本文選題：脊柱關節(jié)炎 + 中軸型��； 參考：《中國人民解放軍醫(yī)學院》2014年碩士論文

【摘要】：研究背景：脊柱關節(jié)炎（spondyloarthritis,SpA）是具有共同臨床特征的一組相互關聯(lián)的疾病，其中強直性脊柱炎（ankylosing spondylitis,AS）是其經典原型。中軸型SpA是近幾年提出的一個新概念，是以中軸癥狀為主要表現的SpA。磁共振成像（magnetic resonance imaging,MRI）是目前檢測早期骶髂關節(jié)炎最敏感的影像學技術，骶髂關節(jié)MRI已被納入SpA的診斷當中。脊柱是中軸型SpA最常受累的部位之一，且臨床中發(fā)現部分患者在出現骶髂關節(jié)病變之前已有脊柱受累，目前國內外尚無利用脊柱MRI診斷中軸型SpA的統(tǒng)一標準。本研究旨在研究中軸型SpA脊柱受累的脊柱MRI表現，探究其與臨床指標之間的相關關系，評價脊柱MRI病變區(qū)分中軸型SpA與慢性機械性腰背痛患者的價值。 方法：第一部分，建立中軸型SpA隊列，納入符合2009年國際脊柱關節(jié)炎評價工作組（theAssessment of SpondyloArthritis international Society,ASAS）關于中軸型SpA分類標準的33例患者，（1）以問卷調查的形式收集相關病史資料，進行Bath強直性脊柱炎病情活動指數（Bath Ankylosing SpondylitisDisease Activity Index, BASDAI）及Bath強直性脊柱炎功能指數調查表（BathAnkylosing Spondylitis Functional Index, BASFI）評分；（2）采用盲法原則對患者進行查體，進行Bath強直性脊柱炎計量指數（Bath Ankylosing SpondylitisMetrology Index,BASMI）評定及強直性脊柱炎疾病活動評分（AnkylosingSpondylitis Disease Activity Score,ASDAS）計算；（3）采血檢測HLA-B27、血沉(erythrocyte sedimentation rate,ESR)、C反應蛋白(C-reactive protein,CRP)；（4）每名患者于同一MR掃描儀進行全脊柱磁共振掃描；（5）采用盲法對患者脊柱MRI進行閱片�？偨Y中軸型SpA脊柱受累的主要表現，分析其與各臨床指標之間的相關關系。 第二部分，建立中軸型SpA與機械性腰背痛患者的配對隊列，（1）納入符合2009年ASAS關于中軸型SpA分類標準的52例患者；（2）每位患者于同一MR掃描儀進行全脊柱磁共振掃描；（3）選取同時期年齡、性別與中軸型SpA組患者相匹配的因機械性腰背痛行頸椎、胸椎及腰椎MR掃描的52例患者；（4）采用盲法對患者MRI進行閱片。比較兩組患者脊柱受累MRI表現的差異，評價脊柱MRI病變區(qū)分中軸型SpA與慢性機械性腰背痛患者的價值。 結果：在本研究的第一部分中，33例中軸型SpA患者中29例出現MRI異常表現，包括Romanus病灶、Andersson病灶、脊椎關節(jié)炎及韌帶骨贅；急性Romanus病灶、慢性Romanus病灶、慢性Andersson病灶及脊柱總病變數目與BASMI均呈正相關(r=0.440，，P0.05；r=0.483，P0.05；r=0.421，P0.05；r=0.589，P0.05)；慢性Andersson病灶與BASFI呈正相關(r=0.392，P0.05)；但脊柱病變與其他臨床指標之間不存在相關關系。 本研究的第二部分發(fā)現SpA患者Romanus病灶的發(fā)生率明顯高于機械性腰背痛患者（椎體水平χ2=132.147，P=0.000；病灶水平χ2=378.613，P=0.000）。且SpA所致的Romanus病灶好發(fā)于下胸段椎體；機械性腰背痛所致的病灶好發(fā)于頸段椎體；以脊柱Romanus病灶診斷中軸型SpA時的敏感性及陽性似然比尚不足以將之定為診斷標準；脊柱各段中以下胸椎的Romanus病灶有相對較高的診斷意義；下胸椎急性Romanus病灶的診斷價值高于慢性Romanus病灶，以脊柱急性Romanus病灶診斷中軸SpA時有較高特異性；兩組患者椎間盤炎發(fā)生率無明顯差別。 結論：（1）中軸型SpA脊柱受累在MRI上表現為Romanus病灶、Andersson病灶、椎小關節(jié)炎及韌帶骨贅形成；（2）上述MRI表現與多數臨床指標之間存在不一致，而急性Romanus病灶、慢性Romanus病灶、慢性Andersson病灶及脊柱總病變數目與BASMI之間存在一定相關關系；（3）以脊柱Romanus病灶診斷中軸型SpA時的敏感性及陽性似然比尚不足以將之定為診斷標準。本研究提示我們在設定SpA的治療目標時應關注脊柱MRI表現，從而為制定治療策略提供有效的依據；以脊柱MRI椎體表現診斷中軸型SpA存在一定局限性，但下胸椎的急性Romanus病灶對于診斷有一定的提示作用。
[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.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R684.3;R445.2

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相關期刊論文 前1條

1 曹鐵梅,韓宏妮,段瑛春,姬艷波,陳立忠,董端祥,李洪濤,王兵,張廣印;東北戰(zhàn)區(qū)部分男性官兵強直性脊柱炎的流行病學調查[J];中華風濕病學雜志;2000年05期

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