全身MRI对axSpA病人外周附着点炎的评估及疗效监测  

Evaluation and monitoring of peripheral enthesitis in patients with axial spondyloarthritis using whole-body MRI

作　　者：郭子康 李博雅 孔纯玉[3] 雷新玮[2] GUO Zikang;LI Boya;KONG Chunyu;LEI Xinwei(Department of Radiology,Shanxi Bethune Hospital,Taiyuan 030000,China;Department of Radiology,Tianjin First Central Hospital;Department of Rheumatology,Tianjin First Central Hospital.)

机构地区：[1]山西白求恩医院放射科,太原030000 [2]天津市第一中心医院放射科 [3]天津市第一中心医院风湿免疫科

出　　处：《国际医学放射学杂志》2024年第5期533-538,共6页International Journal of Medical Radiology

基　　金：天津市卫生健康科技项目(ZC20043)。

摘　　要：目的基于全身MRI(WBMRI)分析中轴型脊柱关节炎(axSpA)病人的外周附着点炎分布情况,并监测附着点炎对治疗的反应结果。方法前瞻性纳入经临床确诊为axSpA病人37例,其中男28例,女9例,平均(33.5±8.2)岁。采用WBMRI对病人行首次检查(基线)和药物治疗后的随访复查,同时收集基线和随访时病人的临床信息。观察基线和随访WBMRI影像并记录肩部、前胸壁、骨盆、膝部及足部特定附着点炎的数量和分布,根据随访显示的附着点炎变化情况将病人分为缓解组和非缓解组。采用独立样本t检验、Mann-Whitney U检验及Fisher确切概率检验比较缓解组与非缓解组的基线临床指标。采用Spearman相关分析外周附着点炎数量与临床指标的相关性。结果共评估37例病人的1739个附着点。基线WBMRI显示110个附着点炎(110/1739个,6.3%),包括前胸壁32个、肩部21个、骨盆26个、膝部21个及足部10个;前胸壁的胸锁关节处和膝部的股骨内侧髁处的附着点炎数量最多(17/110个,15.4%)。随访WBMRI显示87个附着点炎(87/1739,5.0%),包括前胸壁25个、肩部11个、骨盆14个、膝部20个及足部17个;膝部的股骨内侧髁处的附着点炎数量最多(19/87个,21.8%)。缓解组(13例)比非缓解组(21例)基线检查时的体质量指数(BMI)更低、附着点炎数量更多(P<0.05)。axSpA病人基线WBMRI显示的附着点炎数量与CRP、ESR、ASDAS-CRP临床指标及病程均无相关性(均P>0.05)。结论WBMRI可以从整体上观察axSpA病人的外周附着点炎分布,有潜力作为临床疗效评估的重要成像方法。Objective To analyze the distribution pattern of peripheral enthesitis in patients with axial spondyloar-thritis(axSpA)using whole-body MRI(WBMRI)and to monitor the response of enthesitis to treatment.Methods Thirty-seven patients(28 males and 9 females,mean age 33.5±8.2 years)diagnosed as axSpA were prospectively enrolled.All patients underwent WBMRI at initial examination(baseline)and follow up after drug treatment.Clinical information were collected at both baseline and follow-up.The number and distribution of specific enthesitis sites in the shoulders,anterior chest wall,pelvis,knees,and feet were identified on WBMRI images.Based on changes in enthesitis observed in the follow-up images,the patients were divided into the remission and non-remission groups.Independent sample t test,Mann-Whitney U test,and Fisher exact test were used to compare baseline clinical indicators between the two groups.Spearman correlation analysis was used to analyze the correlation between the number of peripheral enthesitis and clinical indicators.Results A total of 1739 entheses were assessed in 37 patients.Baseline WBMRI showed 110 enthesitis sites(110/1739,6.3%),including 32 in the anterior chest wall,21 in the shoulder,26 in the pelvis,21 in the knee,and 10 in the foot.The most common sites of enthesitis were the sternoclavicular joint of the anterior chest wall and the medial femoral condyle of the knee(17/110,15.4%).Follow-up WBMRI revealed 87(87/1739,5.0%)enthesitis sites,with 25 in the anterior chest wall,11 in the shoulder,14 in the pelvis,20 in the knee,and 17 in the foot.The most common sites during follow-up was the medial femoral condyle of the knee(19/87,21.8%).The remission group(13 patients)had a lower baseline body mass index(BMI)and more enthesitis sites than the non-remission group(21 patients)(P<0.05).The number of enthesitis sites on baseline WBMRI was not correlated with CRP,ESR,ASDAS-CRP,and disease duration(all P>0.05).Conclusion WBMRI can reveal the overall distribution of peripheral enthesitis in patients

关 键 词：中轴型脊柱关节炎 全身磁共振成像 附着点炎 强直性脊柱炎 

分 类 号：R593.22[医药卫生—内科学] R681.5[医药卫生—临床医学] R445.2