超声观察英夫利西单抗治疗强直性脊柱炎患者骨质改变的研究

发布时间：2018-04-30 10:43

本文选题：超声 + 脊柱炎　；参考：《中国骨质疏松杂志》2015年02期

【摘要】：目的应用超声观察英夫利西单抗治疗前、后强直性脊柱炎患者骨质改变的情况,并探讨其临床意义。方法 48例活动性AS患者均满足1984年改良的纽约分类标准,并签署知情同意书,所有患者均接受6次infliximab 5 mg/kg静脉输注。用高分辨率B超和能量型多普勒超声观察英夫利西单抗治疗前、后下肢关节及肌腱附着点的骨质形态学及血流供应的变化。并分别在0和30 w记录背痛VAS评分,关节肿痛及CRP、ESR和BASDAI、BASFI、BASMI等指标。结果 48例AS患者完成试验,其中31例复查了超声检查。治疗前48例患者超声检查发现骨侵蚀有37处,骨赘有2处,肌腱增厚有17处,滑囊炎有15处,肌腱钙化1处,异常血流数有22处,关节积液11处,滑膜增生1处。英夫利西单抗治疗后30 w,31例患者复查超声发现骨侵蚀8处,多普勒异常血流1处,与治疗前比较统计学有显著差异(P0.01),滑囊炎3处,与治疗前比较统计学有差异(P0.05)。骨侵蚀中以股骨大转子肌腱点最多,有13处,治疗后只有2处;膝关节内侧副韧带有7处,治疗后为2处,与治疗前相比有统计学差异(P0.05)。骨赘治疗前有2处,治疗后无进展,仍为2处,与治疗前相比无统计学差异(P0.05)。治疗前后各临床指标均有明显好转,统计学有显著差异(P0.01)。结论超声可清晰显示肌腱附着点及关节的骨侵蚀、骨赘形成,并可发现肌腱增厚、滑囊炎、关节滑膜增生及异常血流等情况,能更实时反映AS患者骨质改变的过程及监测疗效。
[Abstract]:Objective to observe the changes of bone in patients with ankylosing spondylitis before and after treatment with infliximab and to explore its clinical significance. Methods 48 active as patients met the New York classification standard and signed an informed consent form in 1984. All patients received infliximab 5 mg/kg intravenous infusion for 6 times. The changes of bone morphology and blood flow supply of lower extremity joint and tendon attachment were observed by high resolution B ultrasound and energy Doppler ultrasound before and after treatment with inflexion McAb. At 0 and 30 weeks, the VAS score, joint swelling and pain, CRP ESR and BASFII BASMI were recorded respectively. Results the test was completed in 48 patients with as and 31 of them were examined by ultrasound. Before treatment, ultrasound examination of 48 patients showed that there were 37 bone erosion, 2 osteophytes, 17 tendon thickening, 15 bursitis, 1 tendon calcification, 22 abnormal blood flow, 11 joint effusion and 1 synovial hyperplasia. After 30 weeks of treatment, 31 patients with infleximab showed 8 bone erosion and 1 abnormal blood flow on Doppler. There were significant differences between before treatment and before treatment (P 0.01) and 3 cases with bursitis, and there was significant difference between before treatment and before treatment (P 0.05). In the bone erosion, there were 13 sites of the great trochanteric tendon of femur, only 2 sites after treatment, and 7 sites of medial collateral ligament of knee joint, 2 sites after treatment, there was significant difference between before and after treatment (P 0.05). There were 2 osteophytes before treatment and 2 without progress after treatment. There was no significant difference compared with that before treatment (P 0.05). Before and after treatment, all the clinical indexes were obviously improved, and there was significant difference in statistics (P 0.01). Conclusion Ultrasound can clearly show the bone erosion and osteophyte formation of tendon attachment and joint, and can find tendon thickening, bursitis, synovial hyperplasia and abnormal blood flow, which can reflect the process of bone change and monitor the effect of as in real time.
【作者单位】：上海交通大学附属第六人民医院肾脏风湿科;上海交通大学附属第六人民医院超声科;
【基金】：上海市卫生局基金(2009092) 国家自然科学基金(30970794)
【分类号】：R445.1;R593.23

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