超声观察英夫利西单抗治疗强直性脊柱炎患者骨质改变的研究

Study of therapeutic effects of infliximab on bone in patients with ankylosing spondylitis using ultrasonography

目的应用超声观察英夫利西单抗治疗前、后强直性脊柱炎患者骨质改变的情况,并探讨其临床意义。方法 48例活动性AS患者均满足1984年改良的纽约分类标准,并签署知情同意书,所有患者均接受6次infliximab 5 mg/kg静脉输注。用高分辨率B超和能量型多普勒超声观察英夫利西单抗治疗前、后下肢关节及肌腱附着点的骨质形态学及血流供应的变化。并分别在0和30 w记录背痛VAS评分,关节肿痛及CRP、ESR和BASDAI、BASFI、BASMI等指标。结果 48例AS患者完成试验,其中31例复查了超声检查。治疗前48例患者超声检查发现骨侵蚀有37处,骨赘有2处,肌腱增厚有17处,滑囊炎有15处,肌腱钙化1处,异常血流数有22处,关节积液11处,滑膜增生1处。英夫利西单抗治疗后30 w,31例患者复查超声发现骨侵蚀8处,多普勒异常血流1处,与治疗前比较统计学有显著差异(P<0.01),滑囊炎3处,与治疗前比较统计学有差异(P<0.05)。骨侵蚀中以股骨大转子肌腱点最多,有13处,治疗后只有2处;膝关节内侧副韧带有7处,治疗后为2处,与治疗前相比有统计学差异(P<0.05)。骨赘治疗前有2处,治疗后无进展,仍为2处,与治疗前相比无统计学差异(P>0.05)。治疗前后各临床指标均有明显好转,统计学有显著差异(P<0.01)。结论超声可清晰显示肌腱附着点及关节的骨侵蚀、骨赘形成,并可发现肌腱增厚、滑囊炎、关节滑膜增生及异常血流等情况,能更实时反映AS患者骨质改变的过程及监测疗效。

Objective To observe the bone change before and after infliximab treatment in patients with ankylosing spondylitis（AS） using ultrasonography,and to explore its clinical significance.Methods All the 48 cases of active AS patients met the modified New York criteria（1984）,signed informed consent forms,and received 6 times of intravenous infusion of infliximab 5mg/kg.Bone change on lower limb joints and tendon insertion sites in terms of morphology and blood flow after infliximab treatment was observed using high-resolution B ultrasonography and energy Doppler ultrasonography.Back pain VAS scores,joint swelling and pain,CRP,ESR,BASDAI,DASFI,and BASMI were recorded on week 0 and week 30,respectively.Results Forty-eight cases of AS patients completed the trial,and 31 of them had recheck using ultrasonography.Before the treatment,37 sites of bone erosion,2 sites of osteophyte,17 sites of tendon thickening,15 sites of bursitis,1 site of tendon calcification,22 sites of abnormal blood flow,11 sites of joint effusion,and 1 site of synovial proliferation were found among the 48 cases using ultrasonography.Thirty weeks after infliximab treatment,8 sites of bone erosion and 1 site of abnormal blood flow were found among the 31 patients who underwent recheck using ultrasonography.The difference was statistically significant（P〈0.01）compared to the amount before the treatment.Three sites of bursitis were found after the treatment,which was statistically different（P〈0.05） compared to the amount before the treatment.There were 13 sites of bone erosion found in the tendons of greater trochanter of the femur and 7 sites in the medial collateral ligaments of knee joints before the treatment.However,only 2 sites in the tendons of greater trochanter of the femur and 2 sites in the medial collateral ligaments of knee joints remained after the treatment,and the difference was significant（P〈0.05）.Two sites of osteophyte remained after the treatment（P〈0.05）.All the clinical indicators improved after the treatment,and the difference was statistically significant（P〈0.01） compared to those before the treatment.Conclusion Ultrasonography can clearly show the formation of bone erosion and osteophyte on tendon insertion sites and joints,and indentify abnormities such as tendon thickening,bursitis,synovial proliferation,and abnormal blood flow.Particularly,it can reflect bone change in AS patients in a real-time manner and monitor the treatment efficacy.