超声评分法诊断强直性脊柱炎髋关节受累的应用价值

Application value of ultrasound score in the diagnosis of hip involvement in ankylosing spondylitis

目的探讨超声评分法诊断强直性脊柱炎(AS)髋关节受累的应用价值。方法选取我院收治的AS患者86例,应用高频超声观察髋关节(包括髋关节囊和大转子肌腱端)受累的异常表现,并应用简化的超声评分法对上述异常超声表现进行评分,获得髋关节囊评分、股骨头评分、肌腱端评分及总体评分(为前3个部位评分累加)。分析各超声评分与临床评分[包括Bath强直性脊柱炎疾病活动性指数(BASDAI)、强直性脊柱炎疾病活动评分-C反应蛋白指标(ASDAS-CRP)、Bath强直性脊柱炎功能指数(BASFI)、视觉模拟评分(VAS)]和实验室指标[C反应蛋白(CRP)、红细胞沉降率(ESR)]的相关性;评估髋关节超声检查结果在检查者间的一致性。结果172个髋关节的髋关节囊评分为(2.42±2.72)分,股骨头评分为(0.87±1.30)分,肌腱端评分为(2.64±2.99)分,总体评分为(5.17±4.20)分。相关性分析结果显示,髋关节囊评分与BASDAI、ASDAS-CRP、BASFI、VAS、CRP及ESR均呈正相关(r=0.452、0.662、0.418、0.613、0.621、0.545,均P<0.01)。总体评分与BASDAI、ASDAS-CRP、BASFI、VAS、CRP及ESR均呈正相关(r=0.352、0.633、0.244、0.424、0.579、0.434,均P<0.05)。髋关节囊急性异常指标中,滑膜增厚与BASDAI、ASDAS-CRP、VAS、CRP及ESR均呈正相关(r=0.351、0.565、0.509、0.605、0.519,均P<0.01)。一致性分析显示,超声评估髋关节囊积液、滑膜增厚、滑膜内血流和肌腱端钙化、骨皮质改变、附着端血流和滑囊炎在检查者间的一致性中等(Kappa=0.712、0.710、0.782、0.610、0.668、0.692、0.703)。结论髋关节各超声评分与AS髋关节受累患者的临床评分及实验室指标均有一定的相关性,其中滑膜增厚提示疾病活动性的效能最高,在AS髋关节受累诊断中有重要的作用。

Objective To explore the application value of ultrasound score in the diagnosis of hip joint involvement in ankylosing spondylitis(AS).Methods A total of 86 AS patients admitted to our hospital were selected,and the abnormal manifestations of hip joint were observed by high-frequency ultrasound,including hip joint capsule and enthesopathy of greater trochanter tendon,the hip joint capsule scores,femoral head scores,entheseal scores and overall scores with the above indicators(add up the scores for the previous three)were calculated by the simplified ultrasonography scores.The correlation between bath ankylosing spondylitis disease activity index(BASDAI),ankylosing spondylitis disease activity score-C reactive protein(ASDAS-CRP),bath ankylosing spondylitis functional index(BASFI),visual analogue scale(VAS)and C reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were analyzed.In addition,the consistency of hip ultrasound findings were assessed by inter-observer.Results Among the 172 hip joints,the hip joint capsule score was 2.42±2.72,the femoral head score was 0.87±1.30,the entheseal score was 2.64±2.99,and the overall score was 5.17±4.20.The correlation analysis showed that hip capsule score was positively correlated with BASDAI,ASDAS-CRP,BASFI,VAS,CRP and ESR(r=0.452,0.662,0.418,0.613,0.621,0.545,all P<0.01),and overall score was positively correlated with BASDAI,ASDAS-CRP,BASFI,VAS,CRP and ESR(r=0.352,0.633,0.244,0.424,0.579,0.434,all P<0.01),respectively.In single abnormal index of hip joint capsule,the synovial hypertrophy was positively correlated with BASDAI,ASDAS-CRP,VAS,CRP and ESR(r=0.351,0.565,0.509,0.605,0.519,all P<0.01).Consistency analysis showed that there were moderate consistency in effusion,synovial hypertrophy and synovial blood flow and calcifications,bone cortical changes,vascularization and bursitis at entheseal sites in inter-observer(Kappa=0.712,0.710,0.782,0.610,0.668,0.692,0.703).Conclusion The ultrasound score has a certain correlation with clinical scores and laboratory indicators in AS patients with hip joint involvement,among which synovial hypertrophy has the highest efficacy in indicating disease activity.It has important value in the diagnosis of AS hip involvement.