中轴型脊柱关节炎患者脊柱MRI病变临床指标及相关性探讨

The analysis of MRI and clinical indicators in patients with Axial spondyloarthritis

目的探讨中轴型脊柱关节炎患者脊柱MRI病变和临床指标的相关性。方法采用回顾性分析，选取我院于2014年9月～2015年6月收治的36例中轴型脊柱关节炎患者为研究对象，对患者Bath强直性脊柱炎活动指数（BASDAI）、Bath强直性脊柱炎功能指数调查表（BASFI）、Bath强直性脊柱炎计量指数（BASMI）、强直性脊柱炎疾病活动评分（ASDAS）进行统计，同时分析患者对疾病总体评价、夜间痛评分及腰背痛评分，检测患者血清HLA-B27、血沉及c反应蛋白，总结患者脊柱MRI表现，脊柱MRI病变和各临床指标的相关性。结果36例中轴型脊柱关节炎患者中31例MRI显示异常，韧带骨赘4例、椎小关节炎2例、Andersson病灶12例及Romanus病灶30例，急性Romanus病灶、慢性Romanus病灶及总病变数目和BASMI呈正相关性（r=0．438，P=0．011；r=0．481，P=0．004；r=0．587，P=0．000）；慢性Andersson病灶数目和BASF1、BASMI呈正相关性（r=0．387，P=0．022；r=0．422，P=0．015）；总病变和BASDAI、夜间痛VAS评分、腰背痛VAS评分、患者对疾病总体VAS评价、ASDAS、ESR、CRP均无相关性（P〉0．05）。结论中轴型脊柱关节炎患者脊柱MRI病变表现和BASDAI、夜间痛VAS评分、腰背痛VAS评分、患者对疾病总体VAS评价、ASDAS、ESR、CRP均无相关性（P〉0．05），只与脊柱功能的急、慢性Romanus病灶及总病变数目和BASMI相关，能够为临床治疗提供指导。

Objective To investigate spinemagnetic resonance imaging （MRI） findings in patients with axial spondyloarthritis （SPA） and 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 and C reactive protein were analyzed. Results 36 patients with axial SpA were included in this study. The image abnormalities of the spine were confirmed in 31 axial SpA patients by MRI, including Romanus lesion, Andersson lesion, the inflammation of facet joints and syndesmophyte. BASM1 was positively correlated to the numbers of acute Romanus lesions, chronic Romanus lesions, chronic Andersson lesions and whole spinal lesions （r= 0. 438, P = 0.011 ;r = 0. 481, P = 0. 004 ; r = 0. 587, P = 0. 000 respectively）. There was a statistically significant correlation between chronic Andersson lesions and BASFI（r=0. 387, P=0. 022;r= 0. 422 ,P= 0. 015）. But no significant associations were found between MRI lesions and other clinical findings. Conclusion Axial spondyloarthritis patients with spinal MRI lesions and BASDAI, night pain VAS scores, low back pain VAS score, patient of disease in the general evaluation of the vas, asdas, ESR, CRP had no correlation （P〉0.05）. Spinal function of acute and chronic Romanus lesion, total lesion number and basmi are correlated to provide guidance for clinical treatment.