本文關鍵詞： SAPHO綜合征 脊柱 骶髂關節(jié) CT MRI SPARCC評分 疾病活動性　出處：《北京協(xié)和醫(yī)學院》2017年博士論文　論文類型：學位論文

【摘要】：第一部分SAPHO綜合征患者脊柱病變的CT表現(xiàn)目的分析SAPHO綜合征患者脊柱病變的CT表現(xiàn),以提高各科醫(yī)師對此疾病的認識。方法分析69例SAPHO綜合征患者的全脊柱CT圖像。對于每位患者,共評估25個椎體。觀察指標:受累椎體所在的脊柱節(jié)段、病變的CT圖像表現(xiàn)、病變在椎體上分布的對稱性及部位、椎體的受累方式、椎間隙高度的異常、椎旁韌帶附著點鈣化、椎小關節(jié)及胸肋關節(jié)的異常。結果69例患者的全脊柱CT圖像均提示異常改變。其中,64例表現(xiàn)為脊柱椎體的病變,52例表現(xiàn)為椎旁韌帶骨化,47例上述兩種病變共存。共441個椎體出現(xiàn)椎體病變,以腰椎及第1骶椎為著。椎體病變于CT圖像上表現(xiàn)為:局灶性骨質破壞、鄰近松質骨內的骨質硬化以及韌帶骨贅形成。其中,65.1%的受累椎體其病變僅累及椎角,而34.9%的受累椎體則同時累及“椎角+附近終板”。上述椎角病變可起源于椎體骺環(huán)的任何部位。78.2%的受累椎體其病變位于椎間盤的上下兩緣,而表現(xiàn)為“對吻狀”的連續(xù)性受累,而21.8%的受累椎體則為跳躍性受累。受累椎體鄰近的椎間隙高度多為正常或輕度狹窄。椎旁韌帶骨化病灶共320處,以棘上韌帶為著,CT圖像表現(xiàn)為:細小的高密度灶、且呈節(jié)段性分布。椎小關節(jié)及胸肋關節(jié)無異常改變。結論SAPHO綜合征患者脊柱病變以腰椎及第1骶椎為著,椎體病變于CT圖像上表現(xiàn)為:局灶性骨質破壞、鄰近松質骨內骨質硬化以及韌帶骨贅形成。椎體多以“對吻狀”的連續(xù)性受累方式為主。椎旁韌帶骨化病灶以棘上韌帶為著。椎小關節(jié)及胸肋關節(jié)無異常改變。以上征象有助于臨床及影像醫(yī)生全面地認識此疾病受累范圍及影像表現(xiàn),結合病史做出精準的診斷。第二部分SAPHO綜合征患者脊柱及骶髂關節(jié)病變的MRI表現(xiàn)目的分析SAPHO綜合征患者脊柱病變的MRI表現(xiàn),以提高各科醫(yī)師對此疾病的認識。方法納入38例SAPHO綜合征患者。對本組患者進行統(tǒng)一掃描參數(shù)的全脊柱MRI檢查及雙側骶髂關節(jié)MRI檢查。結果38例SAPHO綜合征患者的MRI圖像均提示異常。其中,15例僅脊柱受累,4例僅骶髂關節(jié)受累,19例為兩者均受累。(1)共34例患者的310個椎體受累(范圍:2-24個/例,平均:7個/例),以腰椎及第1骶椎為著。80.3%的受累椎體表現(xiàn)為“對吻狀”的連續(xù)性受累,而19.7%的受累椎體則為跳躍性受累。37.4%受累椎體的椎間盤出現(xiàn)輕度狹窄。7.1%的受累椎體鄰近的前縱韌帶水腫增厚。1.3%受累椎體的椎小關節(jié)受累。(2)在受累的310個椎體中,共567個病變。其中,35.8%的病變僅累及椎角,而64.2%同時累及椎角及其附近終板。13.9%的病變在MRI圖像上僅表現(xiàn)為骨髓水腫信號,49.2%的病變表現(xiàn)為骨髓水腫和脂肪沉積混合信號,36.9%的病變僅表現(xiàn)為脂肪沉積信號。50.6%的病變出現(xiàn)骨質侵蝕。46.9%的病變出現(xiàn)骨質硬化。(3)共23例患者的骶髂關節(jié)受累,其中78.3%的患者為雙側受累。以關節(jié)計數(shù),則41個骶髂關節(jié)受累。(4)58.5%的受累關節(jié)其病變以骶骨側為著,14.6%的病變關節(jié)強直,14.6%的病變關節(jié)附近軟組織水腫增厚。結論SAPHO綜合征患者的脊柱病變表現(xiàn)為多椎體受累(水腫、脂肪變及硬化信號為主)。椎體多以連續(xù)性“對吻狀”的受累方式為主。受累椎體鄰近的椎間盤、椎體后部成分及椎旁韌帶受累程度較輕。骶髂關節(jié)多為雙側受累、病變以骶骨側為著,較少發(fā)生關節(jié)強直。以上征象有助于臨床及影像醫(yī)生認識此疾病的受累部位及疾病發(fā)展-轉歸中的MRI信號變化,進而提示其病理特點,有助于早診斷早治療。第三部分MRI評分對SAPHO綜合征患者病情活動性判斷的價值目的評估MRI評分對SAPHO綜合征患者病情活動性判斷的價值。方法納入30例SAPHO綜合征患者。上述患者均于我院進行治療前的基線病情評估。評估方法主要包括:(1)臨床評分:患者整體的VAS(Visual Analogue Score)評分;BASDAI=Bath強直性脊柱炎疾病活動指數(shù);BASFAI=Bath強直性脊柱炎功能指數(shù);BASMI=Bath強直性脊柱炎度量指標;ASDAS-CRP=基于CRP(C反應蛋白)的強直性脊柱炎疾病活動評分。(2)實驗室檢查:ESR(紅細胞沉降率);CRP;血清骨鈣素濃度;血清β-CTx濃度。(3)MRI檢查及評分:對30例患者的脊柱及骶髂關節(jié)進行半定量MRI評分,評分方法采用修訂的SPARCC(加拿大脊柱關節(jié)研究協(xié)會)脊柱及骶髂關節(jié)病變活動性評分方法。對MRI總評分與各臨床評分及實驗室檢查結果的相關性進行Spearman相關分析。結果MRI總評分與ASDAS-CRP及CRP呈線性相關,相關系數(shù)分別為0.601及0.476。結論本研究中修訂的SPARCC半定量MRI評分系統(tǒng)可反映SAPHO綜合征患者的炎癥活動程度,可以作為臨床治療療效評價的重要指標。
[Abstract]:The first part of SAPHO syndrome of spinal lesions in patients with CT CT syndrome SAPHO objective to analyze the comprehensive performance of spinal lesions, in order to improve the understanding of this disease doctor. Method 69 cases of patients with SAPHO syndrome of the whole spine CT image. For each patient, a total assessment of 25 vertebrae. Observation index: segmental vertebral involvement the CT images show the distribution of lesions in the vertebral lesions, the symmetry and location of vertebral involvement, abnormal height of intervertebral disc and paravertebral ligament attachment point calcification, abnormal vertebrae and thoracic rib joint. Results 69 cases of patients with the image of whole spine CT showed abnormal changes. Among them, 64 cases showed spinal vertebral lesions, 52 cases showed paravertebral ligament ossification, 47 cases of the two diseases coexist. 