HLA-B27、X线、CT在强直性脊柱炎早期临床诊断中的价值

Clinical Value of HLA-B27,X-ray and CT in Early Diagnosis of Ankylosing Spondylitis

目的探讨HLA-B27、X线平片、CT检查对临床诊断强直性脊柱炎的价值。方法对50例确诊为强直性脊柱炎的患者HLA-B27检测结果和影像学资料进行回顾性分析和总结。结果50例均行HLA-B27检测,44例为阳性,6例阴性;骨盆平片显示,双侧骶髂关节改变38例,单侧12例;2级改变34例,3级改变12例,4级改变4例;脊柱平片,正常2例,异常改变48例,其中"竹节样脊柱"改变4例;19例行CT检查发现3级以下骶髂关节改变。结论临床诊断强直性脊柱炎依靠症状和特征性的影像学改变,尽管HLA-B27对于强直性脊柱炎具有高度的敏感性和特异性,但不能用于临床确诊,检查仍以X线平片为首选,若诊断有困难或需与其它疾病相鉴别时,则考虑选用CT等进一步检查。

Objective To evaluate the value of HLA-B27,X-ray and CT scan in the early diagnosis of Ankylosing spondylitis （AS）. Methods The findings of HLA-B27 and imaging data from 50 cases with AS were analyzed and summarized retrospectively. Results 50 patients with AS accepted the detection of HLA-B27. The findings showed that 44 cases was positive and 6 negative. The X-ray plain films of the pelvis showed 38 cases with abnormal bilateral sacroiliac joints and 12 with abnormal lateral sacroiliac joints. The joint changes included grade 2 in 34 cases,grade 3 in 12 eases,and grade 4 in 4 cases. The X-ray films of spine displayed normal spinal images in 2 patients, and abnormal changes in 48 cases in which 4 cases present as ＂bamboo knotlike＂ vertebrae. The CT scan of 19 patients revealed abnormal changes in their sacroiliac joint ,which the damaged degree was less than grade 3. Conclusions The diagnosis of AS depends on the clinical symptoms and imaging findings. Although the detection of HLA-B27 shows a high degree of sensitivity and specificity, it can not be used to confirm clinical diagnosis. The X-ray plain films is still the first choice for the diagnosis of AS. When the diagnosis of AS is difficult or needs to be differentiated from other diseases, further inspection would be considered such as CT scanning.