骶髂关节磁共振炎症评分及骶髂关节结构损伤评分在活动期中轴型脊柱关节炎病情评估中的价值  

The value of the spondyloarthritis research consortium of ceanada magnetic resonance imaging sacr-oiliac joint inflammation score and structural score in evaluating the activity of axial spondyloarthritis

作　　者：黄志坚[1] 米存东[1] 杜昱 刘博[1] 廖键侥 刘敏[1] 梁彬彬[1] 邓艳琳[1] 卢炳丰[2] 戴旖[2] Huang Zhijian;Mi Cundong;Du Yu;Liu Bo;Liao Jianyao;Liu Ming;Liang Binbin;Deng Yanlin;Lu Bingfeng;Dai Yi(Department of Rheumatology and Immunology, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China;Department of Radiology, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China)

机构地区：[1]广西医科大学第二附属医院风湿免疫科,南宁530007 [2]广西医科大学第二附属医院放射科,南宁530007

出　　处：《中华风湿病学杂志》2019年第9期612-616,I0002,共6页Chinese Journal of Rheumatology

基　　金：广西医药卫生自筹经费计划(Z20170085).

摘　　要：目的观察治疗前后活动期中轴型脊柱关节炎(axSpA)患者的骶髂关节MRI加拿大脊柱关节炎研究协会(SPARCC)骶髂关节炎症评分(SPARCC评分)及骶髂关节结构损伤评分(SSS)与BASDAI、基于CRP计算的强直性脊柱炎疾病活动评分(ASDAS-CRP)、BASFI、强直性脊柱炎测量指数(BASMI)、CRP、ESR等临床指标的关系,探讨2种评分方法对病情评估的价值。方法按入组标准纳入活动期axSpA患者24例,均予重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(rhTNFR:Fc)联合柳氮磺吡啶及沙利度胺治疗12周。第0、12周记录磁共振SPARCC评分及SSS评分,计量BASDAI、ASDAS-CRP、BASFI、BASMI评分、ESR及CRP的值,分析治疗前后SPARCC评分/SSS评分与诸临床指标之间的关系。统计学分析采用配对样本t检验、Wilcoxon符号秩和检验、Spearman相关分析及Pearson相关分析,并用受试者工作特征曲线(ROC)评估SPARCC评分下降值作为治疗产生应答的效能。结果①与治疗前相比,治疗第12周时患者SPARCC评分[(15±4)与(33±10)]、BASDAI[(3.2±0.9)与(5.2±1.1)]、BASFI[(2.3±0.6)与(4.6±1.0)]、BASMI[(2.3±0.7)与(4.1±1.1)]、ASDAS-CRP评分[(2.0±0.8)与(3.7±0.9)]、ESR[(16±12)mm/1 h与(49±26)mm/1 h]、CRP[(7.2±2.8)mg/L与(30.4±19.3)mg/L]均明显下降,差异有统计学意义(t值分别为7.822、6.950、10.707、7.204、6.281、-4.015及-4.257,P均<0.01);SSS评分在治疗12周后[(20±6)与(19±7)]差异无统计学意义(t=-0.761,P=0.455)。②治疗前SPARCC评分与同期BASDAI(r=0.630,P=0.001)、ASDAS-CRP(r=0.646,P=0.001)、CRP(r=0.574,P=0.003)、ESR(r=0.559,P=0.004)存在线性正相关,治疗后上述指标的相关性消失(P>0.05);SSS评分与上述指标在治疗前后均无相关性(P>0.05)。③受试者工作特征曲线分析显示,以SPARCC评分差值评定治疗有应答的ROC曲线下面积(AUC)为0.797,Youden指数最大时的截断值为20.5,其敏感度为68.8%,特异度为75.0%。结论骶髂关节SPARCC评分对疾病活动度及疗�Objective To analyze the correlation between the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint inflammation score (SPARCC score)/structural score (SSS) and the disease activity as well as the functional indexs. The correlation between the MRI score and inflammatory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] in patients with active axial spondyloarthritis (axSpA) before and after treatment was explored. In addition, the contribution of the two MRI scoring method in evaluating conditions was also explored. Methods According to the inclusion criteria, 24 patients with active axial SpA were recruited and received the recombinant hauman tumor necrosis factor (TNF)-α receptor Ⅱ: IgG Fc fusion protein(rhTNFR:Fc), sulfasalazine and thalidomide for 12 weeks. Subjects were scored at week 0 and 12 by SPARCC/SSS scores. Bath ankylosing spondylitis disease activity index (BASDAI), Assessment of Spondyloarthritis International Society (ASAS)-endorsed disease activity score(ASDAS)-CRP, bath ankylosing spondylitis functional index (BASFI). Bath ankylosing spondylitis metrology index(BASMI), ESR and CRP. The correlation between the SPARCC/SSS scores and that of clinical indicators were analyzed. Paired sample t test, Wilcoxon signedrank test, Spearman correlation analysis and Pearson correlation analysis were used for statistical analysis, and receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of SPARCC score decline as a response to treatment. Results ① Compared with baseline, after 12 weeks treatment, SPARCC scores [(15±4) and(33±10)], BASDAI [(3.2±0.9) and (5.2±1.1)], BASFI [(2.3±0.6) and (4.6±1.0)], BASMI [(2.3±0.7) and (4.1±1.1)], ASDAS-CRP scores [(2.0±0.8) and (3.7±0.9)], ESR [(16±12) mm/1 h and (49±26) mm/1 h], CRP [(7.2±2.8) mg/L and (30.4±19.3) mg/L] were significantly decreased (t values were 7.822, 6.950, 10.707, 7.204, 6.281,-4.015 and-4.257, respectively), and the diff

关 键 词：脊柱关节炎 磁共振成像 疾病活动度 骶髂关节 

分 类 号：R445.2[医药卫生—影像医学与核医学] R593.23[医药卫生—诊断学]