缓解期中轴型脊柱关节病患者亚临床炎症发生情况的分析

Presence of subclinical inflammation in axial spondyloarthropathy patients in clinical remission

目的探讨缓解期中轴型脊柱关节病（SpA）患者骶髂关节（磁共振成像）骨髓水肿的发生情况。方法收集2013至2015年安徽医科大学第一附属医院风湿科87例中轴型SpA患者，分别采用BASDAI和ASDAScrp计算其疾病活动性，所有患者均行骶髂关节磁共振（MRI）扫描并进行SPARCC评分。结果（1）按照BASDAI标准（共87例），缓解期60例（69．0％），其中40例（66．7％）有骶髂关节骨髓水肿表现（SPARCC评分〉0分）；活动期27例（31．0％），其中23例（85．2％）SPARCC评分〉0分；按照ASDAScrp标准（共75例），缓解期12例（16．0％），其中4例（33．3％）SPARCC评分〉0分；活动期63例（84．0％）、其中有52例（82．5％）SPARCC评分〉0分。（2）相关性分析结果显示：SPARCC评分和BASDAI（r=0．271，P〈0．05）、ASDAScrp（r=0．291，P〈0．05）、患者总体评价（r=0．414，P〈0．01）和BASDAI2（r=0．261，P〈0．05）呈正直线相关。（3）将所有SpA患者根据既往治疗情况分为未正规治疗组、传统药物治疗组、生物制剂治疗组，非参数检验结果显示：骶髂关节SPARCC评分在3组间差异有统计学意义（P〈0．01），3组间SPARCC〉0分的比例明显不同（86．8％、75．0％、31．6％，P〈0．01）。结论1／3～2／3的缓解期中轴型SpA患者中仍存在骶髂关节骨髓水肿，提示亚临床炎症在缓解期SpA患者中确实存在，生物制剂治疗的SpA患者具有更好的影像学炎症缓解。

Objective To investigate the incidence of bone marrow edema in sacroiliac joint under examination of magnetic resonance imaging （MRI） in patients with axial spondyloarthropathy （SpA） in remission. Methods A total of 87 patients with axial SpA were recruited. Disease activity was assessed by calculation of BASDAI and ASDAScrp scores. All the SpA patients completed MRI scan of sacroiliac joint and bone marrow edema in sacroiliac joint was quantized by SPARCC scoring standard. Results According to BASDAI standard （ n = 87 ）, 60 patients （69.0%） were categorized as remission, of which 40 patients （66. 7% ） exhibited bone marrow edema in sacroiliac joint （SPARCC 〉 0）. 27 patients （31.0%） were categorized as activity, while 23 patients （85.2%） exhibited bone marrow edema in sacroiliac joint （SPARCC 〉0）. According to ASDAScrp standard （ n = 75 ）, 12 patients （ 16.0% ） were classified as remission, of which 4 patients （33.3%） exhibited bone marrow edema in sacroiliac joint （SPARCC 〉 0）. 63 patients （ 31.0% ） were categorized as activity, while 52 patients （ 82. 5% ） exhibited bone marrow edema in sacroiliac joint （ SPARCC 〉 0）. SPARCC score positively correlated with BASDAI （ r = 0. 271, P 〈 O. 05 ）, ASDAScrp （ r = 0. 291, P = 0. 011 ） and patient global assessment （r = 0. 414, P 〈 0. 01 ）. All the patients were classified as non-regular treatment group, traditional drugs group, and biologics group based on the therapeutic conditions. Percentages of patients with SPARCC 〉 0 in sacroiliac joint were also different among these groups （86. 8%, 75.0%, 31.6%, x2 = 21. 483, P 〈 0. 01 ）. Conclusions About 1/3 to 2/3 axial SpA patients in clinical remission represent bone marrow edema in sacroiliac joint under MRI examination, which indicates presence of subclinical inflammation in axial SpA with clinical remission. SpA patients treated with biologics could have better remission of radiographic inflammation on MRI.