河南安阳455000 [2]河南省安阳市第六人民医院影像科,河南安阳455000

出　　处：《中国CT和MRI杂志》2018年第5期137-139,152,共4页Chinese Journal of CT and MRI

摘　　要：目的分析强直性脊柱炎(AS)应用生物制剂联合来氟米特治疗前后的影像学变化。方法选取2015年10月至2016年9月我科门诊及病房的30例活动性AS患者为研究对象,均给予应用生物制剂联合来氟米特治疗,治疗前及治疗半年后进行MRI检查,并对比MRI表现与临床疗效判定结果,分析MRI的评估价值。结果30例强直性脊柱炎患者治疗前MRI表现为关节间隙积液(86.67%),关节旁骨髓水肿(73.33%),软骨破坏(53.33%),骨髓脂肪沉积(46.67%);治疗后复查MRI表现为关节间隙积液消失(20.00%)、减少(43.33%),骨髓水肿程度减轻(53.33%),骨髓脂肪沉积显著减少(33.33%),同时软骨破坏改变不明显,软骨破坏不同程度加重(13.33%)。MRI扫描检查评定治疗疗效的敏感度、特异度、准确度依次为95.83%、66.67%、90.00%,诊断一致性检验K=0.83,P<0.05,即MRI影像学疗效判定与临床疗效判定具有一致性。结论生物制剂联合来氟米特治疗AS疗效确切,MRI可清晰显示治疗前后关节病变情况,评估治疗疗效,可满足随访复查需要。Objective To analyze the imaging changes of ankylosing spondylitis（AS） before and after the treatment of biologics combined with leflunomide. Methods A total of 30 cases of patients with active AS from October 2015 to September 2016 in our outpatient department and ward were selected and all given the treatment of biologics combined with leflunomide. The clinical and MRI follow-up review were performed before and after treatment for six months.The results of MRI and clinical efficacy were compared and the evaluation value of MRI was analyzed. Results The MR imaging features of 30 cases of ankylosing spondylitis before treatment is joint effusion（accounting for 86.67%）, bone marrow edema（accounting for 73.33%）, cartilage destruction（accounting for 53.33%）, bone marrow fat deposition（accounting for 46.67%）. After treatment, the MRI showed sacroiliac joint space effusion disappeared（20.00%） or reduction（43.33%）, the degree and depth of bone edema with 53.33% reduction, the bone marrow fat deposition with 33.33% obvious decrease, the cartilage destruction with 16.67% unconspicuous changes, the cartilage damage of varying degrees with 13.33% increase. The sensitivity, specificity and accuracy of curative efficacy assessed by MRI scan were 95.83%, 66.67% and 90.00% respectively. The diagnostic consistency test was K=0.83, P〈0.05, that is, the MRI imaging evaluation of clinical efficacy and clinical curative effect is consistent with each other. Conclusion Biologics combined with leflunomide are effective in the treatment of AS. MRI can clearly show the condition of joint lesions before and after treatment, and evaluate the therapeutic effect, which can meet the needs of follow-up review.

关 键 词：强直性脊柱炎 生物制剂 来氟米特 MRI 影像学 

分 类 号：R593.23[医药卫生—内科学] R445.2[医药卫生—临床医学]