441 vertebrae in the lumbar vertebral lesions, and 1 sacral vertebral lesions. For now on CT images on the table: Focal bone destruction, adjacent cancellous bone in bone sclerosis and syndesmophyte formation. Among them, 65.1% vertebral body lesions involving only the vertebral angle, while 34.9% of the vertebral body and involved vertebral angle near the vertebral endplate +. Angle lesions can be originated from the vertebral epiphyseal ring any part of.78.2% the vertebral body lesions located in the intervertebral disc on the two margin, and performance for the "continuous involvement of kiss shaped, and 21.8% for jumping vertebral body involvement. Involvement of vertebral body adjacent intervertebral height were normal or mild stenosis. Paravertebral ossification of ligament lesions were 320 cases with spine ligament the CT imaging showed high density lesions: fine, and a segmental distribution. Vertebral facet joint and Sternocostal joints showed no abnormal changes. Conclusion SAPHO syndrome patients with lumbar spine lesions and 1 sacral vertebra. The vertebral lesions in CT images showed: focal bone destruction Bad, the adjacent cancellous bone with bone sclerosis and osteophyte formation. Vertebral ligament to "kissing" continuous involvement mainly. Paravertebral ossification of ligament lesions with supraspinous ligament. For facet joints and Sternocostal joints showed no abnormal changes. The above features is helpful to clinical and imaging doctors face understanding the disease involvement and imaging findings, combined with history make precise diagnosis. Second patients with SAPHO syndrome the spine and sacroiliac joint lesions in MRI objective analysis SAPHO comprehensive MRI syndrome patients with spinal lesions, in order to improve the recognition of this disease doctor. Methods a total of 38 cases of patients with SAPHO syndrome. This group of patients with uniform scanning parameters of whole spine MRI examination and bilateral sacroiliac joint MRI scan. Results 38 cases of SAPHO MRI syndrome patients showed abnormal image. Among them, 15 cases of spinal involvement, 4 cases of sacroiliac joint involvement, 19 Two cases were involved. (1) a total of 310 vertebral bodies in 34 patients (range: 2-24 / 7 cases, average per case), and 1 in lumbar sacral vertebral involvement for.80.3% were the "continuity of involvement kiss shaped, while 19.7% of the vertebral body is disc skipping involvement.37.4% vertebral involvement appeared facet joint involvement in mild stenosis of.7.1% vertebral body adjacent to the anterior longitudinal ligament thickening of.1.3% vertebral body. (2) in 310 vertebral bodies in 567 lesions. Among them, 35.8% lesions involving