结核性骶髂关节炎临床表现及影像学特点  

Clinical manifestations and imaging features of patients with tuberculous sacroiliitis

作　　者：贺玉杰[1] 丁艳霞[1] 乔博 贺世豪 李天方 刘升云[1] HE Yujie;DING Yanxia;QIAO Bo;HE Shihao;LI Tianfang;LIU Shengyun(Department of Rheumatology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052;Department of Infection Prevention and Control,Henan Provincial Chest Hospital,Zhengzhou 450008)

机构地区：[1]郑州大学第一附属医院风湿免疫科,郑州450052 [2]河南省胸科医院感染防控科,郑州450008

出　　处：《郑州大学学报（医学版）》2022年第3期432-435,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金项目(U1704177,8187811)。

摘　　要：目的:探讨结核性骶髂关节炎的临床表现及影像学特点,以期辅助临床诊疗。方法:回顾性分析2015年9月至2020年1月郑州大学第一附属医院及河南省胸科医院收治的36例结核性骶髂关节炎患者的一般资料、临床表现、合并疾病、实验室检查、影像学表现、治疗及预后等资料。结果:36例中,男11例,女25例,发病年龄中位数(四分位数)32.0(23.0,50.5)岁。30例出现腰骶部、髋部或臀区疼痛,且以单侧疼痛为主。23例伴发热,4例伴乏力、消瘦或盗汗。34例检测T-SPOT,其中阳性27例。28例行骨盆DR或骶髂关节CT检查,其中关节面毛糙18例,关节间隙变窄或增宽10例,骨质破坏6例;17例行骶髂关节MRI平扫,均可见骶髂关节骨髓水肿,11例伴周围软组织受累。1例失访;其余35例均接受规范抗结核药物治疗,疗程12~18个月,其中9例同时接受外科手术治疗,均临床治愈。结论:结核性骶髂关节炎常单侧受累,部分可伴脓肿形成,经规范抗结核药物治疗或联合手术治疗,整体预后良好。Aim:To investigate the clinical manifestations and imaging features of tuberculous sacroiliitis.Methods:A total of 36 tuberculous sacroiliitis cases were enrolled and the demographic features,clinical symptoms,comorbidities,laboratory test results,imaging features,treatment and prognosis were retrospectively reviewed.Results:There were 11 males and 25 females,the median(quartiles) of onset age was 32.0(23.0,50.5) years.Thirty cases had obvious gluteal region pain,hip joint pain or lumbosacral pain,mainly unilateral involvement;23 cases presented with fever,and 4 cases presented with fatigue,weight loss or night sweats.Thirty-four cases were tested for T-SPOT,of which,27 were positive.X-ray examination of pelvis or sacroiliac joint CT was performed in 28 cases,indicating 18 cases with joint surface roughness,10 cases with narrowing or widening of the joint space,and 6 cases with bone destruction;17 cases recieved MRI of sacroiliac joint,indicating all 17 cases with bone marrow edema of the sacroiliac joint,and 11 cases with peripheral soft tissue involvement.Thirty-five cases received standardized anti-tuberculosis drug treatment for 12 to 18 months,except for one case of loss to follow-up,and 9 cases underwent surgical operation.All patients were clinically cured.Conclusion:Tuberculous sacroiliitis is often unilateral and commonly associated with abscess formation.The overall prognosis of tuberculous sacroiliac arthritis is good with standardized anti-tuberculosis medication or combined surgical treatment.

关 键 词：结核性骶髂关节炎 临床表现 影像学 

分 类 号：R529.2[医药卫生—内科学]