强直性脊柱炎髋关节病变患者HLA-B27与CT、MRI联合诊断价值分析

Combined Diagnostic Value of HLA-B27 with CT and MRI in Patients with Ankylosing Spondylitis and Hip Joint Disease

目的探讨人白细胞抗原B27(HLA-B27)与CT、MRI联合诊断强直性脊柱炎(AS)髋关节病变的价值。方法回顾性分析2013年9月-2015年9月医院47例确诊为AS髋关节病变患者HLA-B27检测及CT、MRI影像学资料,分析HLA-B27、CT、MRI单独及三者联合诊断的准确率及CT、MRI影像学表现。结果本组41例HLA-B27阳性(87.23%);本组47例患者84个髋关节受累,HLA-B27+CT+MRI联合诊断的准确率为95.24%高于CT的79.76%、MRI的84.71%(P<0.05)。CT检查显示42髋关节隙狭窄,22髋骨性关节面破坏,38髋关节面或经关节面下骨破坏,67髋髋臼、股骨头边缘硬化,骨赘形成,31髋股骨滑膜附着处突出;31髋有关节腔积液,11髋关节腔内肉芽组织增生。MRI检查47髋关节间隙狭窄;48髋伴随骨骨髓水肿,呈T1低信号,T2高信号,增强扫描后中度强化;54髋软骨呈不规则增厚、扭曲、变薄,41髋关节面破坏,55髋关节囊明显扩张,可见液性信号影,增强扫描可见关节囊增厚。结论 HLA-B27与CT、MRI联合诊断可提高AS髋关节病变诊断准确率,为临床诊治疾病提供丰富信息。

Objective To investigate the value of human leucocyte antigen B27 （HLA-B27） combined with MRI and CT in diagnosis of ankylosing spondylitis （AS） with hip joint lesions. Methods The data of HLA-B27 detection, CT and MRI of 47 patients diagnosed with AS and hip joint lesions in the hospital between September 2013 and September 2015 were retrospectively analyzed. The accuracy of HEA-B27, CT, MRI alone and combined diagnosis and imaging findings of CT and MRI were analyzed. Results Among all subjects, 41 cases of HLA-B27 were positive （87.23%）; In 47 cases, there were a total of 84 hip joints involved. The accuracy rate of HEA-B27 combined with CT and MR1 diagnosis （95.24%） was higher than that of CT （79.76%） and MRI （84.71%） （P〈0.05）. CT scan showed 42 hip joints with space stenosis. 22 hips with articular surface damage, 38 hips with surface or bone destruction under hip surface. 67 hips with acetabulum and femoral head marginal sclerosis, osteophyte formation. 31 hips with extruding femoral synovial adherent sites, 31 hips with articular cavity effusion and 11 hips with intra- articular granulation tissue hyperplasia. MRI examination showed 47 hips with joint space stenosis. 48 hips with bone marrow edema, showing T1 low signal and T2 high signal. After enhanced scan. they was moderate enhancement; 54 hip cartilages showed irregular thickening, distortion and thinning. 41 hip joint articular surfaces were damaged. 55 hip joint capsules significantly expanded, with liquid signal shadow, and enhanced scan showed joint capsule thickening. Conclusion The combined diagnosis of HLA-B27, CT and MRI can improve the diagnostic accuracy of AS with hip joint disease, and provide rich information fbr clinical diagnosis and treatment.