中轴型脊柱关节炎患者全脊柱磁共振成像的初步研究

发布时间：2018-07-10 03:53

本文选题：脊柱关节炎 + 中轴型　；参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：研究背景：脊柱关节炎（spondyloarthritis,SpA）是具有共同临床特征的一组相互关联的疾病，其中强直性脊柱炎（ankylosing spondylitis,AS）是其经典原型。中轴型SpA是近几年提出的一个新概念，是以中轴症状为主要表现的SpA。磁共振成像（magnetic resonance imaging,MRI）是目前检测早期骶髂关节炎最敏感的影像学技术，骶髂关节MRI已被纳入SpA的诊断当中。脊柱是中轴型SpA最常受累的部位之一，且临床中发现部分患者在出现骶髂关节病变之前已有脊柱受累，目前国内外尚无利用脊柱MRI诊断中轴型SpA的统一标准。本研究旨在研究中轴型SpA脊柱受累的脊柱MRI表现，探究其与临床指标之间的相关关系，评价脊柱MRI病变区分中轴型SpA与慢性机械性腰背痛患者的价值。方法：第一部分，建立中轴型SpA队列，纳入符合2009年国际脊柱关节炎评价工作组（theAssessment of SpondyloArthritis international Society,ASAS）关于中轴型SpA分类标准的33例患者，（1）以问卷调查的形式收集相关病史资料，进行Bath强直性脊柱炎病情活动指数（Bath Ankylosing SpondylitisDisease Activity Index, BASDAI）及Bath强直性脊柱炎功能指数调查表（BathAnkylosing Spondylitis Functional Index, BASFI）评分；（2）采用盲法原则对患者进行查体，进行Bath强直性脊柱炎计量指数（Bath Ankylosing SpondylitisMetrology Index,BASMI）评定及强直性脊柱炎疾病活动评分（AnkylosingSpondylitis Disease Activity Score,ASDAS）计算；（3）采血检测HLA-B27、血沉(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)；（4）每名患者于同一MR扫描仪进行全脊柱磁共振扫描；（5）采用盲法对患者脊柱MRI进行阅片。总结中轴型SpA脊柱受累的主要表现，分析其与各临床指标之间的相关关系。第二部分，建立中轴型SpA与机械性腰背痛患者的配对队列，（1）纳入符合2009年ASAS关于中轴型SpA分类标准的52例患者；（2）每位患者于同一MR扫描仪进行全脊柱磁共振扫描；（3）选取同时期年龄、性别与中轴型SpA组患者相匹配的因机械性腰背痛行颈椎、胸椎及腰椎MR扫描的52例患者；（4）采用盲法对患者MRI进行阅片。比较两组患者脊柱受累MRI表现的差异，评价脊柱MRI病变区分中轴型SpA与慢性机械性腰背痛患者的价值。结果：在本研究的第一部分中，33例中轴型SpA患者中29例出现MRI异常表现，包括Romanus病灶、Andersson病灶、脊椎关节炎及韧带骨赘；急性Romanus病灶、慢性Romanus病灶、慢性Andersson病灶及脊柱总病变数目与BASMI均呈正相关(r=0.440，，P0.05；r=0.483，P0.05；r=0.421，P0.05；r=0.589，P0.05)；慢性Andersson病灶与BASFI呈正相关(r=0.392，P0.05)；但脊柱病变与其他临床指标之间不存在相关关系。本研究的第二部分发现SpA患者Romanus病灶的发生率明显高于机械性腰背痛患者（椎体水平χ2=132.147，P=0.000；病灶水平χ2=378.613，P=0.000）。且SpA所致的Romanus病灶好发于下胸段椎体；机械性腰背痛所致的病灶好发于颈段椎体；以脊柱Romanus病灶诊断中轴型SpA时的敏感性及阳性似然比尚不足以将之定为诊断标准；脊柱各段中以下胸椎的Romanus病灶有相对较高的诊断意义；下胸椎急性Romanus病灶的诊断价值高于慢性Romanus病灶，以脊柱急性Romanus病灶诊断中轴SpA时有较高特异性；两组患者椎间盘炎发生率无明显差别。结论：（1）中轴型SpA脊柱受累在MRI上表现为Romanus病灶、Andersson病灶、椎小关节炎及韧带骨赘形成；（2）上述MRI表现与多数临床指标之间存在不一致，而急性Romanus病灶、慢性Romanus病灶、慢性Andersson病灶及脊柱总病变数目与BASMI之间存在一定相关关系；（3）以脊柱Romanus病灶诊断中轴型SpA时的敏感性及阳性似然比尚不足以将之定为诊断标准。本研究提示我们在设定SpA的治疗目标时应关注脊柱MRI表现，从而为制定治疗策略提供有效的依据；以脊柱MRI椎体表现诊断中轴型SpA存在一定局限性，但下胸椎的急性Romanus病灶对于诊断有一定的提示作用。
[Abstract]:Background: spondyloarthritis (SpA) is a group of interrelated diseases with common clinical features, of which ankylosing spondylitis (AS) is the classic prototype. The axis type SpA is a new concept proposed in recent years, and is the SpA. magnetic resonance imaging (magnetic reso) characterized by the symptoms of the middle axis (magnetic reso). Nance imaging, MRI) is the most sensitive imaging technique for the detection of early sacroilitis. The sacroiliac joint MRI has been included in the diagnosis of SpA. The spine is one of the most frequently involved parts of the axis type SpA, and it is found that some patients have spinal involvement before the lesions of the sacroiliac joint, and there is no use of the spinal MRI diagnosis at home and abroad. This study aims to study the MRI manifestations of the spinal column associated with SpA spinal involvement and to explore the correlation between the spinal MRI and the clinical indicators, and to evaluate the value of the spinal MRI lesion to differentiate between the axial SpA and the patients with chronic mechanical low back pain.
Method: in the first part, the middle axis SpA queue was established, which included 33 patients with theAssessment of SpondyloArthritis international Society, ASAS on the central axis SpA classification standard, and (1) collect relevant medical history data in the form of questionnaire and carry out the disease of Bath ankylosing spondylitis. Bath Ankylosing SpondylitisDisease Activity Index (BASDAI) and the functional index questionnaire of ankylosing spondylitis (BathAnkylosing Spondylitis Functional Index, BASFI) score (BathAnkylosing Spondylitis Functional Index, BASFI). (2) the patients were examined by blind principle and the index index of ankylosing spondylitis was carried out. Ex, BASMI) assessment and the evaluation of ankylosing spondylitis disease activity score (AnkylosingSpondylitis Disease Activity Score, ASDAS); (3) blood sampling to detect HLA-B27, erythrocyte sedimentation rate (erythrocyte sedimentation rate, ESR), reactive protein, and (4) all patients were scanned by the same scanner for all spinal MRI; (5) The MRI of the spine was examined by blind method. The main manifestations of axial SpA spinal involvement were summarized, and the correlation between them was analyzed.
