中轴型脊柱关节炎全脊柱磁共振成像的临床研究

The clinical analysis for the whole-spine magnetic resonance imaging of axial spondyloarthritis

目的 通过观察中轴型脊柱关节炎（SpA）患者脊柱受累的磁共振成像（MRI）表现,探讨脊柱MRI病变与临床间的相关性.方法 选中轴型SpA患者,收集其临床资料,进行全脊柱MRI扫描,分析MRI表现,分析脊柱MRI病变与Bath强直性脊柱炎病情活动指数（BASDAI）、Bath强直性脊柱炎功能指数（BASFI）、Bath强直性脊柱炎计量指数（BASMI）、夜间腰背痛评分[采用视觉模拟尺（VAS）评价]、腰背痛VAS评分、患者对疾病总体评价（采用VAS评价）、强直性脊柱炎疾病活动评分（ASDAS）、ESR、C反应蛋白（CRP）间的相关关系.结果 本研究共纳入33例中轴型SpA患者,其中29例出现MRI异常表现,Romanus病灶（又称椎角炎）29例,Andersson病灶（又称椎间盘炎）11例,椎小关节炎2例,韧带骨赘4例;急性椎角炎、慢性椎角炎、慢性椎间盘炎及脊柱总病变数与BASMI呈正相关（r =0.440,P＜0.05;r =0.483,P＜0.05;r =0.421,P＜0.05;r=0.589,P＜0.05）,慢性椎间盘炎与BASFI呈正相关（r=0.392,P＜0.05）,但脊柱各种病变与BASDAI、腰背痛VAS评分、夜间腰背痛VAS评分、患者对疾病总体评价、ASDAS、ESR、CRP无显著相关性（P值均＞0.05）.结论 中轴型SpA MRI表现与反映脊柱功能的指标存在相关性,能更好地指导临床治疗.

Objective To investigate spinemagnetic resonance imaging（MRI） findings in patients with axial spondyloarthritis （SpA） and to analyze the correlation between imaging and clinical manifestation.Methods The clinical data of patients with axial SpA were recorded.All patients underwent whole spine MRI scanning.The MRI findings of spinal involvement were explored.Moreover,the correlation between lesions in spinal MRI and Bath Ankylosing Spondylitis Disease Activity Index（BASDAI）,Bath Ankylosing Spondylitis Functional Index （BASFI）,Bath Ankylosing Spondylitis Metrology Index （BASMI）,nocturnal pain visual analogue scale （VAS） score,back pain VAS score,global disease activity VAS score,Ankylosing Spondylitis Disease Activity score （ASDAS）,erythrocyte sedimentation rate,C-reactive protein was analyzed.Results Thirty-three patients with axial SpA were included in this study.The image abnormalities of the spine were confirmed in 29 axial SpA patients by MRI,including Romanus lesion,Andersson lesion,the inflammation of facet joints and syndesmophyte.In correlation study,BASMI was positively correlated to the numbers of acute Romanus lesions,chronic Romanus lesions,chronic Andersson lesions and whole spinal lesions（r =0.440,P〈0.05; r =0.483,P〈0.05; r=0.421,P〈0.05; r=0.589,P 〈 0.05 respectively）.There was a statistically significant correlation between chronic Andersson lesions and BASFI（r =0.392,P 〈0.05）.But no significant associations were found between MRI lesions and other clinical findings.Conclusions MRI lesions in axial SpA were associated with findings reflecting the spinal function,which can better guide the clinical treatment.