强直性脊柱炎患者急性期腰椎病变的MRI特征分析  

MAGNETIC RESONANCE IMAGING FEATURES OF LUMBAR LESIONS IN PATIENTS IN THE ACUTE STAGE OF ANKYLOSING SPONDYLITIS

作　　者：张圆圆[1,2] 王涛 陈海松[1] 冯卫华[1] ZHANG Yuanyuan;WANG Tao;CHEN Haisong;FENG Weihua(Department of Radiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院放射科,山东青岛266003 [2]单县中心医院放射科

出　　处：《精准医学杂志》2023年第4期365-368,372,共5页Journal of Precision Medicine

基　　金：国家自然科学基金面上项目(81571673)。

摘　　要：目的分析强直性脊柱炎(ankylosing spondylitis,AS)患者急性期腰椎病变的MRI影像学表现,结合柏林(Berlin)评分探究AS患者急性期腰椎病变的分布规律、累及范围及病变特点。方法选取2019—2022年单县中心医院风湿科收治的AS患者70例,收集患者的一般资料、入院时人类白细胞抗原B27(HLA-B27)检测结果及腰椎MRI检查结果。分析患者腰椎MRI影像学表现、病变分布特点和累及范围;将患者椎单位分为3段(上段:T12~L2、中段:L2~L4、下段:L4~S1),对受累椎单位进行Berlin评分,比较不同段椎单位间Berlin评分差异;采用Pearson相关性分析或Spearman相关性分析患者年龄、病程、HLA-B27与Berlin评分间的关系。结果全部患者中椎角炎52例(74.3%),以椎体前角受累为主;椎间盘炎18例(25.7%),以弥漫型受累为主。不同段椎单位在Berlin评分总体分布上存在统计学差异(χ^(2)=20.425,P<0.01),其中Berlin评分2分的中、下段椎单位较上段椎单位显著增多(P<0.05),Berlin评分3分的下段椎单位较上、中段显著增多(P<0.05)。AS急性期患者的年龄、病程与Berlin评分间均无相关性(P>0.05),入院时HLA-B27水平与Berlin评分呈弱正相关(r=0.240,P<0.05)。结论AS患者急性期腰椎病变具有多个椎单位受累、多灶性分布的特点,MRI影像多表现为椎角炎、椎间盘炎,且容易合并椎小关节炎而呈现两种炎症形式混合存在的现象。AS患者急性期严重腰椎病变更易累及下段椎单位。Objective To investigate the magnetic resonance imaging(MRI)features of lumbar lesions in patients in the acute stage of ankylosing spondylitis(AS),as well as the distribution,involvement,and pathological features of lumbar lesions in the acute stage of AS based on Berlin score.Methods A total of 70 patients with AS who were admitted to Department of Rheumatology,Shanxian Central Hospital,from 2019 to 2022 were enrolled,and related data were collected,including general information,human leukocyte antigen-B27(HLA-B27)on admission,and lumbar MRI findings.The MRI findings,distribution characte-ristics,and extent of involvement of lumbar lesions were analyzed.The vertebral units were divided into three segments,i.e.,T12-L2 as the upper segment,L2-L4 as the middle segment,and L4-S1 as the lower segment,and Berlin score was determined for the affected vertebral units and was compared between different segments of vertebral units.The Pearson or Spearman correlation analysis was used to investigate the correlation between age,course of disease,HLA-B27,and Berlin score.Results Of all patients,there were 52 cases(74.3%)of vertebral corner inflammatory lesion,mainly involving the anterior horn of vertebral body;there were 18 cases(25.7%)of discitis,mainly with diffuse involvement.There was a significant difference in the ove-rall distribution of Berlin score between vertebral units in different segments(χ^(2)=20.425,P<0.01);the number of vertebral units with a Berlin score of 2 points in the middle and lower segments was significantly higher than that in the upper segment(P<0.05),and the number of vertebral units with a Berlin score of 3 points in the lower segment was significantly higher than that in the upper and middle segments(P<0.05).There was no correlation between age,course of disease,and Berlin score in the patients in the acute stage of AS(P>0.05),and there was a weak positive correlation between HLA-B27 on admission and Berlin score(r=0.240,P<0.05).Conclusion In the acute stage of AS,lumbar lesions have the cha

关 键 词：脊柱炎 强直性 腰椎 磁共振成像 HLA抗原 

分 类 号：R445[医药卫生—影像医学与核医学]