强直性脊柱炎临床、实验室及影像学的相关分析与评估

Correlative Analysis and Evaluation of Clinical, and Laboratory Measurements and Radiological Changes in Ankylosing Spondylitis

作者对８４例强直性脊柱炎（ＡＳ）的临床、实验室及影像学改变，进行了相关分析和评估。采用Ｋ（卡帕）检验，其中２３例行０～１２个月的纵向敏感试验。经临床实验室及影像学Ｓｐｅａｒｍａｎ等级相关分析，表明：骶髂关节ＣＴ上的侵蚀及硬化与强直呈负相关（ｒ＝－０．５７～－０．４３；Ｐ＜０．０５），ＣＴ上的强直与腰椎和骶髂关节平片的分数呈正相关（ｒ＝０．５９～０．７０；Ｐ＜０．０１）。ＡＳ活动期，临床下背疼痛，关节僵硬及睡眠障碍三者之间密切相关（ｒ＝０．６１～０．７２；Ｐ＜０．０１），且与骶髂关节ＣＴ上的侵蚀及硬化呈正相关（ｒ＝０．４０～０．６８；Ｐ＜０．０５），与关节强直呈负相关（ｒ＝－０．７０～－０．４１；Ｐ＜０．０１）。血沉及Ｃ反应蛋白（ＣＲＰ）水平与临床下背疼痛、关节僵硬及睡眠障碍呈正相关（ｒ＝０．３８～０．５４；Ｐ＜０．０５）。因此，作者认为，骶髂关节影像学上的侵蚀和硬化及血沉和ＣＲＰ升高可预示ＡＳ活动期，而血清粘蛋白升高及影像学上的强直增加则为稳定期表现。

The clinical and Laboratory measurments and radiological cbertges in 84 patients with ankylosing spondylitis were evaluated by correlative analysis. All patients had plain radiographs of sacroiliac joints and lumbar spine and CT scan of sacroiliac joints, 23 had 0～12-month longitudi-nal study. Analysis of reproducibility was done by the Kappa statistics shearman’s rank correlation analysis of clinical and laboratory and radiological changes showed:CT sacroiliac joint erosion and sclerosis correlated negatively with ankylosis(r=-0.57～-0.43;P<0.05) while ankylosis score correlated positively with plain radiography of lumbar spine and sacroiliac joint score(r=0.59～0.70;P<0.01).The clinical indicators of disease activityie pain’stillness and sleep disturbance all correlated well with each other(r=0. 61～0.72; P<0.01)and correlated positively with sacroiliac joint erosion and sclerosis displayed on CT (r=0.40～0.68,P<0.05) but negatively with ankylosis(r=-0.70～-0.41;P<0.01) while correlated positively with ESR and CRP levels (r= 0.38～0.54;P<0.05).There fore the authors suggested that sacroiliac joint erosion and sclerosis in con-junction with elevated ESR, CRP indicated active stage of the disease,on the other hand increased oromucoid and radiological evidence of ankylosis were suggestive of stable stage.