基于磁共振技术探讨强直性脊柱炎不同阶段炎症期中医证型规律及临床特征

Based on magnetic resonance imaging(MRI) technology to investigate the TCM syndrome types and clinical features of AS in different inflammation period

目的依靠磁共振(MRI)成像技术,区分强直性脊柱炎(AS)病变处于早期或晚期成熟炎症阶段,总结MRI下骶髂关节不同炎症阶段AS病人中医证型规律及临床特征,为骶髂关节MRI成像技术指导中医辨治AS,探讨AS不同中医证型影像学特征提供依据。方法通过骶髂关节MRI扫描技术,纳入MRI表现有骨髓水肿(早期炎症)或脂肪浸润(晚期成熟炎症)的40例AS病人,分为早期炎症组和晚期炎症组,通过肾虚湿热证和肾虚督寒证量表进行中医证型区分,比较两组强直性脊柱炎病情活动度评分(ASDAS-CRP)、红细胞沉降率、C反应蛋白、骶髂关节MRI表现区别,分析中医证型与MRI表现相关性。结果(1)肾虚湿热组MRI积分(42. 34±18. 32),肾虚督寒组骶髂关节MRI积分(18. 23±8. 42),两组比较,肾虚督寒组MRI积分显著降低(t=5. 618,P=0. 000);(2)与早期炎症组比较,晚期炎症组ASDAS-CRP积分及红细胞沉降率、C反应蛋白水平显著降低(P <0. 05);(3) Pearson相关分析显示肾虚督寒证总积分与骶髂关节MRI积分无相关性,肾虚湿热证总积分与骶髂关节MRI积分呈正相关性(P <0. 05)。结论骶髂关节MRI区分AS病变处于早期或晚期成熟炎症阶段技术,对探讨AS不同中医证型临床和影像学特征有重要的临床指导意义。

Objective Based on the magnetic resonance imaging(MRI)imaging technique to distinguish the ankylosing spondylitis(AS)lesions in the early or late stage of mature inflammation,to summarize the TCM syndrome pattern and clinical features of AS patients with different inflammatory stages of the sacroiliac joint under MRI,and the sacroiliac joint MRI imaging technology guides TCM in the treatment of AS,and provide a basis for exploring the imaging features of different TCM syndrome types in AS.Methods 40 AS patients with bone marrow edema(early inflammation)or fatty infiltration(late mature inflammation)in the MRI were divided into early inflammation group and late inflammation group,while divided into the kidney deficiency cold syndrome group and kidney deficiency damp heat syndrome group according to the diagnosis scale of TCM syndromes.The scores of ankylosing spondylitis(ASDAS-CRP),erythrocyte sedimentation rate,C-reactive protein and sacroiliac joint MRI were compared.The correlation between TCM syndrome and MRI performance was analyzed.Results(1)The MRI score of kidney deficiency damp heat syndrome group was(42.34±18.32),while the MRI score of the kidney deficiency cold syndrome group was(18.23±8.42).MRI score of the kidney deficiency cold s yndrome group was significantly lower(t=5.618,P=0.000).(2)Compared with the early inflammation group,ASDAS-CRP scores and erythrocyte sedimentation rate and C-reactive protein levels were significantly lower in the late-stage inflammation group(P<0.05).(3)Pearson correlation analysis showed that there was no correlation between the total score of kidney deficiency cold syndrome and the MRI score of sacroiliac joint.The total score of kidney deficiency damp heat syndrome was positively correlated with the MRI score of sacroiliac joint(P<0.05).Conclusion The sacroiliac joint MRI distinguishes AS lesions in the early or late stage of mature inflammation,and has important clinical guiding significance for exploring the clinical and imaging features of different TCM syndromes.