青壮年活动性骶髂关节强直性脊柱炎CT与MRI表现及与炎性因子水平相关性研究  

CT and MRI findings of activesacroiliac joints in young adults with ankylosing spondylitis and their correlation with inflammatory factors

作　　者：赖苑威 罗宏杰 许军 张耿明 温贺龙 王力刚 LAI Yuan-wei;LUO Hong-jie;XU Jun;ZHANG Geng-ming;WEN He-long;WANG Li-gang(Department of Orthopaedics,People's Hospital of Shenzhen Yantian District,Shenzhen,Guangdong,518081,China)

机构地区：[1]深圳市盐田区人民医院骨科,广东深圳518081

出　　处：《颈腰痛杂志》2022年第6期810-814,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的 探讨青壮年活动性骶髂关节(sacroiliac joint, SIJ)强直性脊柱炎(ankylosing spondylitis, AS)的CT及MRI影像表现,及其与血清HLA-27、IL-17、IL-18、IL-28A、IL-28B、IL-29炎性因子水平的相关性。方法 回顾性分析2013年5月~2019年12月于本院就诊的活动期SIJ-AS患者147例及稳定期患者194例,总结青壮年活动期SIJ-AS的CT及MRI影像学表现,评估CT、MRI对活动期SIJ-AS的诊断效能,评估活动期、稳定期SIJ-AS患者的SPARCC评分,分析活动期、稳定期SIJ-AS的SPARCC评分与血清炎性因子的相关性。结果 MRI影像0级、I级诊断率明显高于CT检查(P=0.000);在影像II、III、IV级诊断率中,CT与MRI检查的差异无统计学意义(P>0.05)。MRI对活动期与稳定期的SIJ-AS检出率差异有统计学意义(P<0.05)。活动期SIJ-AS主要CT表现为单侧或双侧髂骨侧、关节中下部关节面锯齿状骨质破坏,伴多发小囊变、关节侵蚀、关节面增生硬化;MRI表现为关节面变窄模糊伴骨髓水肿、关节软骨损伤、滑膜增厚、脂肪沉积改变。MRI显示活动期SIJ-AS骨髓水肿、关节软骨损伤、滑膜增厚、脂肪沉积的诊断效能显著高于CT诊断(P<0.05)。CT显示活动期SIJ-AS关节面下骨质硬化诊断效能显著高于MRI(P<0.05)。活动期与稳定期SIJ-AS的累及范围计分、水肿强度计分、水肿深度计分和总评分差异均有统计学意义(P<0.05);活动期SIJ-AS血清炎性因子均显著高于稳定期(P<0.05)。活动期SIJ-AS的SPARCC评分与血清HLA-27、IL-28A、IL-17、IL-18成正相关(P<0.05),其中IL-18相关系数最大、为0.611,提示血清IL-18与活动期SIJ-AS的SPARCC评分相关性更强,更能反映SIJ-AS处于活动期;与血清IL-28B、IL-29炎性因子无相关性(P>0.05)。稳定期SIJ-AS的SPARCC评分与血清炎性因子均无相关性(P>0.05)。结论 青壮年活动期SIJ-AS的CT与MRI表现具有一定特征性,血清HLA-27、IL-28A、IL-17、IL-18与青壮年活动期SIJ-AS具有较强的相关性Objective To explore the CT and MRI findings of active sacroiliac joint(SIJ) in young adults with ankylosing spondylitis(AS), and to study their correlation with serum levels of inflammatory factors HLA-27, IL-17, IL-18, IL-28 A, IL-28 B and IL-29. Methods From May 2013 to December 2019, the clinical data of 147 SIJ-AS patients in the active phase and 194 cases in the stable phase were analyzed. The CT and MRI imaging manifestations of SIJ-AS in the active phase of young adults were summarized, the diagnostic efficacy of SIJ-AS in the active phase was evaluated by the χ~2 test. The SPARCC score of SIJ-AS patients in the active phase and the stable phase was evaluated by the independent sample t test, and the correlation between the SPARCC score of SIJ-AS in the active phase and the stable phase and the serum inflammatory factors was analyzed. Results The diagnostic rate of grade 0 and grade I of MRI images was significantly higher than that of CT examination(P=0.000). There was no statistically significant difference in diagnostic rate of imaging grade II, III and IV between CT and MRI results(P>0.05). The difference between the detection rate of SIJ-AS in the active phase and that in the stable phase by MRI was statistically significant(P<0.05).The main CT findings of SIJ-AS in the active phase were unilateral or bilateral iliac crest side, serrated bone destruction in the lower part of the joint with multiple small cystic changes, joint erosion, and joint surface hyperplasia and sclerosis. MRI showed narrowing and blurring of the articular surface with bone marrow edema, articular cartilage injury, synovium thickening, and changes in fat deposition. MRI showed that the diagnostic efficacy of SIJ-AS bone marrow edema, articular cartilage injury, synovium thickening and fat deposition in the active phase was significantly higher than that of CT, and the difference was statistically significant(P<0.05). CT showed that the diagnostic efficacy of SIJ-AS in the active phase was higher than that in MRI, and the diffe

关 键 词：青壮年 活动性骶髂关节强直性脊柱炎 CT MRI 炎性因子 

分 类 号：R593.23[医药卫生—内科学]