强直性脊柱炎患者X线脊柱结构损伤的影响因素分析

Analysis of factors influencing X-ray images of spinal injury in patients with ankylosing spondylitis

目的探讨AS患者脊柱X线结构损伤的影响因素。方法收集206例AS患者,详细记录AS患者各临床和实验室指标,计算疾病活动性指标[BASDAI、CRP的AS疾病活动性(ASDAScrp)]和功能指标等,摄骶髂关节和脊柱X线片并计算改良的Stoke AS脊柱评分(mSASSS),骶髂关节磁共振扫描。利用SPSS 17.0软件,使用χ2检验、秩和检验、Logistics回归分析等统计学方法,比较各组间mSASSS的水平、脊柱受累(mSASSS>0)和骨桥形成率的差别。结果①年龄≥40岁患者脊柱受累率(100%)和骨桥形成率(65.2%)显著高于年龄<40岁患者(90.6%、31.9%)(χ2=4.651,P=0.031;χ2=16.647,P<0.01),且mSASSS水平更高(Z=5.575,P<0.01);BMI≥24 kg/m2、病程≥5年的AS患者骨桥形成率(49.2%、50.4%)显著高于BMI<24 kg/m2患者、病程<5年的患者(34.5%、19.7%)(χ2=4.014,P=0.045;χ2=18.173,P=0.03)且mSASSS水平更高(Z=2.281,P=0.023;Z=4.828,P<0.01);吸烟的AS患者骨桥形成率(50.6%)显著高于不吸烟患者(31.0%)(χ2=7.346,P=0.007)且mSASSS水平更高(Z=2.045,P=0.041)。②ESR和CRP升高组AS患者骨桥形成率(48.6%、49.0%)显著高于ESR和CRP正常组患者(25.6%、28.9%)(χ2=10.784,P=0.001;χ2=8.102,P=0.004),且mSASSS水平更高(Z=2.379,P<0.01;Z=3.112,P<0.01);BASDAI≥4组和ASDAScrp≥2.1组患者骨桥形成率(52.8%、46.4%)显著高于BASDAI<4和ASDAScrp<2.1(34.2%、30.7%)(χ2=5.681,P=0.017;χ2=4.646,P=0.031)患者且mSASSS水平更高(Z=3.887,P<0.01;Z=3.895,P=0.004)。③骶髂关节X线分级(10.8%、35.6%、60.3%)、不同MRI表现组别间骨桥形成率(33.3%、50.0%、15.4%)差异有统计学意义(χ2=25.714,P<0.01;χ2=6.855,P=0.032)。④Logistics回归分析结果显示:BMI[OR(95%CI)=1.145(1.037,1.265),P<0.01]、病程[OR(95%CI)=1.144(1.055,1.239),P<0.01]、吸烟[OR(95%CI)=2.832(1.343,5.969),P<0.01]和骶髂关节X线分期[OR(95%CI)=2.584(1.337,4.997),P<0.01]为AS患者脊柱骨桥形成的危险因素。结论AS患者的脊柱受累与疾病活动相关,其骨桥形成与病程、BMI及病情相关,且与吸烟密切相关。

ObjectiveTo investigate factors affecting X-ray structure of the spine in patients with ankylosing spondylitis(AS).MethodsA total of 206 AS patients were recruited.Clinical and laboratory parameters in AS patients were recorded in detail.Disease activity index[Bath ankylosing spondylitis disease activity index(BASDAI),ankylosing spondylitis disease activity score(ASDAScrp)],X-ray structural damage index-modified stoke ankylosing spondylitis spine score(mSASSS)and grading results of radiographic examination of sacroiliac joint were calculated.Statistical analysis using Statistical Package form Soci-science(SPSS)17.0 Chi-square test,rank test,Logistics regression analysis and other statistical methods were used.Differences of mSASSS levels,spine involvement(mSASSS>0)and rates of bone bridge formation were compared between different groups.ResultsIncidences of spine involvement(100%)and bone bridge formation(65.2%)in AS patients≥40 years old were significantly higher than those in AS patients<40 years old(90.6%、31.9%)(χ2=4.651,P=0.031;χ2=16.647,P<0.01),and the level of mSASSS was also higher(Z=5.575,P<0.01).In AS patients with BMI≥24 kg/m2,disease duration≥5 years(49.2%,50.4%),rates of bone bridge formation was significantly higher than those in AS with BMI<24 kg/m2,but the disease duration(34.5%,19.7%)(χ2=4.014,P=0.045;χ2=18.173,P=0.03),and mSASSS values were significantly higher(Z=2.281,P=0.023,Z=4.828,P<0.01).Bone bridge formation rate in smoking patients(50.6%)was significantly higher than that in non-smoking patients(31.0%)(χ2=7.346,P=0.007)and mSASSS value was significantly higher(Z=2.045,P=0.041).Bone bridge formation rates in AS with high-ESR and high-CRP(48.6%,49.0%)were significantly higher than those in patients with normal-ESR and normal-CRP(25.6%,28.9%)(χ2=10.784,P=0.001;χ2=8.102,P=0.004)and mSASSS value was clearly higher(Z=2.379,P<0.01;Z=3.112,P<0.01).Bone bridge formation rate in AS with BASDAI≥4 or ASDAScrp≥2.1 groups(52.8%,46.4%)were significantly higher than that in AS with BASDAI<4 or ASDAScrp<2.1 groups(34.2%,30.7%)(χ2=5.681,P=0.017;χ2=4.646,P=0.031)and mSASSS values were significantly higher(Z=3.887,P<0.01;Z=3.895,P=0.004).Rates of bone bridge formation among different X-ray grading of sacroiliac joint(10.8%,35.6%,60.3%)and MRI findings(33.3%,50.0%,15.4%)differed with each other(χ2=25.714,P<0.01;χ2=6.855,P=0.032).Logistics regression analysis showed that BMI[OR(95%CI)=1.145(1.037,1.265),P<0.01],disease duration[OR(95%CI)=1.144(1.055,1.239),P<0.01],smoking[OR(95%CI)=2.832(1.343,5.969),P<0.01]and sacroiliac joint X-ray staging[OR(95%CI)=2.584(1.337,4.997),P<0.01]were risk factors for the bone bridge formation in spine of AS.ConclusionSpinal involvement in AS is related to disease activity.Bone bridge formation correlateswith disease duration,BMI and disease-status,especially with smoking.