only the vertebral angle, and 64.2% involved the vertebral angle and near endplate.13.9% lesions in MRI images showed only bone marrow edema signal, 49.2% lesions showed bone marrow edema and fat deposition in mixed signal, 36.9% lesions showed only fat deposition signal.50.6% lesions on bone erosion.46.9% lesions appear bone sclerosis. (3) a total of 23 cases The sacroiliac joint involvement of patients, including 78.3% patients with bilateral involvement. The joint count, 41 sacroiliac joint involvement (4). 58.5% of the affected joint lesions in the sacral side, 14.6% lesions ankylosis, thickened lesions near the joint soft tissue edema in 14.6%. Conclusion the SAPHO spinal lesions the patients with multiple vertebral body involvement (edema, fatty degeneration and sclerosis. In the main signal) vertebral continuity "to kiss" involvement style. Intervertebral disc adjacent vertebral body, vertebral posterior components and paravertebral ligament involvement to a lesser degree. The sacroiliac joint is more bilateral involvement, lesions in the sacral side the less occurrence of joint ankylosis. Above findings contribute to the clinical outcome of the changes of MRI signal and image understanding of the disease doctors and disease development in the affected areas, and suggest the pathological characteristics, contribute to the early diagnosis and treatment. The third part MRI The score of SAPHO syndrome and the disease activity of the purpose to evaluate the value of MRI score for SAPHO syndrome, the disease activity of value judgment. Methods a total of 30 cases of patients with SAPHO syndrome. The patients were evaluated at baseline condition before treatment in our hospital. The evaluation method mainly includes: (1) the clinical score of patients: the VAS (Visual Analogue Score) score; BASDAI=Bath ankylosing spondylitis disease activity index; BASFAI=Bath Ankylosing Spondylitis Functional Index; ankylosing spondylitis BASMI=Bath index; ASDAS-CRP= based on CRP (C protein) of the ankylosing spondylitis disease activity score (2). Laboratory examination: ESR (erythrocyte sedimentation rate); CRP; the serum osteocalcin concentration; serum beta -CTx concentration. (3) MRI examination and semi quantitative score: the MRI score of the spine and sacroiliac joints in 30 patients, using the revised SPARCC score method (Canada spine Joint Research Association) the sacroiliac joint disease activity score method. The Spearman sacral spine and correlation analysis of MRI score and the clinical score and laboratory results. Results the total score of MRI was linearly correlated with ASDAS-CRP and CRP, the correlation coefficients were 0.601 and 0.476. conclusion in this study SPARCC MRI semi quantitative score the system can reflect the severity of inflammation in patients with SAPHO, can be used as an important index to evaluate the clinical curative effect.

【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R597;R816.8

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