结合磁共振成像分析强直性脊柱炎早期髋关节损害的临床特征和相关因素

Study on the associated factors of early-stage hip involvement in patients with ankylosing spondylitis based on magnetic resonance imaging

目的探讨AS患者发生早期髋关节损害的临床特点及相关因素。方法对2014—2018年于广州市第一人民医院连续就诊的570例AS患者进行回顾性分组对照研究。伴髋关节疼痛或髋关节活动受限症状但X线无明确髋关节受累证据的患者行髋关节磁共振检查。依据影像学的结果,将患者分为3组:①无髋关节受累;②早期髋关节受累(X线阴性而磁共振提示髋关节受累);③晚期髋关节受累(BathAS影像学评分-髋关节评分≥2分)。研究因素包括患者人口数据、实验室数据、临床和影像学数据。与早期髋关节受累和晚期髋关节受累相关的因素分析采用单因素和多因素Ordinal Logistic回归分析。结果236例患者(41.4%)伴髋关节受累,其中146例患者(25.6%)有早期髋关节受累而90例患者(15.8%)有晚期髋关节受累。经多因素Ordinal logistic回归分析显示AS起病年龄越晚[OR=0.80,95%CI(0.72,0.90),P<0.01]、BASMI评分更差[OR=3.06,95%CI(2.14,4.13),P<0.01]和骶髂关节炎的炎症病变更活跃[OR=1.13,95%CI(1.07,1.18),P<0.01],与发生早期髋关节受累相关。结论磁共振可发现X线检查阴性的AS早期髋关节受累;对于有可疑症状及有髋关节受累危险因素的患者,磁共振更适用于髋关节受累情况的评估。

Objective To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis(AS)based on the magnetic resonance imaging(MRI).Methods A retrospective group control study was carried out in 570 AS patients who were consecutively admitted to our hospital from 2014 to 2018.Patients with hip pain or hip function limitation but lacking definitive evidence of hip involvement on radiography were underwent hip MRI.Patients were divided into three groups:no hip involvement,early-stage hip involvement(hip involvement detected by MRI but with negative radiographs)and advanced-stage hip involvement(Bath Ankylosing Spondylitis Radiology Index-hip score≥2).The study factors included demographic,laboratory,clinical and radiographic data.Simple and multiple ordinal logistic regression analysis were used to identify factors associated with the early-stage hip involvement and advanced-stage hip involvement.Results A total of 236 patients(41.4%)presented with hip involvement,in which 146 cases(25.6%)were diagnosed with early-stage hip involvement,while 90 cases(15.8%)were diagnosed with advanced-stage hip involvement.Multivariate logistic regression analysis demonstrated that older age at onset[OR=0.80,95%CI(0.72,0.90),P<0.01],more active inflammation in the sacroiliac joints[OR=1.13,95%CI(1.07,1.18),P<0.01]and worse BASMI score[OR=3.06,95%CI(2.14,4.13),P<0.01]were associated with the occurrence of early-stage hip involvement.Conclusion MRI is superior to radiography in detecting early-stage hip involvement.MRI is more suitable for hip involvement assessment in AS patients with suspected symptoms or risk factors of hip involvement.