In the second part, a paired cohort of middle axial SpA and mechanical low back pain was established. (1) 52 patients were included in the 2009 ASAS on the middle axis SpA classification standard; (2) each patient was scanned with the same MR scanner for all spinal magnetic resonance imaging; (3) selection of the age, sex and the mechanical waist of the patients with the middle axis type SpA group. 52 patients with MR scan of cervical vertebra, thoracic vertebra and lumbar spine were performed on back pain; (4) a blind method was used to read the patient's MRI. The difference in the MRI manifestations of the spinal involvement in the two groups was compared, and the value of the spinal MRI lesion to distinguish between the middle axis SpA and the chronic mechanical low back pain was evaluated.
Results: in the first part of this study, 29 of 33 patients with axial SpA had abnormal MRI manifestations, including Romanus focus, Andersson focus, spinal arthritis and ligamentum osteophyte; acute Romanus focus, chronic Romanus focus, chronic Andersson focus and total spinal lesion number were positively correlated with BASMI (r=0.440, P0.05; r=0.483, P0.0). 5; r=0.421, P0.05; r=0.589, P0.05); chronic Andersson lesions were positively correlated with BASFI (r=0.392, P0.05), but there was no correlation between spinal lesions and other clinical indicators.
The second part of this study found that the incidence of Romanus lesions in SpA patients was significantly higher than those of mechanical low back pain (vertebral level x 2=132.147, P=0.000; the level of 2=378.613, P=0.000). And the Romanus focus caused by SpA was better in the lower thoracic vertebrae; the focal lesions caused by mechanical low back pain were found in the cervical vertebrae, and Romanus disease of the spine. The sensitivity and positive likelihood ratio of the focal SpA in the focal diagnosis are not enough to be defined as diagnostic criteria; the Romanus focus of the lower thoracic vertebrae in the spinal column has a relatively high diagnostic value; the diagnostic value of the acute Romanus focus in the lower thoracic vertebrae is higher than that of the chronic Romanus focus, with a higher specificity for the diagnosis of the middle axis SpA with the acute Romanus focus of the spine. There was no significant difference in the incidence of intervertebral disc inflammation between the two groups.
Conclusions: (1) the involvement of the middle axis SpA spine in MRI is Romanus focus, Andersson focus, vertebral small arthritis and ligamentum osteophyte formation; (2) the above MRI manifestations are inconsistent with most of the clinical indicators, and the number of acute Romanus focus, chronic Romanus focus, chronic Andersson focus, and the number of spinal total lesions and BASMI exist between them. Correlation; (3) the sensitivity and positive likelihood ratio of the spinal Romanus focus in the diagnosis of the middle axis SpA is not enough to be defined as a diagnostic criterion. This study suggests that we should pay attention to the MRI performance of the spinal column in setting the target of SpA treatment and provide an effective basis for the formulation of the treatment strategy; the diagnosis of the axial SpA in the spinal MRI vertebral manifestation of the spine. There are some limitations, but the acute Romanus lesions of the lower thoracic vertebrae may be helpful in the diagnosis.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R684.3;R445.2

【参考文献】