耻骨联合磁共振成像急性炎性改变在中轴型脊柱关节炎诊断中的价值及临床因素分析

The diagnostic value of active inflammatory changes of the symphysis pubis on magnetic resonance imaging scans in patients with axial spondyloarthritis and clinical factors analysis

目的评价耻骨联合MRI急性炎性改变与中轴型脊柱关节炎(ax-SpA)临床特点的相关性。方法回顾性分析我院2014年2月至2020年11月住院的112例ax-SpA患者,将其分为耻骨联合炎+骶髂关节炎组,耻骨联合炎+非骶髂关节炎组,非耻骨联合炎+骶髂关节炎组,非耻骨联合炎+非骶髂关节炎组共4组,使用组内相关系数(ICC)分析耻骨联合MRI急性炎症与骶髂关节炎的相关性,应用单因素方差和χ^(2)检验比较4组之间年龄、性别、BMI、吸烟史、症状持续时间、HLA-B27阳性率、CRP、ESR之间的差异。结果ax-SpA患者耻骨联合MRI急性炎性改变的发生率为35.7%(40/112)。耻骨联合MRI急性炎症与骶髂关节急性炎症之间无相关性(r=-0.06,P=0.559),69例骶髂关节急性炎症组有24例同时伴有耻骨联合急性炎症,43例骶髂关节无急性炎症组有16例有耻骨联合急性炎症。骶髂关节无急性炎症时,耻骨联合急性炎症组的CRP、ESR分别为(49±60)mg/L、(40±19)mm/1 h,明显高于非急性炎症组(19±22)mg/L、(22±37)mm/1 h(t=2.36,P=0.023;t=2.88,P=0.006),耻骨联合有急性炎症时,骶髂关节无急性炎症组的症状持续时间为(14±9)年,明显长于急性炎症组(5±4)年(t=4.07,P=0.001)。结论耻骨联合MRI炎性改变与骶髂关节炎临床特点之间无相关性。对于ax-SpA患者,出现腰背部或臀部,大腿根部疼痛不适,ESR及CRP明显升高,而MRI骶髂关节没有急性炎性改变的患者,需要警惕耻骨联合急性炎性病变。

Objective To evaluate the correlation of active inflammatory changes of the symphysis pubis on magnetic resonance imaging(MRI)scans with clinical factors in patients with axial spondyloarthritis.Methods We retrospectively evaluated 112 patients with axial spondyloarthritis(ax-SpA)in our hospital from February 2014 to November 2020.Patients were divided into 4 groups:symphysis pubis+sacroiliac arthritis,symphysis pubis+non-sacroiliac arthritis,non-symphysis pubis+sacroiliac arthritis,and non symphysis pubis+non-sacroiliac arthritis group.Intra-group correlation coefficient(ICC)was used to analyze the correlation between MRI active inflammation of the symphysis pubis and the sacroilioarthritis.Age,sex,symptom duration,smoking,body mass index,human leukocyte antigen(HLA)-B27 positive rate,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)among the four groups were compared by one-way analysis of variance(ANOVA)and Chi-square test.Results The proportion of active inflammation of the symphysis pubis was 35.7%(40/112).There was no correlation between active inflammation of the symphysis pubis and sacroilioarthritis(r=-0.06,P=0.559).Twenty-four patients of the 69 patients with sacroilioarthritis had active inflammation of the symphysis pubis,16 patients of the 43 patients without sacroilioarthritis had active inflammation of the symphysis pubis.In patients without active inflammation of the sacroiliac joint,the CRP and ESR of the active inflammation of the symphysis pubis group was(49±60)mg/L,(40±19)mm/1 h,statistically higher than that of the non-active inflammation group(19±22)mg/L,(22±37)mm/1 h(t=2.36,P=0.023;t=2.88,P=0.006).In patients who had active inflammation of the symphysis pubis,the symptom duration of the non-active inflammation of the sacroiliac joint,was(14±9)years,which was significantly longer than that of the active inflammation group(5±4)years(t=4.07,P=0.001).Conclusion There is no correlation between active inflammatory changes of the symphysis pubis and bone marrow edema of the sacroiliac joint.Therefore,in ax-SpA patients with inflammatory low back pain and/or hip/groin pain,and also with high levels of CRP,ESR,but no active inflammatory changes of the sacroiliac joint on MRI scans,active inflammation of the symphysis pubis should be considered.